One day with a “sex detective”

Melissa Nelson is a disease intervention specalist with the Jefferson County Department of Health, in Birmingham, Albama. When Melissa is alerted that someone in her country has been diagnosed with a sexually-transmitted infection (STI), her job is to investigate where the infection has come from and to stop it from being spread further. “People will affectionately call us ‘sex detectives’,” says Melissa.

Alabama has one of the highest infection rates for STIs in the United States. There were 11,000 reported cases of gonorrehoea in the state last year alone, largely concentrated in urban centres like Birmingham. Across the US the number of gonorrhoea cases continues to grow, and is at its highest rate in almost 30 years. Reasons for the increase include reduced condom use, as well as gonorrhoea becoming progressively resistant to available treatments.

Because gonorrhoea often lacks symptoms, particularly in women, many people don’t know they have been infected until much later in life. The consequences of untreated gonorhoea can include infertility, pelvic inflammatory disease and ectopic pregnancy. It can also increase the transmission risk of other STIs, like HIV. This is why Melissa’s work to stop the spread of this infectious disease is so important.

Melissa’s day typically starts in her Birmingham-based office, where she receives notification cases of STIs like gonorrhoea. However, much of her time is spent on the road, tracing people in order to provide them with education, counseling and linkages to care and treatment. Outbreaks of STIs can be especially difficult to contain because of stigma: people might not want official records of their infections, or they might not know or be unwilling to report the names of sexual partners. This means the work of a disease intervention specialist requires tact and discretion, alongside strong relationships with the local community. “We’re community workers in a sense,” says Melissa. “Whether it be at churches or at mosques, people know us and trust us.”

In the US, gonorrhoea is most common in people 15-24 years old. Melissa explains the majority of the people she speaks with who have been infected with gonorrhoea are young people who feel they are invincible. “When I have a person who has that mindset, I always talk to them about: what would you do if we started to see a drug-resistant strain of gonorrhoea here in Birmingham, Alabama? Because it exists,” says Melissa. She adds that the effect of this information is sobering.

Melissa says she dreams of a day in which there is no longer a need for people in her line of work, because infections like gonorrhoea have been eradicated.

“My hope is that one day disease intervention specialists will not need to have to track down partners of someone who tested positive for an STI, to get them tested and treated, only because there are no more sexually-transmitted infections.”

The Global Antibiotic Research and Development Partnership (GARDP) is working to address the rise of drug-resistant gonorrhoea through the development of a novel antibiotic called zoliflodacin, the only drug being developed specifically to treat this infection. The treatment is currently being evaluated in a global phase 3 trial. One of the places where the drug is being trialled is in Birmingham, Alabama.