Running head: COMMUNITY INTERVENTIONS

Pinellas County and Community Interventions for the Treatment and Prevention of Gonorrhea
Amanda Seeds
University of South Florida

COMMUNITY INTERVENTIONS

Pinellas County and Community Interventions for the Treatment and Prevention of Gonorrhea
Pinellas County is an urban community with a population of 920,453 people as of 2013
(Florida Department of Health, n.d.). With the population spanning across only 280 square miles,
Pinellas County is the state of Floridas second smallest county (Pinellas County, Florida, n.d.).
In fact, According to Pinellas County, Florida (n.d.), Pinellas County has 3,347 residents per
square mile, making it Floridas most densely populated county. Major employers of these
residents are Baycare Health System, Publix Super Markets and Home Shopping Network
(Tampa Bay Partnership, 2014). The people of Pinellas County rank seventh out of 67 counties in
Florida for clinical care; there are more primary care physicians, dentists and mental health care
providers per resident in Pinellas County than the average in the state of Florida (County Health
Rankings & Roadmaps, 2015).
In terms of the population and the socioeconomic elements, in 2010 the percentage of
families who fell below the level of poverty in Pinellas County was 8.1% compared with the
state of Florida rate of 9.9% (Florida Department of Health, n.d.). The Florida Department of
Health noted that in 2012 the rate of those 25 years of age and over who hold a high school
diploma was 88.8% in Pinellas County compared with the state of Florida rate of 85.8%. Also,
the rate of the population over the age of 5 years who do not speak English in Pinellas County is
5.5% compared with the state of Florida rate of 11.8% in 2010, according to the Florida
Department of Health.
Pinellas County has many positive and negative attributes as can be seen in the information
contained in the County Health Rankings & Roadmaps and Florida Department of Health
websites. One specific need that will be addressed is that of improved treatment and prevention
of gonorrhea. According to the Florida Department of Health, as of 2013 the cases of gonorrhea

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are considered to be a quartile 4, meaning that the rate of gonorrhea is found to be a least
favorable occurrence compared to the other counties in the state of Florida. It is necessary that
interventions are carried out at the primary, secondary and tertiary levels to aid in successfully
lowering the incidence rate of this sexually transmitted disease.
Examples of the strengths of Pinellas County, all gathered from Florida Department of
Health (n.d.), include that the case rate of diseases that are preventable via vaccine is at or below
state level. These diseases include: mumps, measles, rubella, acute hepatitis B, pertussis and
tetanus. This is important because it is being shown that those diseases that are made preventable
from vaccines are being prevented. Also, Pinellas County has more full-time employees who
work for the county health department; 68.8 per 100,000 people compared to the state of Florida
rate of only 53.8 per 100,000 people. This is a strength in that more county health employees are
available to aid in addressing health care needs of the population in Pinellas County.
Additionally, as mentioned above, the rate of those 25 years of age and over who hold a high
school diploma is 88.8% in Pinellas County compared with the state of Florida rate of 85.8%.
The strength behind this statistic is that the more people who are in school, the more they can be
reached to address preventative measures for health complications, such as gonorrhea.
Examples of topics that are in need of improvement in Pinellas County, all gathered from
Florida Department of Health (n.d.), consist of forcible sex crimes, with Pinellas County having
a 3 year rate of 67.2 per 100,000 people compared with the state 3 year rate of 52.2 per 100,000
people. The need is to not only lower or eliminate the forcible sex occurrences because this
happens against the person free will but also due to the unwanted pregnancies or sexually
transmitted diseases that may result. Also, although the 3 year rate per 100,000 people for
acquired immunodeficiency syndrome cases is lower in Pinellas County (13.7) than the state of

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Florida (16.1), it is still an area in need of improvement as it is a serious threat to Pinellas County
due the dense population with sexually active people and overall higher rate of sexually
transmitted disease acquisition. Additionally, the 3 year rate per 100,000 people of gonorrhea
cases in Pinellas County is 126.5 compared to 105.3 cases in the state of Florida. There is need
for improvement in that gonorrhea is a preventable disease and so the incidence rate can be
lowered significantly (Centers for Disease Control and Prevention, 2014).
The health indicator that will be discussed as the priority is cases of gonorrhea. This is
important to focus on as the number of cases is much higher in Pinellas County than the state
average and is deemed quartile 4, meaning that the rate of gonorrhea is found to be a least
favorable occurrence compared to the other counties of the state of Florida (Florida Department
of Health, n.d.). According to the Centers for Disease Control and Prevention (CDC) (2014), the
symptoms of gonorrhea are often absent or mild in women, and if untreated the disease can lead
to pelvic inflammatory disease which may cause complications such as fallopian tube blocking
scar tissue, abdominopelvic pain, ectopic pregnancy and even infertility. The CDC also provided
that in men, the symptoms of gonorrhea may also be absent and if left untreated can cause pain
in the tubes leading to the testicles and rarely, infertility. Additionally, it is becoming more
difficult to treat this sexually transmitted disease due to the increasing rate of strains of
gonorrhea that have proven to be drug-resistant, and in rare situations gonorrhea may spread to
joints or blood; this may be a life-threatening condition (Centers for Disease Control and
Prevention, 2014).
One of Healthy People 2020s leading health indicators is sexual and reproductive health.
Per this indicator it is essential in lowering infertility and infectious disease rates, ridding of
health disparities, educational achievement increases, financial stability and career opportunities

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that sexual and reproductive health are improved (Healthy People 2020, 2015). In fact, a goal of
Health People 2020 pertaining to sexually transmitted diseases is to encourage sexual behaviors
that are healthy, fortify community capacity, as well as to improve access to quality care as to
inhibit sexually transmitted diseases and the complications associated with them.
Community health nurses may utilize a model called the determinants of health to develop
appropriate interventions to attend to health issues of the populations at hand, such as high
incidence rates of gonorrhea. The model does this by aiding the nurses to realize that peoples
health is determined by the circumstances of their lives and that the determinants are the
economic, social and physical environments as well as the individuals behaviors and
characteristics (World Health Organization, 2015). Some of the elements that contribute to the
rates of gonorrhea cases are human biology (in that gonorrhea is an infectious disease; in the
United States gonorrhea is one of the most frequently reported infectious diseases) and lifestyle
(in that sexual behaviors that are considered high-risk correlate with a positive history of
infection with gonorrhea), and health system (in that gonorrhea prevention education and
screening can be provided in a primary care setting, or even school setting for the youth)
(Salerno, Darling-Fisher, Hawkins, & Fraker, 2013).
From the information discussed, a population diagnosis can be made: Pinellas County
residents are at higher risk of acquiring gonorrhea than the state average of Florida related to
sexual risk behaviors and the need for more preventative education and screening as evidenced
by the 3 year rate per 100,000 people of gonorrhea cases in Pinellas County being 126.5
compared to 105.3 cases in the state of Florida, as of 2013. This diagnosis can be addressed on
several different levels. These levels include primary, secondary and tertiary levels of prevention.

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At the primary level of prevention communities should be counseled and health teaching
should be provided as to prevent new cases of gonorrhea infection from occurring. This would
promote health and aid in modifying risk factors. According to Fantasia (2013), it is critical that
patients are educated regarding gonorrhea to prevent infection from occurring, and community
health nurses play a crucial role in delivering this teaching. It is recommended that preventive
education pertaining to high-risk sexual behaviors is included in the counseling (Salerno et al.,
2013). The stakeholders involved in this intervention are community members in that the patients
participate in the education, health care providers and professionals in that they are the ones
providing the education, and funding sources to provide the educational materials.
The secondary level of prevention should involve those in the community being screened
and provided early treatment, and for those cases of gonorrhea that are diagnosed, the results
should be reported to the departments of health at the local and state level, as gonorrhea is a
reportable disease (Fantasia, 2013). The stakeholders involved at this level of prevention are the
community members in that they are to be screened and treated and health care providers in that
the physicians are ordering the tests and writing the prescriptions and the community health
nurses provide aid by educating the patients regarding the management of the disease and
contacting the necessary public officials per Fantasia (2013). Additionally, since there should be
efforts made to have all patients with gonorrhea treated regardless of their ability to pay for the
necessary treatments, funding sources may be needed in some circumstances (Workowski &
Berman, 2010).
At the tertiary level of prevention individuals should follow-up, a role in which the
community health nurses have a crucial function, to monitor for the effectiveness of the
treatment and ensuring that advanced negative impacts of gonorrhea are not occurring (Fantasia,

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2013). Every sex partner who the effected person has been active with in the past 60 days is to be
contacted, screening is to be offered and treatment provided, if necessary, as to prevent the
spread of gonorrhea and possible reinfection per Fantasia (2013). Fantasia (2013), also provides
that the community health nurses may offer patients guidance pertaining to communicating a
gonorrhea diagnosis; nurses frequently aid those patients with positive test results in notifying
past and present partners. The stakeholders in this case are community members in that the
patients are to recall their recent sexual partners so they can be contacted and health care
providers because they are the ones providing follow-up care.
The known high gonorrhea case number in Pinellas County along with the diagnosis and
levels of prevention previously mentioned can guide the proposal of a health policy. Health
policies impact health care in that they are plans, decisions and actions that are set forth to realize
particular goals of health care in society (Guido, 2014). The proposed health care policy
pertaining to the high incidence rate of gonorrhea in Pinellas County will be targeted at the
primary level of prevention; education and avoidance of risky sexual behavior preventing the
contraction of gonorrhea is the vision. This is due to the lack of effective gonorrhea prevention
education. The number of people contracting gonorrhea in Pinellas County is too high; the 3 year
rate per 100,000 people of gonorrhea cases in Pinellas County being 126.5 compared to 105.3
cases in the state of Florida, as of 2013. Those who are infected and the persons who have sexual
contact with them are affected by this issue. Providing proper, effective education pertaining to
reducing or avoiding risk factors associated with acquiring gonorrhea should be discussed in
high schools and in primary care settings. The desired outcome of this health policy proposal is
to have more schools and primary care offices in Pinellas County teach gonorrhea prevention via
their nursing staff and lower the cases of gonorrhea to at least that of the state level.

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The stakeholders involved in this proposal are community members in that the community
would be participating in the education, public officials and legislators to pass the requirement of
Pinellas County schools to provide this information as well as primary care offices, health care
providers and professionals in that nurses will provide the education in primary care offices and
schools, and funding sources to provide the educational materials needed. Supporters of the
health policy proposed are community members, healthcare providers and professionals, and
funding sources. These supporters influence the policy in the forward direction because lowering
the rate of gonorrhea has positive health effects for the community members and is a goal for
health care providers, health care professionals and the funding sources. Those opposed to the
health policy proposed may be the public health officials and legislature due to potential
resistance from parents of those receiving the preventive education in high school, and their
potential worry that the program may take from other budgets if the funding sources could not
cover the whole cost. The influence of those opposed may be to change the policy to better suit
their ideals. This would not be known however, until the policy was presented.
To begin the process of putting this proposed health policy into action lobbyists with the
same goal would be contacted first. Pinellas County schools and primary care offices should
also be contacted to evaluate their receptiveness to the policy and test what education styles
would be more effective in delivering lasting knowledge in the population. Funding sources
should be contacted as well, such as the Division of Adolescent and School Health of the CDC
for the high school education and health care agencies for the primary care offices. Nurses at the
schools and primary care offices should also be contacted to assess their knowledge of gonorrhea
prevention and willingness to educate the public. To get this started, supporters of the cause
should aid in bringing awareness to the high cases of gonorrhea in Pinellas County and aid in

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rallying for change in the education delivered and so, raise the effectiveness of it and minimize
the incidence rate of gonorrhea acquisition.
The population of Pinellas County, Florida would be positively affected by this proposed
health policy. Being that this policy would be in effect in high schools it serves the underserved
population well, in that aspect, as every adolescent is to attend school. Pertaining to adults of the
underserved population, while the free primary care offices would provide the education too,
there may be difficulty with some of these adults having adequate transportation to the providers
offices. Overall, the populations health would be enhanced in that gonorrhea and the spread of it
would be minimized due to proper education and resulting lowered sexual risk behaviors. Being
proactive in preventing this sexually transmitted disease would undoubtedly have a positive
influence on the community of Pinellas County.
Pinellas County has positive and negative attributes pertaining to health in relation to the
state of Florida. The determinants of health model can be used to aid nurses in developing
appropriate interventions for the population at hand and an applicable population diagnosis can
be made. Such as in the case of Pinellas County: Pinellas County residents are at higher risk of
acquiring gonorrhea than the state average of Florida related to sexual risk behaviors and the
need for more preventative education and screening as evidenced by the 3 year rate per 100,000
people of gonorrhea cases in Pinellas County being 126.5 compared to 105.3 cases in the state of
Florida, as of 2013. This diagnosis was addressed at all three levels of prevention and a health
policy was proposed using the primary level of prevention in hopes of successfully lowering the
gonorrhea incidence rate in Pinellas County through the use of effective education and resulting
lowered sexual risk behavior. Personally, this is relevant in that Pinellas County has many of the

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clinical sites used by the University of South Florida and providing meaningful health education
that can improve a populations health is one of the duties of being a nurse.

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References

Centers for Disease Control and Prevention. (2014). Gonorrhea-CDC Fact Sheet. Retrieved from
http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm
County Health Rankings & Roadmaps. (2015). County Snapshot. Retrieved from
http://www.countyhealthrankings.org/app/florida/2015/rankings/pinellas/county/outcome
s/overall/snapshot
Fantasia, H. C. (2013). Updated treatment guidelines for gonorrhea infections. Nursing for
Women's Health, 17(3), 231. doi:10.1111/1751-486X.12037
Florida Department of Health. (n.d.). Florida Charts. Available from http://www.floridacharts
.com/charts/QASpecial.aspx
Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ:
Pearson Education.
Healthy People 2020. (2015). Available from http://www.healthypeople.gov/
Pinellas County, Florida. (n.d.). Facts About Pinellas. Retrieved from http://www.pinellascounty
.org/facts.htm
Salerno, J., Darling-Fisher, C., Hawkins, N. M., & Fraker, E. (2013). Identifying relationships
between high-risk sexual behaviors and screening positive for chlamydia and gonorrhea
in school-wide screening events. Journal of School Health, 83(2), 99-104.
doi:10.1111/josh.12004

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Tampa Bay Partnership. (2014). Major Employers. Retrieved from http://www.tampabay.org
/site-selection/major-employers
Workowski, K. A., & Berman, S. (2010). Sexually transmitted diseases treatment guidelines,
2010. Morbidity and Mortality Weekly Report (MMWR), 59(RR12), 1-110. Retrieved
from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm.
World Health Organization. The Determinants of Health. (2015). Retrieved from
http://www.who.int/hia/evidence/doh/en/

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