It's gotten so bad that health officials from the counties will ask state officials and possibly the national Centers for Disease Control and Prevention to send investigators who can get to the core of the problem.

The numbers don't lie, even if they might represent only a fraction of the truth.

In Stanislaus County alone, the number of reported cases of gonorrhea in 2004 will likely double to more than 400 compared to a year ago, and more than four times the 25-year low of 135 in 1999.

The numbers, health officials say, are also rising in Merced, Madera, San Benito and Santa Clara counties. The epidemic caught the eye of state officials, who recently brought health officials from those counties together to determine possible links.

This much they know, and it's consistent with data from elsewhere in the state: the majority of the cases reported involve 15- to 29-year-olds, and most are white or Latino, although African-Americans have the highest rate among any single race.

"Historically, we've seen more women with gonorrhea," said Jean Yokotobi, program manager for Stanislaus County's public health department.

She and other health officials know the numbers reflect only a portion of those infected. It isn't easy to get patients to talk openly after they've tested positive for a sexually transmitted disease. They're worried and embarrassed. They're distrustful of how information might be used.

Thus, the people they got it from or gave it to can continue to spread the disease, and there now are fewer state investigators to track down others who might have been infected.

"At one time, there were 100 (investigators)," Yokotobi said.

Now there are 17.

Just a decade ago, investigators got involved whenever a person tested positive for gonorrhea. They conducted interviews to determine how many partners that person had and who they were. They then tracked down the partners to make sure they received treatment.

Currently, Stanislaus County case workers can only follow up on treatment for those who have tested positive. They don't have the resources to track down partners — particularly in chlamydia cases, which likely will surpass 1,600 this year.

They do follow up on syphilis cases.

"We follow every partner because of the nature of the disease and because it impacts all kinds of things — the mental and physical parts of the body," Yokotobi said. "It's just an insidious disease."

Yokotobi said the state is looking at the link between teen pregnancies and gonorrhea. It's looking at one theory that states its spread could follow a pattern of migration among younger farm workers who arrive in the Central Valley and work their way up in to Oregon.

A similar gonorrhea outbreak happened recently in Butte County. The county averaged roughly 27 cases over several years preceding 2003. But that year, it spiked to 156 cases.

Carmen Ochoa, public information officer for the Butte County Public Health Department, said officials reacted quickly.

They called in the state, which sent a team of sexually transmitted disease investigators and physician specialists to attack the problem. They compiled a questionnaire to get the information needed. They determined geographic areas where the numbers had increased. They found the majority of the cases involved white women who were undereducated and unemployed and lacked health insurance.

Butte County officials have been involved in conference calls with state officials and the five counties down here experiencing the same kind of outbreak.

Stanislaus County officials, meanwhile, are just beginning their attempts to corral a disease that had all but disappeared in a county of 470,000 people.

The county will step up its outreach and awareness programs, said David Jones, the department's marketing and public relations director.

That will include asking physicians to get more information from patients who come in for treatment.

"The disease is preventable," Yokotobi said.

Jeff Jardine's column appears Sundays, Tuesdays and Thursdays in Local News. He can be reached at 578-2383 or jjardine@modbee.com.