With imagery of the doomed Titanic and the extra-dire warning “drug-resistant GONORRHEA ALERT,” the billboard off I-83 in Baltimore is not subtle.

It’s a run-don’t-walk message for the public to get tested for the sexually transmitted infection that is rising in numbers.

“It’s a serious subject but that doesn’t mean the message can’t be kind of funny,” said Michael Weinstein, president of AIDS Healthcare Foundation, the Los Angeles-based nonprofit medical provider that sponsored this ad and several others since it opened a clinic in Baltimore in 2019.

The ads have been going up for years in the 25 metro areas and 17 states where group, known as AHF, has clinics. They aim to focus attention on STIs generally by using four words or less and directing people to the website, freestdcheck.org.

The Titanic ad, with the cruise liner hitting the iceberg, is meant to convey that “there could be something on the horizon making things more dangerous,” said Weinstein, who came up with the idea.

There’s a team to carry out the vision on the billboards. One campaign features a giant condom and the words “Plan A” and “useacondom.com” to avoid an infection or a pregnancy.

That’s a play on “Plan B,” the medication to prevent pregnancy after unprotected sex.

All playfulness aside, there is more urgency to the messages. Weinstein pointed to national data showing more than 710,000 new gonorrhea infections nationwide in 2021, a 5% increase from the year before and a 28% rise in five years. The pandemic compounded the problem by limiting access to care.

Local health care officials and providers think the billboards can help raise awareness.

Surveys show half of Americans will get an STI in their lifetime, and those like gonorrhea can be cured. Untreated, gonorrhea can cause infertility and leave people more vulnerable to other potentially more dangerous infections, such as HIV.

Gonorrhea, as well as chlamydia and syphilis, are common STIs and easily spread through unprotected sex.

There were 12,052 cases in Maryland in 2020, nearly doubling since 2011, state data shows. Cases of chlamydia were up about 20% in that time to nearly 32,400.

Cases of syphilis, a potentially more dangerous infection, nearly doubled to 893. There were 32 cases of infants born with syphilis.

STIs are most common in teens and young adults, gay and bisexual people, racial and ethnic minorities and pregnant people. Rates in Baltimore are among the highest in the country, and people often don’t know they have an infection.

“If the billboard is raising awareness, I’m all for it,” said Dr. Liz Gilliams, medical director for STI services at the Baltimore Department of Health’s two sexual health clinics.

She said she’s “gotten a lot of questions” about it, and called it “a conversation starter.” While it’s vital to be tested and treated, she said, it’s important not to panic anyone.

Of particular concern, antibiotics against gonorrhea are losing their punch. There is only one treatment now recommended for the common strain circulating, according to the CDC: ceftriaxone . Gilliam said the concern is if a lot more people are infected, this treatment will become ineffective.

She said the first case of a more drug-resistant gonorrhea — the kind referenced on the billboard — was identified in Massachusetts earlier this year. She said there have been no such cases in Maryland, and the risk of contracting that strain remains low.

Further, there is at least one new antibiotic in late-stage trials.

Ensuring proper testing is another issue. Some clinics only perform urine tests, which aren’t always effective in identifying infections in the throat, for example, said Amit “Mickey” Dhir, a nurse practitioner specializing in STIs at Chase Brexton Health Care, which offers testing and treatment.

Swabbing throats and rectums is necessary, he said. Improvements in those methods, as well as a lot more testing, is likely responsible for some of the rise in of reported cases, he said.

Dhir also said a person can be tested for multiple STIs at once, though some infections, such as HIV, require a blood test.

Gonorrhea and some other bacterial infections are curable if people know they are infected. HIV is treatable.

Gilliam said the city also hopes to roll out a preventive gonorrhea treatment, similar to one for HIV known as PrEP, once officials decide who would most benefit. Condoms may be sufficient protection for others.

She and Dhir also said they hope the billboards, as well as other ads and use of social networks, get more people to test regularly.

“The problem is that there isn’t equal access to health care,” he said. “Some people don’t have cars or computers. Rural and even suburban areas may not have enough clinics.”

Telehealth is helping some get care, and he and Gilliam also pointed to free testing for Marylanders from a home testing program offered through the Johns Hopkins School of Medicine.

“You can’t get treatment if you don’t get tested,” Dhir said.

meredith@thebaltimorebanner.com