New Hampshire is not immune to a national increase in sexually transmitted diseases, as state health officials say the number of cases of gonorrhea have more than tripled.

State Epidemiologist Dr. Benjamin Chan reported on Thursday that 465 cases of the disease were reported in New Hampshire in 2016, compared to an annual average of 130 cases between 2007 and 2013.

It’s not clear what led to the increase, but health officials throughout the country have been reporting a sharp rise in sexually transmitted diseases over the past three years, including chlamydia and syphilis as well as gonorrhea.

In October, the Centers for Disease Control and Prevention reported that the number of these three STDs was at an all-time high in the U.S. after years of decline.

Dr. Jonathan Mermin, director of the National Center for STD Prevention for the CDC, told Congress at the time he attributed the rise to cutbacks in care and prevention services among public health clinics.

“New Hampshire historically has had one of the lowest rates of gonorrhea infections in the country; however, over the last year we have seen a significant increase in the number of reported cases,” Chan, the state epidemiologist, said in a news release. “We are actively working to identify individuals who may have been exposed to gonorrhea in order to connect them with testing and treatment. We are also asking health care providers and patients with gonorrhea to help connect sex partners with medical care for evaluation and treatment of gonorrhea infection.”

Gonorrhea is caused by infection with the Neisseria gonorrhoeae bacterium and can be transmitted through vaginal, anal or oral sex. It most commonly infects the reproductive tract, but it also can infect the throat and rectum.

Infections can usually be treated with antibiotics if caught in time, although it is not uncommon for the disease to go unnoticed because many people have no symptoms or only mild symptoms.

Symptoms can include burning or pain with urination, penile or vaginal discharge, and pain or swelling in the testicles of men. Rectal infection can also cause rectal pain, bleeding or discharge, and throat infection can cause a sore throat.

Left untreated, gonorrhea can cause serious and permanent health problems, including pain, disability and infertility.