CDC Reports "Unprecedented" Trends in STI Rates

At the 2017 Annual Pediatric Academic Societies Meeting (PASM) in San Francisco, California, Gail Bolan, MD, director of the Centers for Disease Control and Prevention (CDC)’s Division of STD Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, referred to 2015 as “an unprecedented time for…the CDC” due to disturbing trends regarding the number of sexually transmitted infections (STIs) that had been reported.

In her talk, Dr. Bolan delved into the CDC’s latest STI treatment guidelines. She began by noting that the CDC’s surveillance systems for STIs is “diagnostic, not case-by-case surveillance, [so] we have an underestimate of STIs in this country.”

In 2015, when the CDC’s STI Treatment Guidelines were originally published, reported cases of chlamydia were up by 5.9%, while reported gonorrhea cases were up by 13%. The increase in gonorrhea diagnoses was largely driven by an 18% increase in the male population reporting diagnoses, said Dr. Bolan Primary and secondary (P&S) syphilis cases increased by 19%, with this increase primarily driven by a 27% increase in women reporting P & S diagnoses. Furthermore, Dr. Bolan noted, “Men having sex with men (MSM) accounted for 60% of all P&S cases.” She added that congenital syphilis, which occurs in children whose mothers have syphilis and pass the infection through the placenta to the fetus, is, once again, appearing across the United States. “We should not be seeing congenital syphilis. We have the resources to prevent it, but it is becoming evident again,” she warned.

Dr. Bolan noted that a decline in reporting of chlamydia among adolescent women has CDC analysts concerned, as well. “Starting in about 2011, we have been seeing declines in reported cases of chlamydia in adolescent women, and we are concerned because this generation has the most to lose in terms of reproductive health,” she said.

Although a decline in reported cases might, at first, appear to be good news, CDC researchers believe that the drop in numbers os a result of fewer women seeking and receiving treatment for infection, not a result of a decrease in actual infections. “There [has] been a number of changes in healthcare, including changes in Pap smear recommendations and older adolescents and young adults who, starting in 2011, could remain on their parents’ health insurance at a college age,” Dr. Bolan noted. “Those students do not want parents to see the bill [for chlamydia treatment] and there are some providers who do not really think chlamydia is a priority preventative service.”

Dr. Bolan concluded that these troubling trends should lead to annual cervical and vaginal chlamydia screenings for adolescents and women under 25 years of age. She added that, due to a prevalence of syphilis in young, gay, men, some physicians might wish to start screening for syphilis in this higher-risk group as well—although, she said, in general, syphilis has not been very common among adolescents. Dr. Bolan also noted that, for all STI screenings, “bring your own partner,” or BYOP treatment — which allows a provider to send medication with the patient for the partner if the partner is not likely to come in for treatment on their own – may also be an option. “The legal landscape has dramatically changed to allow this delivery,” she said, although, she added this is still prohibited in Kentucky and West Virginia.

Dr. Bolan concluded by emphasizing that medical practitioners must be prepared not just to answer questions from patients about STIs, but to discuss these infections with patients who may be at risk. “If you can’t talk about it, you’re not going to identify sites of exposure that need to be tested or diagnose infections,” she warned. She added that in many cases, STI testing will rely on the practitioner to identify an at-risk patient and encourage testing, since many standard guidelines exclude individuals who appear to be at possible risk — for example, young, gay males for syphilis. “We’re trying to come up with some guidelines to define ‘high prevalence’ and ‘at-risk’ communities,” she said.