Incidence of Sexually Transmitted Disease Rises Steeply

A new report issued by the US Centers for Disease Control and Prevention (CDC) reveals an unfortunate truth: The number of sexually transmitted disease (STD) cases in the United States went up for the fifth year in a row in 2018, with chlamydia, gonorrhea, and syphilis at their highest in decades. The number of chlamydia cases increased 3% to 1.7 million in 2018. Gonorrhea cases went up 5% to more than 580,000, while syphilis cases increased 13.3% to more than 115,000. Combined, these diseases represent an all-time high caseload for the United States.

“Some of the increase in diagnosed and reported cases is due to expanded screening,” Elizabeth Torrone, PhD, MSPH, an epidemiologist at the CDC, told Contagion®. “However, the steep and sustained increases in recent years are unlikely [to be] explained by increased screening alone and likely reflect increasing new infections as well.” She added that the rising rate of infection has a variety of causes, such as socioeconomic inequality: “Poverty, [lack of] education, drug use, stigma, discrimination, and unstable housing all [make] it difficult for people to access quality STD prevention and care.” Also at the root of the problem, she said, are cuts to government health programs and decreased condom usage.

Particularly consequential was the 40% increase in cases of congenital syphilis between 2017 and 2018. This is dwarfed by the 185% increase in congenital syphilis between 2014 and 2018. The number of newborn deaths due to congenital syphilis rose from 77 in 2017 to 94 in 2018, a 22% increase. But even when congenital syphilis doesn’t result in infant death or miscarriage, it can cause serious lifelong disabilities in children who acquire it.

“Early prenatal care and STD testing are essential with each pregnancy,” Torrone said. “The increases in congenital syphilis show we are missing opportunities to screen and treat pregnant women for STDs, especially syphilis. All cases of congenital syphilis are preventable.”

Experts estimate that about half of all new STDs are diagnosed in people between the ages of 15 and 24. Women outnumber men when it comes to diagnoses of chlamydia, the most common STD nationwide, and the disease is particularly prevalent in women between the ages of 20 and 24 years (4064.6 cases per 100,000 women). Although women in this age group experienced an increase in chlamydia cases at a rate of just 0.8% from 2017 to 2018, they experienced an 11.9% increase in the period from 2014 to 2018. While men in this age group experienced a 3.3% increase from 2017 to 2018, they experienced a 31.1% surge from 2014 to 2018.

Why is there such an epidemic of STDs among youth? “We know that condom use is declining among some young people,” Torrone said. “Also, young people may experience multiple barriers to accessing quality STD prevention and care services, including an inability to pay for services, lack of transportation, or conflict between clinic hours and school and work schedules. Young people also may have concerns about confidentiality or may be embarrassed to seek STD services or provide specimens for testing.” Other key populations that suffer disproportionately from STD infection, as outlined in the CDC’s report, are men who have sex with men and racial and ethnic minorities.

According to Torrone, health care providers should play a crucial role in helping to bring down the rates of these infections. One important step is to ask patients about their sexual histories during exams, which helps normalize disease screening and lets clinicians know who is at risk. It’s also imperative that clinicians be familiar with the latest treatment recommendations if they’ll be prescribing medication, or that they connect patients to health departments that can treat STDs in a timely manner.