The Centers for Disease Control and Prevention (CDC) have released a new report on sexually transmitted infections (STIs) and the numbers are grim. An announcement about the report states that the rate of STIs has skyrocketed in the past two decades, with significant increases in each successive year.
The CDC suggests this steady rise in cases “may be due to a lack of sexual education and existing disparities” in healthcare and testing, particularly among groups traditionally disadvantaged in healthcare and treatment, like LGBTQ+ and people of color.
Documented cases of the sexually transmitted diseases chlamydia, gonorrhea and syphilis in the U.S. hit an all-time high in 2019, the most recent year for which data is available. This marks the sixth year in a row that cases have reached record numbers.
Numbers were highest in the 15-24 age range, but were found in all ages, races and ethnicities. But there were also racial disparities. Although Black people comprise only 12.5% of the population, about 31% of chlamydia, gonorrhea and syphilis cases were reported in non-Hispanic Black people. Men who have sex with men (MSM) were also disproportionately impacted by STIs.
“Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination, and advances in chlamydia diagnostics made it easier to detect infections,” said Raul Romaguera, acting director of the Division of STD Prevention at the CDC, in the announcement of the new data. “That progress has been lost, due in part to challenges to our public health system.”
The CDC says disparities in STI cases likely reflect lack of access to quality sexual health care and education about individual sexual health. The CDC cites the example of having a greater chance of encountering an STI in communities with a higher prevalence of STIs compared to lower-risk communities, regardless of sexual behavior patterns. Which means the LGBTQ+ community is at higher risk.
The individual statistics are startling. Chlamydia remains the most common STI. While the infection is reported most among women, who are regularly screened for chlamydia, CDC reports that “rates among men increased 32.1% during 2015–2019. Increases in rates among men may reflect an increased number of men, including gay, bisexual, and other men who have sex with men (MSM).”
The new stats for gonorrhea, the second most commonly reported STI, also signaled a dramatic increase. Rates of reported gonorrhea have increased 92% since the historic low in 2009.
Among men, the rate of reported gonorrhea increased 5.9% during 2018–2019 and 60.6% during 2015–2019. Rates among women increased 5.1% during 2018–2019 and 43.6% during 2015–2019.
Most concerning in all the data is the rise in antibiotic-resistant gonorrhea. Gonorrhea can quickly develop resistance to antibiotics used to treat infection, and in 2019, more than half of all infections were estimated to be resistant to at least one antibiotic.
Since reaching an historic low in 2000 and 2001, the rate of primary and secondary syphilis has increased almost every year, increasing 11.2% during 2018–2019.
CDC states, “MSM are disproportionately impacted, accounting for a majority (56.7%) of all male P&S syphilis cases in 2019.”
And although rates of P&S syphilis are lower among women, “rates have increased substantially in recent years, increasing 30.0% during 2018–2019 and 178.6% during 2015–2019, suggesting the heterosexual syphilis epidemic continues to rapidly increase.”
Congenital syphilis, a disease that happens when a mother with syphilis passes the infection on to her baby during pregnancy, increased by 279% since 2015.
Dusty Latimer, a physician assistant at Mazzoni Center, expanded on the concerns of CDC on why these infections continue to rise. Latimer told PGN, “The current upward trends in STI cases can definitely be tied to a lack of LGBTQI-sensitive sex education.”
Latimer said the current pandemic climate has daunting aspects. “We have new challenges to address: negotiating sexual health in the middle of a pandemic, changes in CDC STI treatment guidelines and the looming fear of treatment resistant gonorrhea.” He added, “We also have to get our patients vaccinated and re-engaged in frequent STI screenings.”
Eric Paulukonis, MS, Director of Prevention Services, was unsurprised by the new report. Paulukonis said, “Through our Washington West Project, we have always identified a large number of STI infections. A considerable number of our clients come in every three months for routine testing. Routine testing allows infections to be identified early to reduce the possibility of disease progression and transmission.”
But like Latimer, Paulukonis explained that the pandemic had created a new set of problems. “Due to the pandemic, STI screenings were halted abruptly,” he said, “so it is likely that a large number of individuals who were infected, were not tested and treated.”
Paulukonis added, “Further, COVID safety restrictions and a COVID-related shortage of testing supplies, resulted in further reduced STI service capacity.”
The impact of the past year on sexual health has been largely ignored, and Paulukonis said that there were other healthcare issues that likely have been predominant for everyone, including LGBTQ+ people.
“Community members have been dealing with a myriad of other issues which likely took precedence over their sexual health,” he said. “This is a highly risky combination, making it not surprising that there would be high infection rates.”
Larry Benjamin, Director of Communications/Interim Director Development, told PGN that Mazzoni was working to mitigate these alarming new STI increases. He said, “In response to rising STI infection rates, we are actively working to secure funding for the purchase of a recreational vehicle (RV) that can be retrofitted and used as a state-of-the-art mobile clinic delivering high quality, full spectrum, community-based HIV/STI testing, diagnosis, treatment and prevention services to high-risk populations within Philadelphia.”
Benjamin added, “We believe low threshold access to comprehensive sexual health care is critical to bringing down STI infection rates.”
Paulukonis said, “We need to get our community back to regular STI screenings and on a routine STI screening schedule as soon as possible.”
He added, “We need to get our community back to regular STI screenings and on a routine STI screening schedule as soon as possible. As COVID restrictions relax, it is my hope that more free walk-in STI screenings can be offered, allowing us to address the soaring STI infection rate.”
Latimer pointed to the uptick in cases among MSM and noted, “Widespread sex education programs have rarely been focused on the specific needs of our community, and it is the challenge of queer health organizations like Mazzoni Center to find, educate and empower our people.”
Latimer said, “Anyone who is an active Mazzoni Center patient can contact the medical center directly for scheduling, and our Washington West Project is open for testing as well.”
There is also testing available at all Planned Parenthood sites in the Philadelphia area.
The entire CDC report, replete with graphs and other explanatory details is available at www.cdc.gov/.