By Bara Vaida
After decades of decline, the number of people diagnosed with many sexually transmitted diseases in the U.S. began steadily rising in 2000. Five years ago, the number of cases sharply increased. Between 2013 and 2017, STD cases were up 31 percent.
In 2017, there were 2.3 million new reported cases of chlamydia, gonorrhea, syphilis and congenital syphilis, according to the Centers for Disease Control and Prevention. The number of cases of gonorrhea has risen 67 percent and syphilis has risen 76 percent since 2013.
“If you look at the history [of STD rates], we were doing a good job until the 2000’s,” Gail Bolan, director of the CDC’s Division of Sexually Transmitted Disease Prevention, said during an April 2018 podcast sponsored by the Association of State and Territorial Health Officials. “And since then, we have seen these steady increases, related to prevention challenges in the U.S.”
The reasons for the increases are multi-faceted. They include decreased public health funding, lack of understanding about how STDs spread, social stigma, less access to health care and fewer health provider screenings. Social determinants also play a role in which populations are more at risk of exposure to an STD and whether they get treatment. Further, the opioid epidemic has been associated with increase in STDs among pregnant women, said David C. Harvey, executive director of the National Coalition of STD Directors during a Nov. 1 AHCJ webcast.
“STD rates are up among all population groups in the US, but they are disproportionately up among more vulnerable populations,” said Harvey. “Among those are young people, communities of color, the gay community and among older Americans in retirement communities who aren’t aware that there is a risk of STDs.”
STDs are diseases transmitted through intimate or sexual contact. The CDC estimates that 20 million new STD infections occur annually. Seven – chlamydia, chancroid, gonorrhea, hepatitis B, hepatitis C, HIV (human immunodeficiency virus) and syphilis – are “nationally notifiable diseases” and are required to be reported to the agency, while other common STDs, like herpes and HPV (human papillomavirus) are not.
Three common STDs are caused by bacteria. Chlamydia is caused by chlamydia trachomatis and can infect the urinary tract or rectum, causing painful discharge. Gonorrhea is caused by neisseria gonorrhoeae, and can infect the urinary tract, rectum, throat and cervix. Syphilis is caused by treponema pallidum and can infect the organs, brain and nervous system. All three can cause infertility and other severe complications. Chlamydia and gonorrhea can lurk without symptoms, so people don’t know they are carrying the disease and are passing it on.
Wide-spread access to antibiotics, and aggressive efforts by public health officials to screen and track the STDs in the 1970s helped to drastically reduce the prevalence of STDs caused by bacteria. CDC charts show the number of gonorrhea and syphilis cases steadily fell throughout the 1970’s and 1990’s, and then began to rise during the 2000’s.
As bacterial STDs have been rising, so has antibiotic resistance. Physicians worry that there soon could be cases of an STD that is untreatable with antibiotics.
STDs are also caused by viruses. HPV is a common STD in the U.S., which can infect the genital tract. Around 80 percent of sexually active Americans will be infected with HPV at some point during their lives, according to the American Sexual Health Association. There are more than 40 types of HPV, and the body effectively fights most of the virus types, but about 16 to 18 types can cause cervical cancer. There is a vaccine to fight the most dangerous HPV types, but only about half of girls and about a third of boys are getting the vaccine.
Herpes is another prevalent STD. The CDC says herpes prevalence has declined or remained steady among most populations since 1999.
Another STD that isn’t on the rise nationally is HIV. Though HIV remains an ongoing epidemic, the number of new HIV infections fell 8 percent between 2010 and 2015, says the CDC. The decrease has come as a new combination drug, called Truvada, was approved by the Food and Drug Administration to prevent disease from HIV. The treatment is known as pre-exposure prophylaxis, or PrEP. The U.S. Preventive Services Task Force in November 2018 recommended that health providers prescribe it to all patients that are at risk for HIV exposure. They also recommend that all patients 15 through 65 be tested for HIV, because though the number of HIV cases in general is declining, it is rising among 25 to 29-year-olds.
Why public health officials have done a better job at reducing HIV rates, but not STD’s isn’t clear, but Harvey said that health providers may be focusing just on preventing HIV, rather than all STDs.
“It’s been a compartmentalized approach…we might talk about preventing HIV…[but] we aren’t doing a good job saying that using condoms will prevent STDs, so we need to harmonize these programs,” Harvey said.
About 1.1 million Americans are living with HIV. Since the first cases of HIV were reported in 1981 by the CDC, about 693,000 people have died in the U.S. from AIDS [Aquired Immune Deficiency Syndrome] related disease caused by the virus.
Among the key ways public health officials are working to stop STDs is by deploying disease intervention specialists, which are a type of public health investigator trained to track down those with STDs and their contacts, to get them treated. State public health departments currently employ about 1,400 of these detectives, down from about 4,000 twenty years ago.
Story ideas:
- Spend a day following around a local disease intervention specialist. They track down people who may have been exposed to an STD to stop their spread.
- A story about how many STD clinics are in your community. Has that fallen in the past decade? Are they seeing a rise in STD rates? What are local authorities doing to combat the increase? Are they changing messaging?
- Look into whether social media dating apps causing more STDs or helping to curb them
- Check with local hospitals and maternity clinics to learn if there are more babies that have been born with syphilis. What is being done to prevent more cases?
- Check out AHCJ’s November 2018 webcast for more story ideas
More reading:
- AHCJ Tip Sheets on Covering HIV/AIDS (AHCJ, December 2017)
- AHCJ Tip Sheet on Covering Social Determinants and Infectious Diseases (AHCJ, September 2018)
- AHCJ Tip Sheet on Covering Antibiotic Resistance (AHCJ, November 2018)
Articles:
- The Era of Cheap and Easy STD Treatment is Over: What Went Wrong? (Wired, November 2018)
- Herpes Rates Decline Across U.S. (CNN, February 2018)
- Five reasons why 3 STDs are roaring back in America (Vox, August 2018)
- STD Cases Reach a Record 2.3 Million (New York Times, August 2018)
- Primary Care Doctors Not Doing Enough to Curb STD’s (KHN, October 2018)
- HPV Vaccine: Why Parents Choose to Refuse (Johns Hopkins University, October 2018)
- The Cancer-Preventing HPV Vaccine A Dozen Years On: Progress, Fear and Loathing (The Philadelphia Inquirer/Daily News, November 2018)
- An Underused Strategy for Surge in STD’s: Treat Patients’ Partners (KHN, November 2018)
- U.S. Officials Recommend Use of PrEP pills to Stop Spread of HIV (UPI, November 2018)
- Meeting the challenge of engaging men in HIV prevention and treatment (National Institutes of Health, November 2018)
- Testing times: the four emerging STIs that you can’t afford to ignore (December 2018)
Experts:
David Harvey, B.S.
Executive director, The National Coalition of STD Directors
Email: dharvey@ncsddc.org
Expertise: He leads one of the country’s largest public health membership organizations that represent public health department STD directors and their community partners.
Leslie M. Kantor, Ph.D., M.P.H.
Chair, Rutger’s University Department of Urban-Global Public Health
Email: lk481@sph.rutgers.edu
Expertise: Prior to Rutgers, she was vice president of education for Planned Parenthood Federation of America. Kantor is a leader in sexual and reproductive health and an advocate for underserved and marginalized populations
Peter Leone, M.D.
Professor of Medicine, School of Medicine; Adjunct professor of epidemiology, Gillings School of Global Public Health at the University of North Carolina
Email: pal007@med.unc.edu
Expertise: He specializes in infectious diseases, antibiotic resistance and STDs
Jonathan Mermin, M.D., M.P.H.
Director, CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Can be reached via press coordinator Rachel Wingard: miv1@cdc.gov, 404 639-2013 or 678 708 9171
Expertise: Mermin oversees the nation’s efforts to prevent the spread of HIV and STDs.
Dan Wohlfeiler, M.J., M.P.H.
Director, Building Health Online Communities
Email: danwohlfeiler@bhocpartners.org
Expertise: Serves in the California’s Department of Public Health and has decades of expertise in working on STD and HIV prevention.
More resources:
- CDC’s Sexually Transmitted Diseases section and data and statistics
- The CDC’s Atlas Plus platform provides interactive data on HIV/
- AIDS, STDs, Viral Hepatitis and TB Prevention.
- Transcripts of CDC Meetings on STD Prevention and Treatment
- CDC section on HIV/AIDS
- STD Outreach in Action (A story of several disease intervention specialists)
- HHS Department of Disease Prevention and Health Promotion on STDs and national prevention goals
- National Coalition of STD Directors and Disease Intervention Specialists program
- Association of State and Territorial Health Officials – STD section
- National Association of Health of County and City Health Officials – STD section and Disease Intervention Specialists
- National Coalition for Sexual Health
- American Sexual Health Association
- Global HIV Organizations
Webcast/Podcast:
- AHCJ Webcast on STDs
- Association of State and Territorial Health Officials podcast series (Scroll down to find April 2018 podcast on STDs)
