What is the state of Sexually Transmitted Diseases (STDs) today?
Last fall, the Centers for Disease Control and Prevention (CDC) reported the highest ever STD rates in the U.S. The 2.4 million cases reported in 2018 mark sustained national rising STD rates (also commonly referred to as sexually transmitted infections or STIs). “We’re documenting an increase in STDs for the fifth consecutive year,” said Elizabeth Torrone, an epidemiologist with the CDC. There are multiple reasons for the continued increase, and reducing STDs will involve safer sex practices and increased STD testing.
Why does it matter?
These infections have consequences that affect Americans on an individual and national level. Untreated chlamydia and gonorrhea can lead to pelvic inflammatory disease (PID), a major cause of infertility, ectopic pregnancy, and chronic pelvic pain. The CDC estimates 20,000 cases of infertility each year from undetected STDs, and $16 billion in direct medical costs alone. The worst part about these consequences is that people can avoid them if they access treatment. However, the majority of people are not getting STD tested regularly enough to catch these infections and access appropriate treatment.
One particularly upsetting trend is the increase in infant deaths due to congenital syphilis. This occurs when syphilis infects a fetus during pregnancy or birth. A 36% increase in syphilis among young people who can become pregnant drove this rise in congenital syphilis. Infant deaths caused by this syphilis rose 40% from just 2017-2018, with 94 infant deaths in 2018 alone. Infected babies that do survive birth suffer long-term irreversible consequences. That said, syphilis is curable with antibiotics once detected. So, it’s important that pregnant people ask their prenatal care providers about syphilis testing.
What is most common?
Along with the substantial rise in syphilis, gonorrhea and chlamydia have continued to increase in recent years. With Alaska reporting the highest rate of chlamydia and Mississippi reporting the highest rate of gonorrhea, the two infections have made a comeback across the United States. Like syphilis, both of these infections can be cured, but can be quite harmful when patients don’t get treatment.
Chlamydia alone, the most reported STD, infected 1.8 million people in 2018. Young women accounted for 44% of infections and suffer the most severe consequences without treatment1. In fact, the CDC estimates that one in 20 sexually active young women has chlamydia.
Gonorrhea also affects mainly young people. Women accounted for many of the 583,405 cases in 2018, but men who have sex with men (MSM) were most at risk, accounting for over half of the cases. Diagnoses among MSM have nearly doubled in the past five years and the rate of gonorrhea in general has risen 82.6% since the historic low in 20093.
What is causing the increase?
In part, the rising STD rates could be related to the increase in screening rates in recent years. The more people tested, the more infections found, and the higher the reported rates. But this trend doesn’t account for all of the increase in disease.
Poverty, drug use, decreases in condom use, recent cuts to STD programs, and continued stigma surrounding STDs have all played roles in the rising STD rates. Poverty is associated with lack of access to adequate screening and safer sex supplies. Meanwhile, condom use has declined as HIV treatment improves and highly effective contraception becomes more common. Also, funding cuts have forced many clinics to close, which means reduced screening and patient follow up. Fred Wyans, communications director for the nonprofit American Sexual Health Association, reports that “the public health experts who advise us consistently refer to an eroding STD prevention infrastructure as a key element in driving STD rates.” In addition to these challenges, there is still stigma associated with STDs that stops people from getting tested.
What can we do?
Test and treat! Chlamydia, gonorrhea, and syphilis are all treatable! As for the other STDs? Mostly curable and entirely treatable. Unfortunately, people often don’t get treated because they don’t know they are infected. With the majority of STDs showing no signs or symptoms, often times the only way to know your status is to get tested.
Though access to STD screening has been increasing, it is still inadequate. The CDC recommends annual chlamydia screening for all sexually-active women younger than 25 years old and older women with new or multiple sex partners. And yet, over half of sexually-active women aged 16–24 years are not receiving chlamydia screening, leaving them vulnerable to the consequences of undetected infection.
Accessing testing can be intimidating considering the number of potential infections, testing options, and continued stigma. A sexual health risk assessment can be useful in discerning exactly which testing may be most useful. While assessments were traditionally only accessible through visits with clinicians, binx health has developed a free and completely confidential online assessment that can be accessed here.
Ending the epidemic will involve increasing access to STD testing through novel methods like rapid testing and at-home testing. Through innovative techniques, we can catch more infections in time to avoid their expensive and harmful consequences. Looking for convenient, discreet, at-home STI Testing? Take our simple quiz to find the right test for you.