Health officials are raising alarm about a rise in STDs across the United States.
For the fifth consecutive year, combined cases of gonorrhea, chlamydia and syphilis have risen in the United States, according to a Sexually Transmitted Disease Surveillance Report from the US Centers for Disease Control and Prevention published on Tuesday.
“Combined they total 2.4 million infections that were diagnosed and reported just in last year alone,” said Elizabeth Torrone, a CDC epidemiologist who worked on the new report, adding that the combined number marks “the most cases” ever recorded since monitoring began in the United States.
A rise in the prevalence and incidence of STDs can come with serious public health consequences and concerns, including infertility, drug-resistant gonorrhea and congenital syphilis, which can cause infant death.
“Yet not that long ago, gonorrhea rates were at historic lows, syphilis was close to elimination, and we were able to point to advances in STD prevention,” Dr. Gail Bolan, director of the CDC’s Division of STD Prevention, wrote in the new report’s foreword.
“That progress has since unraveled. The number of reported syphilis cases is climbing after being largely on the decline since 1941, and gonorrhea rates are now increasing.
“Many young women continue to have undiagnosed chlamydial infections, putting them at risk for infertility.”
Possible factors driving this rise in STD cases, which vary depending on where you live, include a surge in people getting tested and cases being diagnosed and reported. There’s also a decline in people using condoms.
The new report found that rates of reported cases tended to be highest among adolescents and young adults.
The new CDC report calls for federal, state and local agencies to employ strategies that reduce STD incidence and help to improve sexual, reproductive, maternal and infant health.
“STDs cause a significant burden to the health care system – both in terms of direct medical costs for treating STDs as well as the personal cost for people who have an STD,” Torrone said. “As the STD epidemic continues to grow in the United States, the direct medical costs and the quality of life lost will just increase as well.”
Where cases are highest and lowest
Four STDs are monitored nationwide and nationally notifiable to the CDC: chlamydia, gonorrhea, syphilis and chancroid.
The states with the highest rates of cases were:
- Alaska for chlamydia
- Mississippi for gonorrhea
- Nevada for primary and secondary syphilis
For each of those three diseases, rates in the District of Columbia were higher than all states.
“We’ve seen increases like the nation as a whole has seen increases. We’ve seen some recently bigger jumps and there’s a number of factors to which we attribute that,” said Michael Kharfen, senior deputy director of the HIV/AIDS, Hepatitis, STD and TB Administration at the DC Department of Health, who was not involved in the new CDC report.
One factor includes that testing services have been more easily accessible, which likely led to a large prevalence of cases being identified, Kharfen said. The DC Department of Health is continuing to invest in screening and testing efforts.
“We have been very aggressive in making STD screening available in lots of different both clinical and community settings, particularly among young people, who have a disproportionate number,” he said.
The new report, which analyzed STD data for the year 2018, found that a total of about 1.8 million cases of chlamydia infection were reported to the CDC last year, making it the most common notifiable condition in the United States.
Last year, rates of chlamydia cases by state ranged from 198.2 cases per 100,000 people in West Virginia to 832.5 cases per 100,000 people in Alaska, according to the new report. The rate for the District of Columbia was 1,298.9 cases per 100,000, the report found.
The report also found that a nationwide total of 583,405 cases of gonorrhea were reported to the CDC last year, making it the second most common notifiable condition in the United States.
Rates of reported gonorrhea climbed 82.6% since a historic low in 2009, the report found.
In 2018, rates of reported gonorrhea cases by states ranged from 43 cases per 100,000 people in Vermont to 326.7 per 100,000 in Mississippi, according to the report.
The gonorrhea rate in Washington, DC, was 611 cases per 100,000 people, the report found.
The report also found that 115,045 cases of syphilis nationwide were reported to the CDC last year. In 2018, states’ rates of reported primary and secondary syphilis cases ranged from 1.8 per 100,000 people in Vermont to 22.7 per 100,000 in Nevada. The rate of reported primary and secondary syphilis cases in DC was 40.2 cases per 100,000.
Among other STDs included in the report, there has been overall declines in reported chancroid cases, in the prevalence of herpes simplex virus infections and in the prevalence of the human papillomavirus or HPV-related complications such as genital warts, which may be due to having access to a HPV vaccine, according to the report.
’The most tragic consequences of this growing epidemic’
There has been a concerning rise in congenital syphilis cases, increasing each year since 2013, according to the report. Congenital syphilis is a severe, disabling and often life-threatening infection that occurs in infants when a pregnant mother who has syphilis spreads the disease through the placenta to her baby.
“One of the things that really stands out in this new report is the new and updated data on congenital syphilis, which is one of the most tragic consequences of this growing epidemic,” Torrone said.
The STD surveillance report for the year 2017 found that cases of congenital syphilis have more than doubled since 2013. The new report found that last year there were 1,306 cases of congenital syphilis among newborns reported to the CDC.
“Most concerning in that overall case count – there were 94 infant deaths related to congenital syphilis,” Torrone said.
“All of those cases could have been prevented if pregnant women had been treated appropriately and in a timely way prior to delivery,” she said. “We really need to make sure that all pregnant women are screened at their first prenatal care visit, treated appropriately and that their partners are treated so that we prevent reinfection.”
’We have a real threat with drug resistance’
As the United States sees these steep increases in STDs, there also has been a slow decline in treatment options for one infection in particular: gonorrhea.
The threat of antibiotic-resistant gonorrhea persists across the United States and around the world. There have been a growing number of gonorrhea cases that are resistant to some of the antibiotics used to treat the infection.
Last year in the United Kingdom, a man was infected with a multidrug-resistant form of gonorrhea that was resistant to first-line treatment, a combination of the antibiotics azithromycin and ceftriaxone, according to Public Health England. The man had to be treated intravenously with the antibiotic ertapenem.
“With gonorrhea in particular, we have a real threat with drug resistance,” said Dr. Mark Mulligan, chief of infectious diseases at NYU Langone Health in New York and director of the NYU Langone Vaccine Center, who was not involved in the new CDC report.
“For most gonorrhea, we’re down to a single drug and if we lose that it could potentially become untreatable,” he said. “One need is to develop new antimicrobials for resistant organisms like gonorrhea. Another need or another strategy to combat the much broader problem of antimicrobial resistance is using vaccines to try to prevent the infections and therefore reduce the impact of drug resistance.”
Why STDs are on the rise
The report had some limitations, including that the data only included STD cases that had been reported to the CDC.