The numbers are shocking, the headlines scary. Rates of sexually transmitted diseases in the United States reached an all-time high in 2018 — 2.5 million diagnoses, according to the Centers for Disease Control and Prevention.
The increases over the past five years are staggering:
- Gonorrhea spiked 83%
- Primary and secondary syphilis is up 71%
- Chlamydia rose 19%
- Congenital syphilis, the type passed from mothers, mushroomed 185%.
In Nassau County, the overall rate of STDs rose from 2016 to 2017 — including increases of 18.2% for chlamydia, 37% for gonorrhea, and 10.4% for primary and secondary syphilis. In Suffolk County, that rate rose from 2016 to 2017 — including increases of 22.1% for chlamydia, 26.7% for gonorrhea, but a decrease of 12.1% for primary and secondary syphilis.
And those numbers only represent people who are diagnosed; meaning most will get a treatment that can cure them. And although state and local health authorities fund and expand STD-testing programs, what scares me as a public health scientist is the number of undiagnosed people unknowingly spreading infections, and the lack of the proper sex education in schools.
Lack of testing opportunities, poor sexual and reproductive health education, inconsistent and incorrect condom use, stigma and discrimination in health care settings, lack of prenatal care, substance use and poor social determinants of health (conditions in the places where people live, learn, work, and play) drive the epidemic.
We need to do more — and need to do it smarter.
Anyone who has sex may be at risk. This includes the 77% of Americans who had sex in the past year. The groups most impacted are 15- to 24-year-olds, particularly young sexually active women (1 in 4 had an STD in 2018); gay and bisexual men; and pregnant women (especially those not receiving prenatal care).
While antibiotics can cure syphilis, gonorrhea, and chlamydia, individuals repeatedly infected may become antibiotic resistant. Unfortunately, most people with STDs do not have symptoms. If untreated, STDs can increase vulnerability to other STDs, including HIV, as well as infertility and miscarriages.
While the nation has a National HIV/AIDS Strategic Plan, it does not yet have a similar STD plan. Earlier this year, the Department of Health and Human Services began developing a plan expected to be released next year. It would lay out strategies to improve the response to the increasing STD rates, to facilitate testing and treatment services, and to help to reduce STD-related stigma and discrimination. I applaud the development of a national STD plan, but two major issues need to be resolved if it’s to end the epidemics.
First, policy-makers must be held accountable for instituting age-appropriate, medically accurate, school-based sexual and reproductive health education, inclusive of sexual and gender minority young people including those who are transgender and gender nonconforming. Evaluations of abstinence-until-marriage programs show they have little impact on young people’s sexual behavior. Comprehensive sex education is associated with increased condom and contraceptive use and declines in unintended pregnancies.
Second, programs that train physicians, nurse practitioners and physician assistants need to better instruct future health care professionals on STD prevention, screening and treatment. Some clinicians follow the guidelines, but many fall short with site-specific testing in the throat, rectum and urethra. By taking only a urine sample, a provider may misdiagnose patients. For example, urine-only chlamydia and gonorrhea testing misses up to 88% of infections in gay and bisexual men.
Many are shocked over the nationwide rise of STDs, so let us refocus our efforts and promote best practices.
Anthony J. Santella is an associate professor of public health at Hofstra University.