Photo by JD Mason/Unspalsh

Special to The Dallas Examiner

More than 2.5 million people in the United States have a sexually transmitted infection and those numbers appear to be continually rising, according to the Centers for Disease Control and Prevention.

African Americans have been disproportionately infected. Overall, the highest rate of increased cases was in the Southern states, according to Sexually Transmitted Disease Surveillance, 2021, a recent study conducted by the CDC.

The report showed:

  • African American men had the highest rate of reported cases of gonorrhea with a rate of 800.8 per 100,000, compared to White men at a rate of 84.9 per 100,000.
  • African American women had the second highest rate of gonorrhea at 514.5 per 100,000, compared to White women with a rate of 72.8 per 100,000.
  • African Americans had the highest rate of reported cases of congenital syphilis with a rate of 385 per 100,000, compared to Whites at a rate of 41 per 100,000.
  • During 2020 to 2021, the chlamydia rate among men increased 6.9% and the rate among women increased 2.4%. In 2021, the rate of reported chlamydia was higher among women.
  • In 2021, those aged 20 to 24 years had the highest rate of reported cases of chlamydia, followed by those aged 15 to 19 years.

“The U.S. STI epidemic shows no signs of slowing. The reasons for the ongoing increases are multifaceted – and so are the solutions,” stated Leandro Mena, MD, MPH, director of CDC’s Division of STD Prevention.

During 2020, the COVID-19 pandemic led to disruptions in STD-related prevention and care activities, including reduced screening during the initial shelter-in-place orders, according to the report.

STD program resources, including STD case investigations, were also redirected to COVID-19 activities. Because STDs often do not show symptoms, and screening is necessary for timely diagnosis and treatment, changes in access to sexual health care could affect the number of infections diagnosed and reported. The impact of these disruptions likely continued in 2021 and, as a result, STD surveillance data collected during 2020 and 2021 and presented in the study should be interpreted cautiously.

COVID-19 had the greatest impact on surveillance data in March and April 2020, when the number of STD reports rapidly fell due to shelter-in-place orders across the country. Most notably, the number of gonorrhea and primary and secondary syphilis cases fell below the 2019 case counts.

However, as 2020 came to an end, cases of gonorrhea increased 10% and reported cases of syphilis increased 7%. The trend continues as gonorrhea increased 15% and syphilis increased 38% by the end of 2021.

The increase in case numbers could be attributed to health clinics opening up, vaccines becoming available and people seeking care in late 2020 and 2021. But increases in diagnosed and reported cases could also reflect higher disease transmission. For example, due to reduced access to care, those with an STD may have had their infections longer, providing more opportunities to transmit infection to their sexual partners. Additionally, following the initial shelter-in-place orders, sexual behaviors like the frequency of new sex partners may have changed, causing STDs to spread in sexual networks.

The number of chlamydia cases was likely disproportionately affected by reduced screening during the pandemic, resulting in undiagnosed infections. The number of chlamydial infections diagnosed and reported in 2021 was 9% lower than the number reported in 2019. Most people with chlamydia usually have no signs or symptoms and most cases are identified through screening at routine preventive care visits.

Additionally, in response to reduced staffing resources, many health departments prioritized the diagnosis and treatment of syphilis and gonorrhea. This likely further reduced the number of chlamydia cases processed and reported.

Concerningly, rates of P&S syphilis increased 24% among reproductive-aged women from 2019 to 2020, resulting in increases in congenital syphilis. In 2020, there were 2,148 congenital syphilis cases, an increase of 15% since 2019. During 2020 to 2021, rates of P&S syphilis increased 52% among reproductive-aged women and the number of congenital syphilis cases increased 32%. Increases in congenital syphilis, including increases in congenital syphilis-related deaths, are a stark reminder of the need to prevent the worst outcomes related to STDs.

The new report underscored that STDs continue to persist as a significant public health concern. It reflected the realities of a strained public health infrastructure, while simultaneously providing the most current data on reported cases of STDs in the United States.

However, the picture remains very unclear. The COVID-19 pandemic significantly affected trends in STDs – resulting in likely underreporting of infections and possibly increased STD transmission. It’s likely that such effects will persist for several more years and researchers may never know the full impact of the pandemic on STDs. What is clear, however, is the state of STDs did not improve in the United States. Prevention and control efforts remain as important as ever, according to researchers.

There is much to be done to rebuild, innovate, and expand STD prevention in the U.S. It will take many groups working together:

  • Health care providers play a pivotal role in reducing stigma by integrating STD prevention and sexual health into their routine practice and creating a welcoming environment for all people.
  • Local clinics and communities can play a critical role in promoting STD prevention and empower individuals to prioritize their sexual health.
  • The public health sector must prioritize on-the-ground support for STD prevention and surveillance programs at the state and local levels and encourage innovative solutions to improve accessibility and affordability of STD services.
  • Industry and the private sector have a responsibility to develop new STD testing, treatment and vaccine innovations that are desperately needed.

“For the first time in decades, we’re seeing promising new STI interventions on the horizon, but these alone will not solve this epidemic,” Mena concluded. “It will take many of us working together to effectively use new and existing tools, to increase access to quality sexual health care services for more people, and to encourage ongoing innovation and prioritization of STI prevention and treatment in this country.”

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