STD Rates: A Public Health Crisis for the Fourth Straight Year

Crisis. Emergency. Epidemic.

These are just some of the words public health advocates and officials are using to describe the rising rates of syphilis, gonorrhea and chlamydia in the U.S.

A recent report from the Centers of for Disease control showed in 2017, about 2.3 million cases of STDs were diagnosed. It marks the highest number ever reported, by more than 200,000 (the record previously set in 2016).

In regards to syphilis public health officials went from “plans to eliminate (the STD) to a public health crisis,” said Adam Sukhija-Cohen, the Director of Advocacy and Policy Research for the AIDS Healthcare Foundation. “This is an insane resurgence.”

Sukhija-Cohen noted that at the turn of the century public health officials were preparing for the elimination of Syphilis in the U.S. but then “the CDC budget has decreased by a third since early 2000s.”

While there are many factors involved in why STD rates are increasing all three of the public health advocates SFGN spoke with cited the decrease in federal funding as a main cause.

“This is a public health emergency,” said Jeffrey D. Klausner, Professor of Medicine and Public Health at UCLA. “But most concerning is a lack of a federal response. We’ve not seen any response from the secretary of health and human services’ office.”

Matthew Prior, Director of Communications for the National Coalition of STD Directors concurred that a federal response is needed to address the growing epidemic.

“We’re seeing STDs increase across the nation, every age group, every demographic…these national trends are very worrisome,” he said.

A more detailed report from the CDC is expected by the end of September that will include state level data.

While STD rates continue to increase, new HIV infections continue to decrease.

“We know that investing in prevention works because of the progress we’ve made in HIV prevention,” Prior said.

The Consequences

Sukhija-Cohen and Prior both were particularly concerned about mothers passing syphilis to their children which is called congenital syphilis. It’s life threatening and entirely preventable. Those rates have doubled over the past decade.

“Forty percent of babies born with syphilis are stillborn. It’s tragic,” Prior said. All it takes is to make sure to test pregnant women for the infection, which is fairly easy to do since most women receive regular checkups during their pregnancy.

“Ultimately we don’t have a healthcare infrastructure for our pregnant women,” Sukhija-Cohen said. Prior added “It’s so easy to test for, in most places it’s just checking a box.”

Drug resistant gonorrhea is another major concern. Right now cases have been reported overseas. It’s only a matter of time before a strain appears in the U.S. If normal treatment of gonorrhea fails it may require an expensive hospital stay to rid a patient of the infection.

“Our public health system is ill prepared for this,” Prior said.

Obamacare

Some people might assume the Affordable Care Act, also known as Obamacare, would have addressed this public health issue. It hasn’t. While it’s been a tremendous success in getting people covered by insurance and access to primary health care, it has not really impacted the STD rates.

“STDs are public health issue. They are not controlled with better primary care,” Klausner said. “That’s partly why Obamacare is not a solution. It takes special knowledge, special training, and special management.

Prior had similar thoughts.

“We fully support the ACA but unfortunately that network is ill-equipped. Many doctors have a severe lack in knowledge about STDs,” he said.

Prior noted that many areas of the U.S. do not have STD clinics like South Florida. In fact Klausner pointed the Broward Wellness Center, a joint venture between the Florida Department of Health and AHF, as a very effective model.

“Broward has the newest and most advanced testing and treatment program in the United States,” Klausner said. “That’s a breakthrough in terms of sexual health services. There is no reason, other than funding, that this couldn’t be replicated in urban areas around the United States.”

What can be done?

“We are calling for a 70 million dollar increase in STD prevention... this will kick start our response to rising STDs,” Prior said. “We need federal funding to support the public health infrastructure. STD programs should be supplemented by state and local level, but we really need a national response to address this. I will say in most states the federal STD funding line is the only funding stream for STD prevention.”

All three public health advocates are calling for an increase federal funding. Increased condom usage would also reduce the rates of STDs. Beyond those two items there are other things that can be done.

Sukhija-Cohen explained that currently the CDC recommends opt out testing for HIV, meaning all healthcare patients should be screened for HIV unless they specifically ask not to. There is no such recommendation for other STDs like chlamydia, gonorrhea and syphilis.

Sukhija-Cohen also said that there needs to be anatomically site specific testing. For instance gonorrhea and chlamydia can occur in the genitals, and the mouth. Many healthcare providers only use a urine test, which will not pick up gonorrhea of the throat or rectum.

Lastly Sukhija-Cohen recommends more access to rapid result testing. Rapid testing for HIV has been around since the 1990s but only recently have rapid tests for STDs come onto the market. This year in Florida AHF rolled out rapid testing for gonorrhea and chlamydia, which takes about 90 minutes. AHF is currently conducting a pilot test for rapid syphilis testing in some locations across the country. Those results take 10 minutes.

In regards to Syphilis Klausner noted there may be some hope on the horizon in terms of prevention. Just like PrEP, the once a day pill to prevent HIV, has ushered in a new era of HIV prevention Klausner said one drug has shown promise in reducing the rates of syphilis, and chlamydia. According to the The Lancet, a medical journal, using doxycycline, a common antibiotic, after a sexual encounter significantly reduced the rates of syphilis, and chlamydia. It had no affect on gonorrhea. That study was focused on men who have sex with men, a high risk group for STDs.

“It’s been talked about in STD meetings. There have been whole debates on it. Journals have written about it,” Klausner said. “So it’s emerging from under the radar. But there is not a whole lot of awareness yet. It’s definitely something people should know about.”

This is a first part of a series of reports SFGN will publish on the rising STDs rates in the U.S.