We don’t talk much about chlamydia, gonorrhea, or syphilis, in part because it can seem like they’re not big health issues anymore. But it turns out more and more Americans may be quietly suffering from these once nearly eliminated STDs.
According to a new report from the Centers for Disease Control and Prevention, there were more than 2 million cases of chlamydia, gonorrhea, and syphilis reported in the United States in 2016 — the highest cumulative number ever recorded.
The leap in cases in just one year is truly eye-popping. Between 2015 and 2016, the rate of:
- Gonorrhea increased by 18.5 percent to 468,514 cases
- Syphilis increased by 17.6 percent to 27,814 cases
- Congenital (spread from mother to infant) syphilis increased by 27.6 percent to 628 cases
- Chlamydia increased by 4.7 percent, to 1.59 million cases
To appreciate just how astonishing the trends are, consider that as recently as a decade ago, these STDs were at historic lows or near elimination, with more and better screening and diagnostics to help identify cases and get people into treatment.
Syphilis can show up on the body in sores and rashes. Gonorrhea and chlamydia can lurk with no symptoms. They’re all generally easy to cure with a timely antibiotics prescription, but when left untreated, they can lead to infertility or life-threatening health complications. That’s what makes screening and access to health care so important.
The increase in cases between 2015 and 2016 across all three diseases was significant, and represents changing disease dynamics. “Not only are we at an all-time high,” said Gail Bolan, the director of the division of STD prevention at the Centers for Disease Control and Prevention, “but we’re starting to see increases in all kind of communities.”
African Americans and men who have sex with men have traditionally been the populations most plagued by gonorrhea and syphilis (and they’re still disproportionately affected). But other groups are now catching up too, especially women and babies when it comes to syphilis.
So what’s behind the spread of these diseases here? There’s no single explanation. Like most health trends, it’s complicated. But here are a few ideas, according to experts:
1) There’s been a rise in condomless sex among men who have sex with men: Gay, bisexual, and other men who have sex with men are generally more at risk for STDs than women and men who have sex with women only. (The majority of new syphilis and gonorrhea cases occurred among men, and in particular, men who have sex with men.) And there’s been some concern about a shift toward riskier sexual behaviors in this group — like not wearing condoms — that may be contributing to the rise in STDs. The reason for this shift has been explained by everything from the success in treating HIV (and therefore making sex less scary) to the advent of PrEP (pills that can prevent HIV).
“These advancements in HIV risk prevention may impact risk behaviors,” Bolan said. HIV and syphilis are interlinked: Some half of men diagnosed with a new syphilis infection also have HIV. And as these diseases spread in particular populations, like men who have sex with men, there’s a greater risk of them moving even further.
“The fear, which I share, is that we won’t contain syphilis among men who have sex with men,” said Matthew Golden, director of the Public Health for the Seattle and King County HIV/STD control program. “And if the epidemic in men who have sex with men gets big enough, which is what is happening, there are enough people who have sex with both men and women that it won’t be possible to contain it.”
2) STDs are spreading more broadly and into populations that weren’t traditionally affected — like babies: The CDC report shows that more women are getting syphilis these days, and they’re passing it to their babies. When an expectant mother is infected with the disease, and goes undiagnosed and untreated, the bacteria can get into her bloodstream and move through her placenta to her baby. Congenital syphilis is associated with serious health consequences, like stillbirths and neonatal deaths.
In 2016, there were 628 cases of congenital syphilis, an increase of 27.6 percent from 2015 — and that number includes 41 related deaths. According to the CDC, much of the rise was driven by increases in cases in the Western US. Between 2012 and 2016, Western states saw an astounding 366 percent rise in congenital syphilis.
The large increase has to do, in part, with the fact that many Western states have recently had few syphilis cases in women. “We were starting from almost nothing [in Washington],” said Golden. But that’s changing, and with more women getting the disease, their babies are at risk too.
3) With the rise of dating apps, sex is more readily available and more anonymous — and that makes it harder for health investigators to track outbreaks: Dating apps like Tinder and Grindr have made sex more readily available — and have also made the job of public health more difficult to do, said John Auerbach, president and CEO of the public health nonprofit the Trust for America’s Health.
Traditionally, when a person is diagnosed with a serious STD, a public health official would call or go and meet with his or her sexual partners to talk about getting tested and on potential treatment. But with more anonymous sexual encounters, it’s becoming harder and harder to track down people’s partners and notify them that they might have an STD. And that means any diseases they could have can spread more easily too.
4) The numbers may be higher because we may be better at detecting cases in some groups: The rise in chlamydia — which overwhelmingly causes no symptoms but can lead to infertility in women — may be an artifact of better detection and screening. The CDC keeps finding that rates of chlamydia are highest among young women, the group that’s been targeted for routine chlamydia screening. So an increase could just mean more testing.
5) Cuts to public health funding mean fewer STD clinics: Public health in the US — which includes operating STD clinics where people can get tested and into treatment — is historically underfunded. (As of 2012, only 3 percent of the health budget went to public health measures; the rest went mostly to personal health care.) And since the global financial crisis, public health funding has really taken a battering. There are 50,000 fewer public health jobs since 2008, and many STD clinics have had to reduce their hours or shut down.
STD clinics were a traditional safety net for people with these diseases, Bolan noted. “Many people with STDs find them stigmatizing, and they’re embarrassed to talk to their [doctors]. STD clinics provided confidential and timely diagnosis and treatment.” If those clinics continue to be harder to reach or vanish, finding and treating STDs will become even more difficult — and the diseases will continue to spread.
So the STD rate increases across the country may have less to do with a changing sexual landscape, and more to do with more limited access to sexual health care. With Trump’s proposed public health budget cuts, the problem may be poised to get worse.
To reverse the trend, health officials called for better awareness campaigns about safer sex and these STDs, and money to keep STD clinics open and accessible. “The resurgence of syphilis, and particularly congenital syphilis, is not an arbitrary event,” Bolan wrote in the preface of the CDC report, “but rather a symptom of a deteriorating public health infrastructure and lack of access to health care.”