The Centers for Disease Control and Prevention’s (CDC) 2016 Sexually Transmitted Diseases Surveillance report, released last week, revealed that rates of sexually transmitted diseases (STDs) are rising across the United States. The rise in these preventable and treatable diseases has coincided with the slashing of funding for public health programs and clinics which provide accessible testing and treatments.
Notably, the report points to the social roots of the crisis and the entirely preventable rise in infections: “STD public health programs are increasingly facing challenges and barriers in achieving their mission. In 2012, 52% of state and local STD programs experienced budget cuts. This amounts to reductions in clinic hours, contact tracing, and screening for common STDs. CDC estimates that 21 local health department STD clinics closed that year.” The annual estimated cost of treating STDs in the US was nearly $16 billion dollars last year.
The report found an increase in a host of common STDs including gonorrhea and chlamydia as well as the now less common syphilis, a disease which was at record low rates of infection at the beginning of the century
New cases of syphilis increased by 27,814, or a 17.6 percent increase from 2015. Reported cases of gonorrhea increased by 468,514, or 18.5 percent. There were also 1.59 million new cases of chlamydia reported, representing an increase of 4.7 percent.
Altogether, from 2015 to 2016, new cases reported for the three diseases were over 2 million, a new record according to the CDC. All three diseases are treatable with antibiotics, but if they are not diagnosed early can lead to multiple health problems, including stillbirth in infants, infertility, and an increased risk of HIV infection.
Young people between the ages of 15-24 make up over half of new cases of STDs. In the period between 2012 and 2016 rates of chlamydia and gonorrhea infections amongst males in this age group increased by 14 percent and 29.9 percent respectively, while decreasing only slightly for females. During the same time period, syphilis infections increased by 54.2 percent for males and 64.5 percent for females.
There are an estimated twenty million new cases of STDs in the US reported each year, and a total of 110 million cases at any given time. The report notes that certain demographic groups are at particularly high risk of contracting STDs. These include gay and bisexual men, pregnant women and especially young people between the ages of 15-24, who make up approximately half of all new cases each year.
Pregnant women and their children are at especially high risk. In many cases, both gonorrhea and chlamydia are asymptomatic in women, and the lack of treatment can cause Pelvic Inflammatory Disease, which can lead to damage to the reproductive system, including infertility. Other consequences of the lack of treatment of these two diseases can include “stillbirth, low birth weight, and premature rupturing of the membranes.”
The report also takes note of the many secondary health problems caused by STD infection, including “ocular and neurosyphilis, pelvic inflammatory disease, ectopic pregnancy, infertility, HIV, congenital syphilis, and neonatal herpes.”
Rates of chlamydia infection increased across all regions in the US between 2015 and 2016. The highest reported cases of infection are amongst younger women, who are more widely tested. The overall rate of infection is 497.3 per 100,000 people.
Gonorrhea, which saw the largest year over year increase of any of the three STDs, had previously reached a historic low in 2009 of 98.1 per 100,000 people. Since that time, rates of infections have steadily increased. Today that figure is 145.8 per 100,000 people.
The increase in infections has occurred across ethnic lines, with African Americans hit hardest at a rate of 481.2 per 100,000, followed by Native Americans at a rate of 242.9 per 100,000. The rise in gonorrhea is especially troubling due to the fact that the disease has evolved to become resistant to many common antibiotics, such as penicillin and tetracycline. It is now routinely treated with two antibiotics simultaneously.
Syphilis had steadily been in decline for many years and reached a low of 2.1 per 100,000 people in 2000/2001, the lowest rate since testing began in 1941. That figure has increased to 8.7 per 100,000 in 2016. The increase has occurred across every region of the US and across all ethnic groups, with African Americans having the highest rate of infections at 23.3 per 100,000 followed by Hawaiian/Pacific Islanders at 13.9 per 100,000. The infection rate also increased across all age groups, with those between the ages of 20-29 hit the hardest.
The human papillomavirus (HPV) is the most common STD in the US and worldwide. There are more than forty different types of the virus that have been identified, many of them asymptomatic. In fact, a study conducted in 2013-2014 found that 42.5 percent of American adults aged 18-59 years carried some form of HPV.
The majority of diseases caused by HPV are the result of only a few varieties of the virus. As the report notes: “HPV types 16 and 18 accounts for approximately 66 percent of cervical cancers in the United States, and approximately 25 percent of low-grade and 50 percent of high-grade cervical intraepithelial lesions, or dysplasia. HPV types 6 and 11 are responsible for approximately 90% of genital warts.”
Several vaccines have been developed that target the most dangerous strains of HPV, and since the mid-2000s have become more widely used. The CDC has recommended that all children be vaccinated. A national survey in 2015 found that 63 percent of girls age 13-17 had taken at least one dose of the vaccine, with 42 percent having completed the entire series of vaccinations. Amongst boys, the number was lower with just 50 percent of boys in the same age group taking the initial dose and 28 percent completing all recommended doses.