The “out of control” STD situation calls for change

NEW YORK – Sharp increases in cases of some sexually transmitted diseases, including a 26 percent increase in new syphilis infections reported last year, are prompting U.S. health officials to call for new prevention and treatment efforts.

“It is imperative that we … work to rebuild, innovate and expand STD prevention in the United States,” Dr. Leandro Mena of the US Centers for Disease Control and Prevention said in a speech Monday at a medical conference about sexuality transmitted diseases

Infection rates for some STDs, including gonorrhea and syphilis, have been rising for years. Last year the rate of syphilis cases reached its highest level since 1991 and the total number of cases reached its highest level since 1948. HIV cases are also on the rise, up 16% last year .

And an international outbreak of monkeypox, which is spreading primarily among men who have sex with men, has further highlighted the nation’s worsening problem with diseases that are primarily transmitted through sex.

David Harvey, executive director of the National Coalition of STD Directors, called the situation “out of control.”

Officials are working on new approaches to the problem, such as at-home testing kits for some STDs that will make it easier for people to learn they are infected and take steps to prevent spreading to others, Mena said.

Another expert said a key part of any effort should be working to increase condom use.

“It’s pretty simple. More sexually transmitted infections occur when people have more unprotected sex,” said Dr. Mike Saag, an infectious disease expert at the University of Alabama at Birmingham.

Syphilis is a bacterial disease that appears as genital sores but can ultimately lead to severe symptoms and death if left untreated.

New syphilis infections plummeted in the US starting in the 1940s when antibiotics became widely available. They fell to their lowest level in 1998, when fewer than 7,000 new cases were reported nationwide. The CDC was so encouraged by the progress that it launched a plan to eliminate syphilis in the US

But in 2002 cases began to rise again, especially among gay and bisexual men, and have continued. In late 2013, CDC ended its eradication campaign in the face of limited funding and escalating cases, which that year exceeded 17,000.

By 2020 the cases had reached nearly 41,700 and last year they increased even more to more than 52,000.

The rate of cases has also been rising, reaching about 16 per 100,000 people last year. It is the highest in three decades.

Rates are higher among men who have sex with men, and among black and Hispanic Americans and Native Americans. While the rate for women is lower than for men, officials noted that it has increased more dramatically, by 50 percent in the past year.

This is linked to another problem: the rise of congenital syphilis, in which infected mothers pass the virus to their babies, which can lead to the death of the child or health problems such as deafness and blindness. A decade ago only about 300 annual cases of congenital syphilis; they rose to nearly 2,700 last year. Of last year’s total, 211 were deaths or child deaths, Mena said.

Experts say increases in syphilis and other STDs may have several causes. Testing and prevention efforts have been hampered by years of inadequate funding, and the spread may have worsened, especially during the pandemic, as a result of delays in diagnosis and treatment. Drug and alcohol use may have contributed to risky sexual behavior. Condom use has been decreasing.

And there may have been an increase in sexual activity as people emerged from COVID-19 lockdowns. “People feel liberated,” Saag said.

The arrival of monkey pox added a huge additional burden. The CDC recently sent a letter to state and local health departments saying that its resources on HIV and STDs could be used to combat the monkeypox outbreak. But some experts say the government needs to provide more funding for STD work, not divert it.

Harvey’s group and some other public health organizations are pushing a proposal for more federal funding, including at least $500 million for STD clinics.

Mena, who last year became director of the CDC’s Division of STD Prevention, called for reducing stigma, expanding screening and treatment services, and supporting the development and accessibility of testing in house “I envision a day where getting tested (for STDs) can be as simple and as affordable as taking a home pregnancy test,” she said.

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