This report from the CDC is very troubling, but perhaps not for why most of us would think. This is an old tale. It began with all the fear-mongering WW II posters that warned soldiers concerning the awful venereal disease (VD). Most Americans are quite terrible when trying to talk about sex, and much worse when discussing sexually transmitted diseases (STDs).
In 2013, as one study discovered that 50% of patients who visited Sexually Transmitted Disease (STD) clinics had been unwilling to allow health insurance to pay the cost of these visits—most likely due to privacy concerns, scientists have concluded. During 2016, the US budget for “Abstinence Only Until Marriage” which promotes sex education in public schools—has shown over and over again to be completely ineffective in reducing both sexually transmitted infections and teen pregnancies—was boosted up to $85 million annually. For instance, typical high school health courses comprise of fewer than 4 hours used in discussing pregnancy prevention and Sexually Transmitted Infections (STIs) combined, and that 87 percent permit guardians to keep their children from receiving this coursework.
So it is really not that shocking to hear about how these rates of infections are rising rather than going down. And because of the lack of education as well as discourse regarding these health issues, it just makes sense for Americans to interpret these findings from the CDC’s yearly Sexually Transmitted Disease Surveillance Report as some type of moral decline. However, medical professionals are telling us that it not that these people have been engaging in sex more often, it is actually a problem with the sexual healthcare that is not been satisfactory or even available.
So How Have Infection Rates Changed?
The new 2016 report from the CDC focuses on three infections which medical professionals are by law required to report: chlamydia, syphilis, and gonorrhea. It does not include HIV, which is probably the most notorious STI in the nation. On average, rates of attracted HIV have been on the decline as of the prior data evaluation. This new report from the CDC has not included data which refutes this fact. It should also be noted that herpes has not been included in this 2016 report.
But it is very true—and also very troubling—that gonorrhea, chlamydia, and syphilis have all become more prevalent from the year 2015 to the year 2016. The CDC has reported about 1.6 million instances of chlamydia, 470,000 new incidents of gonorrhea, and approximately 28,000 cases of syphilis.
The chlamydia rates have risen by 4.7 percent and reports of increases virtually in all regions across the country. While gonorrhea rates had dropped to all-time lows in 2009, it has increased by more than 18 percent from the year 2015. And while syphilis hit its a historic low in 2000, it has since increased steadily. There was a 17.6 percent rise from the year 2015 to 2016, these increases were observed in women and men in all regions. Syphilis cases are by far more common in men who choose to have sex with other men, but infection rates in women rose by nearly 36 percent in 2016—more than double the increase seen in men.
How worried should people be about these infections?
The good news is that all three of the aforementioned infections are bacterial, and they’re generally easy to treat. The bad news is that tricky “generally.”
Antibiotic resistance—the evolution of bacteria to evade the drugs we’ve designed to kill them—is on the rise, and the bacteria that cause STIs are no exception. A recent report by the World Health Organization (looking at data from 77 countries) found that gonorrhea is increasingly resistant to antibiotics. The organization called for new antibiotics to add to our line of defense. Unfortunately, they reported that only three such drugs were in any stage of development at the time. As chlamydia becomes more common, it too will no doubt increasingly evade pharmaceutical interventions. Both chlamydia and gonorrhea are often asymptomatic, but can cause pain and infertility if left untreated.
Syphilis is typically still easy to treat with good old penicillin—though again, increased infection rates offer more chances for the bacteria to develop resistance—but it might actually be the most troubling infection in the CDC’s report. That’s because people aren’t getting treated, and that, in turn, is causing a rise in a potentially fatal fetal condition that simply shouldn’t exist in the age of antibiotics.
Congenital syphilis is a terrible disease. When syphilis goes untreated during pregnancy, miscarriages are incredibly common. And 40 percent of fetuses with syphilis that are carried to term are stillborn or die shortly after birth. Those who survive can suffer from deformed bones, anemia, enlarged livers and spleens, jaundice, meningitis, rashes, blindness, deafness, and other brain and nerve-related problems. 2016 saw 628 cases of congenital syphilis in the U.S., up from 492 in 2015.
The sharp increase in this particular condition gets at the crux of the whole issue: it’s not just that more people are getting STIs. It’s that they’re not getting adequate access to healthcare.
“This is a completely preventable problem,” Gail Bolan, director of CDC’s Division of STD Prevention, told CNN. “Every baby born with syphilis represents a tragic public health system failure. All it takes is a simple STD test and antibiotic treatment to prevent this tragedy from occurring.”
Why are rates going up?
A recent study actually found that teens are waiting longer to have sexual intercourse, and are more likely to use contraception. This is slightly misleading, since an increase in oral sex—and a lack of thorough sex-ed to teach young people that protection is also needed during these sort of encounters—could help STIs keep spreading. But still, doctors don’t think individual behaviors are to blame for these upticks.
“People working in this area have known for several years that decreases in resources committed to STD prevention would ultimately result in increases such as we’ve seen,” says J. Dennis Fortenberry, a professor of pediatrics at Indiana State University School of Medicine. Fortenberry serves on the American Sexual Health Association’s board of directors, and is also the president of the American Sexually Transmitted Diseases Association. He and other clinicians say that funding cutbacks for both prevention education and healthcare are to blame.
“We have passed a threshold of minimal investment and are seeing the predictable consequences,” he says.
Funding issues aside, he says, it’s important to remember that STIs are disproportionately more common in young and marginalized people. “STI are consequences of far more than individual behaviors, and are products of our society’s continued inattention to community, to racism, sexual and gender discrimination, and tolerance of violence,” he says. Without a broad commitment to sexual health as a public health priority, these rates will keep going up.
“We can’t address STI epidemics by pretending they are simply a matter of individual choice,” Fortenberry says.
What can I do about it?
Supporting policies that give everyone access to reliable medical care—and comprehensive sex education, early and often—is a great start.
If you’re worried about your own personal sexual health, well, that’s easier: get tested. Often. Get tested more than you think you need to get tested, and educate yourself about the actual risk factors for sexually transmitted infections. If you swear you’d never, ever have sex with someone with herpes, but haven’t asked for an STI panel at the doctor in over a year? You haven’t educated yourself. If you blanch at ads for drugs that allow HIV-positive people to stop using condoms with their HIV-negative partners but engage in oral sex without condoms or dental dams? Ditto. We need less stigma and more efforts to actually improve our health.
“Unfortunately, STDs carry enormous stigma in this country, and it’s hard for people to come forward for treatment,” David Harvey, executive director of the National Coalition of STD Directors, told CNN. “Ironically, HIV is an STD, but we have a very visible community who advocates and works to tell stories about the impact of HIV on people’s lives. We don’t have that going for us with gonorrhea, syphilis and chlamydia. We need a network of voices that say it’s OK to get help.”
Given that so many medical practitioners are less informed about STIs than they should be, the onus often falls on patients to ask for testing. Don’t assume your annual physical has you covered, and don’t be embarrassed about what your test results might show. Knowing your status is always, always better than blissful ignorance.
