Illustration by Dave van Patten

Why Are STDs Spiking?

The CDC points to stigma, drug resistance and our crumbling health care system.

Although HIV rates in America have been in decline for the past decade, treatable STDs have been on the rise for the past two years. A record high number of gonorrhea, chlamydia and syphilis cases were reported last year, according to a report authored by the Centers for Disease Control and Prevention. Cases of syphilis rose 19 percent, the largest increase of the three. Instances of gonorrhea and chlamydia are rising too, but less sharply—12.8 percent and 5.9 percent, respectively. According to the CDC, a major culprit for the sharp rise in STDs is the erosion of public programs used to treat and educate the public about sexual infections.

Over half of the new chlamydia and gonorrhea cases were in people under 25. Also on the rise was the spread of congenital syphilis, i.e., that which is passed from mother to child at birth. Syphilis, if untreated, can result in internal organ failure, dementia, blindness and miscarriage.

Men who have sex with men (MSM) made up 82 percent of new gonorrhea and syphilis cases. Although women still only make up 10 percent of new syphilis cases, their rate of diagnosis increased by more that 27 percent.

The CDC lists “difficulty accessing quality health care” as a potential reason MSM make up the largest group of new syphilis infections. “[G]ay and bisexual men who live in poverty may have trouble accessing and affording quality health care, making it difficult to receive STD testing and other prevention services,” they write. “Additionally, complex issues like homophobia and stigma can also make it difficult for gay and bisexual men to find culturally sensitive and appropriate care and treatment.” That’s why, according to Eloisa Llata, a medical epidemiologist with the CDC, federal and state programs need “to direct resources to people hardest-hit by the STD epidemic and work with community and healthcare partners to maximize their impact.”

Many sociological factors could be affecting rates of STD infection, including new HIV-preventive drugs. But the CDC lays the blame on budget cuts. According to their data, more than half of state and local STD programs have had their budgets cut, forcing many clinics to close. As the support structures for treating STD outbreaks erode, transparency and personal accountability become more important. “Everyone should learn to talk more openly about STDs, get tested regularly, and reduce their risk by using condoms or practicing mutual monogamy if they are sexually active,” Llata says. She recommends that people routinize STD testing as “a standard part of medical care.” More cases will be caught and treated if doctors “integrate STD prevention and treatment into prenatal care and other routine visits,” she says.

Another troubling statistic in the 2015 STD report was the rise in cases of antibiotic-resistant gonorrhea. “Over the years, gonorrhea has developed resistance to nearly every class of antibiotics,” Llata says. The current treatment for the disease is a combination of ceftriaxone and azithromycin. But this year, the US saw its first cases of gonorrhea that were resistant to the two drugs. “While all the patients linked to the cluster of gonorrhea that showed decreased drug susceptibility were successfully treated, if resistance continues to increase and spread, our current treatment will ultimately fail,” Llata says. If untreated, gonorrhea can lead to infertility, pelvic inflammatory disease and ectopic pregnancy.

The 2015 STD Surveillance Report collects data from different sources across the country. It is an aggregate of data reported from state and local clinics, national surveys, and programs that track STD data like the National Job Training Program and the Gonococcal Isolate Surveillance Project. The CDC gathers all the data it can, but some information is still slipping through the cracks. “[D]ata on several additional STDs — such as human papillomavirus, herpes simplex virus, and trichomoniasis — are not routinely reported to CDC,” reads a CDC fact sheet. “As a result, the annual surveillance report captures only a fraction of the true burden of STDs in America.” HIV rates are tracked in a separate surveillance report. The data for 2015 have yet to be released, but in 2014 there were 44,073 new HIV diagnoses.

“We have reached a decisive moment for the nation. STD rates are rising, and many of the country’s systems for preventing STDs have eroded,” said Dr. Jonathan Mermin in a statement released by the CDC. “ We must mobilize, rebuild and expand services — or the human and economic burden will continue to grow.”