Surge in STI Rates Cause Alarm

By: Ranier Simons, ADAP Blog Guest Contributor

Public health in the United States has been challenged heavily in recent years with the coronavirus, meningococcal disease, and monkeypox virus. Newly released data, from the U.S. Centers for Disease Control & Prevention (CDC), paints a grim picture evidenced by the rates of sexually transmitted infections (STIs) sharply increasing during this time.[1] Personal behavior choices, regarding sexual activity, are one of many factors contributing to unfavorable STI numbers. For example, research is indicating that MSM (men who have sex with men) who are taking PrEP are using condoms less.[2] The protection provided by PrEP against HIV is causing MSM to have a false sense of security even though it does not protect against other STI’s.[3] However, behavior modification is only part of the discourse towards solutions.[4] Issues with insufficient public health funding, persistent social stigma, demonizing politics, and inconsistent policy comprise the scaffolding that undergirds the increased STIs rates.

Photo Source: ACT for Youth

Recent CDC reporting of the preliminary data indicates 2.5 million reported cases of chlamydia, gonorrhea, and syphilis in 2021.[1] The numbers will increase as 2021 numbers continue to be reported in 2022. New cases of chlamydia, gonorrhea, and syphilis all increased. In 2021, syphilis infection rates reached the highest level since 1991 and the total number of cases was the highest since 1948.[5] There was a 26% increase in new syphilis infections from 2020 to 2021 in contrast to a 7% increase from 2019 to 2020.[6] The number of gonorrhea and chlamydia infections increased 4%. HIV cases also increased 16% in 2021 from 2020.[5] Increased numbers of congenital syphilis cases coincided with the increase in overall syphilis infections. Higher congenital syphilis numbers mean more child deaths, deformities, blindness, and stillbirths.[5]

Higher STI numbers indicates increases in sexual activity. Surges in sexual activity can partially be attributed to people becoming more active as covid lockdowns ended and people relaxed their social distancing practices. Data also indicates increased substance abuse during the pandemic has led to more unprotected sex and other less safe sexual practices.[5] 

Prevention and treatment are the best ways to combat STIs. However, existing barriers hamper  efforts. During the pandemic, many people lost their jobs which meant a loss of health insurance. Additionally, many free clinics paused in-person testing and some closed. Funding issues existed even before the pandemic. Elizabeth Finley, Director of Communications for the National Coalition of STI Directors states: “The programs and safety net clinics that provide essential services have long been operating on shoestring budgets and are at a breaking point – a trend accelerated by the devastating impact of COVID-19 and monkeypox…It’s long past time to increase program budgets so that they can respond to the exploding number of infections in their communities and to create a dedicated funding stream for STI clinical services.”

The federal Title X program is an example of a funding challenge. In its most recent spending bill, Congress kept the program funding flat at $286 million dollars instead of increasing it. Many state health departments and independent sexual health clinics are part of the Title X family planning program. Keeping funding flat means that the U.S. Department of Health and Human Services had to shift resources to try and reach the areas of the country with the most need. Thus, many providers in the program, in states with high STI rates, received large budget cuts.[7] Title X providers reach those who fear getting an STI test or treatment at a regular doctor’s office for fear of it showing up on insurance statements; especially youth still on parents’ insurance policies. 

Photo Source: Signature Care

Jen Laws, President and CEO of Community Access National Network, states: “Social stigma associated with sex is an extraordinary contributing factor in both the rise of STIs and the refusal of legislators to appropriately fund treatment and prevention programs. The current socio-political environment is toxic – rhetoric demonizing LGBTQ people and ignoring the educational needs of adolescents only fosters an environment where it's increasingly dangerous for patients to seek the care and advice they need to navigate a healthy sex life.”

The Biden Administration has proposed to increase Title X funding to $400 million for 2023, but that will not help the current situation. Other solutions involve the current infrastructure as well as private industry. Leandro Mena, the CDC’s director of STI prevention, suggests that drug addiction treatment facilities should add STI services, and the private sector needs to develop more effective STI tests, treatments, and vaccines.[7] Home test kits for STI’s would be a worthwhile private sector development effort. Kits will make it easier for people to find out if they have an STI as well as take steps to prevent spread in the same manner that home coronavirus test kits do.

A multi-pronged approach is required to battle surging STI rates. Proper funding is required, private sector interest and innovation is necessary, normalizing sexual health as a part of wholistic healthcare, and increasing education efforts. Even though money is a large part of the equation, a paradigm shift is also key to effective change.

[1] CDC. 2022. Preliminary 2021 STI Surveillance Data. Retrieved from https://www.cdc.gov/STI/statistics/2021/default.htm
[2] Hendrie, D. (2018, June 7). Rapid uptake of PrEP linked to declining condom use. Retrieved from https://www1.racgp.org.au/newsgp/clinical/rapid-uptake-of-prep-linked-to-declining-condom-us
[3] Nelson, R., Nagata, J. Condom Use for Anal Sex in the Era of Pre-exposure Prophylaxis (PrEP). Journal of Adolescent Health. 2022. 71(2). 245. DOI: https://doi.org/10.1016/j.jadohealth.2022.05.014
[4] Samuel, K. (2020, Nov 30). How PrEP users decide whether to use condoms. Retrieved from https://www.aidsmap.com/news/nov-2020/how-prep-users-decide-whether-use-condoms
[5] Stobbe, M. (2022, September 19). Out of control STI situation prompts call for changes. Retrieved from https://apnews.com/article/monkeypox-science-health-covid-epidemics-aaac64591251293f45c225d3fe963d0c?utm_campaign=KHN%3A%20First%20Edition&utm_medium=email&_hsmi=226604169&_hsenc=p2ANqtz-9DxmD1qskNMHydAQMYYJt6z-rEy9GkI1vckbWlm85Rf6g4BgWoG5YdpKYLf4iD7wLXHxxFxmWJ3bIHEHk5BX0HmKU0Ng&utm_content=226604169&utm_source=hs_email
6] Muller, M. (2022, September 19) Syphilis cases in the US Surged 26% last year, along with other STIs. Retrieved from https://www.bloomberg.com/news/articles/2022-09-19/us-sees-sharp-rise-in-some-sexually-transmitted-infections
7] Ollstein, A. (2022, April 12) STIs are surging. The funding to fight them is not. Retrieved from https://www.politico.com/news/2022/04/12/STIs-funding-00024678

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.