Rates of sexually transmitted infections (STIs), such as syphilis, have increased in recent years in the United States. But why are STI rates rising now and what can be done to reverse this trend?
The reduced public health focus on sexual health has been a big factor in rising STI rates, experts told Live Science.
“Rising opioid use, COVID-19 and the mpox the epidemic has exacerbated the lack of funding and resources in sexual health care, creating a perfect storm that has driven cases up in recent years,” Casey Pinto (opens in a new tab)associate professor of public health sciences at the PennState Cancer Institute, told Live Science.
Changes in sexual behavior, such as decreased condom use and increased risky sexual behavior due to opioid use, likely also play a role, experts told Live Science.
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Why are STI rates increasing?
THE US Centers for Disease Control and Prevention (opens in a new tab) (CDC) tracks the national rate of gonorrhea, chlamydia, and syphilis infections. Rates of these bacterial STIs were already increasing in the six years before the pandemic. During this period, gonorrhea rates increased by an average of about 10% per year, chlamydia rates increased by an average of 3.6% per year, and syphilis rates increased by an average of 14% per year. year.
In 2021, during the pandemic, gonorrhea and chlamydia rates continued to rise, up about 2.5% from 2020, according to the latest CDC data. Both diseases can make sex painful and lead to infertility, while gonorrhea can also lead to yellow-green secretions from the genitals.
Syphilis case rates rose more sharply over the same period, reaching their highest rate in three decades – a 27% increase from 2020. Syphilis can cause genital ulcers and rashes on the hands and feet.
The surge in syphilis infections is of particular concern as it is linked to increased rates of congenital syphilis, where bacteria cross the placenta during pregnancy, potentially causing bone deformities, nerve problems and, in some cases, miscarriage, stillbirth or death of the newborn. Congenital syphilis infection rates have roughly tripled from 2017 to 2021, according to CDC data.
“In the early 2000s, we were on the verge of eradicating syphilis here in the United States, so it’s kind of terrifying to see how syphilis has returned, heartbreaking and roaring in our communities,” Dr Joseph Cherabie (opens in a new tab)assistant professor of medicine and medical director of the St. Louis County Sexual Health Clinic, Live Science told Live Science.
The real picture may be even worse as ‘cases have been under-reported’, especially amid pandemic-related disruptions that have caused widespread closures of sexual health clinics and diverted staff from STI tracking to surveillance of COVID-19, Cherabie said. These disruptions, along with those caused by last year’s mpox outbreak, likely increased STI rates because more people were having sex while unknowingly infected, Cherabie said.
The growing opioid epidemic is one of the factors behind the rising rates of STIs, according to many scientists. Use of opioids, including prescription pain relievers and street drugs such as heroin and fentanyl, reaching new heights amid the pandemic (opens in a new tab) and has been linked to risky sexual behaviors that increase the risk of spreading STIs, such as not using a condom and having many sexual partners, Cherabie said.
Moreover, the high levels of opioid use (opens in a new tab) seen in Native American and Alaska Native (AI/AN) communities may help explain their increasing HIV rates seen in recent years, Cherabie said.
After declining for some time, rates of new HIV diagnoses among RN/NA individuals began to rise again between 2018 and 2021, CDC data (opens in a new tab) suggest. This could theoretically be linked to opioid use, as sharing needles can increase the risk of contracting HIV, which is also spread through sexual contact, Cherabie said. In addition, drugs that significantly reduce the risk of contracting HIV, called pre-exposure prophylaxis (PrEP), are less readily available in these communities, compared to groups with declining HIV rates, he said. declared.
Another driver of soaring STI rates is the decline in condom use, Dr.Jodie Dionne (opens in a new tab)an assistant professor of infectious diseases at the University of Alabama at Birmingham told Live Science.
“Several studies show a fairly consistent decrease in condom use,” which acts as a physical barrier against the transfer of STIs, Dionne said. A study of condom use among more than 29,000 U.S. female residents aged 15-44 found that 3% fewer people said they used a condom the last time they had vaginal sex (opens in a new tab) between 2017 and 2019, compared to rates reported a decade earlier.
Condoms are particularly losing popularity among those taking PrEP, Cherabie added. A recent study revealed that between 2012 and 2017, condomless sex rates have increased (opens in a new tab) in men who have sex with men, and other research suggests that this change in behavior may be partially linked to increased use of PrEP (opens in a new tab)which protects against HIV but not against other STIs.
“We need to make sure these people are aware that they can get other STIs besides HIV, and that they should get tested every three to six months if they have new sexual partners,” Cherabie said.
How to reduce STI rates?
So what measures can reverse this trend?
One strategy is to increase STI screening. Strengthening testing efforts for STIs, as well as congenital syphilis, through increased funding could help reverse rising infection rates, Cherabie said. Sexual health care has been underfunded for decades, he said.
A “tremendous opportunity” to increase testing is through home testing kits, Dionne said. “One useful thing we have learned during the COVID-19 pandemic is how easily people can self-swab at home when high-quality test kits are available. We can and should expand this capacity to ‘self-testing to include self-testing for chlamydia and gonorrhea outside the clinic,’ Dionne said. blood test, she noted.
Ongoing trials are exploring the feasibility of government-funded test kits for chlamydia, gonorrhea and HIV, which can each cost between about $80 and $300. “In trials in Jefferson County, Alabama, we found that many people ordering free STI self-test kits have rarely or never been screened for STIs in the past,” said said Dionne. Home testing could be a worthwhile investment if it reaches historically stigmatized groups who face a disproportionate risk of STIs, she said.
Using less stigmatizing language to educate vulnerable groups about STIs could also encourage people to get tested, which could lower infection rates, Cherabie said. However, it’s unclear whether this will actually impact the results – researchers have a “very limited understanding” of whether changing levels of stigma have contributed to the recent increase in STI rates, said Dione.
Scientists first wondered if STI rates were increasing due to the emergence of antibiotic resistance among pathogens. But so far, that doesn’t appear to be the case, Dionne said. Still, antimicrobial resistant strains are “something we want to watch out for, because with increasing antimicrobial resistance we are less likely to clear the infection,” Cherabie said.
As the burden of STIs mounts, the CDC announced funding for a new STI research consortium (opens in a new tab) aiming to reverse current trends on February 27, 2023. This could be a first step in slowing or reversing rising STI rates.