STI rates rise for sixth consecutive year
Annual cases of sexually transmitted infections (STIs) in the United States jumped for the sixth consecutive year in 2019, according to a new CDC report which highlights an increase in syphilis and increasing rates of syphilis, chlamydia and gonorrhea in men, especially men who have sex with men (MSM).
The report says nothing about STI rates during the COVID-19 pandemic, when screening and surveillance for casual sex and illness declined dramatically, at least in the early months. But epidemiologist Patricia Kissinger, PhD, MPH, from the Faculty of Public Health and Tropical Medicine at Tulane University in New Orleans, said Medscape Medical News that the results reflect how “a confluence of factors” drove rates up before the age of COVID. These factors include online dating, the opioid epidemic, the decline in condom use in the MSM community, HIV has become more avoidable, and indifference among policy makers and the community at large.
The CDC report, based on data from local health departments, says there were 129,813 cases of syphilis in 2019, up 74% since 2015. Almost 2,000 cases of congenital syphilis have been reported, up 279% since 2015, and 128 infants have died.
“There is no reason for us to have congenital syphilis,” said Kissinger, who noted that the disease can cause birth defects and meningitis in addition to death. “Women should be screened, and it is relatively easy to treat with penicillin injections.”
Indeed, medical guidelines suggest that pregnant women should be routinely tested for syphilis. But that doesn’t always happen because “it goes through the cracks,” Kissinger said. Or, she says, women might not be tested enough times during their pregnancy: “You have to screen women in the third trimester. You can’t just do it in the first trimester because people have sex during their pregnancy. pregnancy.”
The growing number of congenital syphilis has convinced at least one healthcare system to take action. Starting June 1, the University of California, San Diego will regularly test pregnant women for syphilis in the emergency department in addition to HIV and hepatitis VS, Martin Hoenigl, MD, an infectious disease specialist at UCSF, said Medscape Medical News.
The CDC report also notes 1.8 million cases of chlamydia in 2019, a 19% jump in 4 years and a 56% increase in gonorrhea during that period, for a total of 616,392 cases.
The report says the increase in cases of gonorrhea and chlamydia in men, especially MSM, could be due to increased testing / screening, increased transmission, or both. Although women are generally diagnosed with chlamydia more often than men, according to the report, the number of men increased by 32% from 2015 to 2019. And since 2013, gonorrhea rates in men have increased to a much faster rate than in women.
MSM accounted for the majority of male cases of primary and secondary syphilis in 2019, although the report says the apparent long-term increase in these cases may slow.
Many MSM no longer use condoms because they use pre-exposure prophylaxis (PrEP) or have undetectable levels of HIV due to treatment, said Jeffrey Klausner, MD, MPH, an STI specialist at the Keck School of Medicine at the University of Southern California, Los Angeles, in an interview with Medscape Medical News.
Many MSM may be screened for STIs much more often than in the past because frequent testing is needed for people on PrEP. However, Tulane’s Kissinger said some clinics were unable to perform testing at times during the pandemic due to a shortage of tampons. In addition, patients of all types have avoided routine medical care during the pandemic, and some medical professionals in the infectious disease field have been referred to COVID care.
Clinical trials have investigated a possible preventive strategy against STIs in MSM who do not wear a condom – prophylaxis, before or after exposure, with the antibiotic doxycycline. “It’s a very good solution,” Klausner said, but he believes greater challenges remain. According to him, the existence of the report itself – which offers statistics from 2 years ago instead of more relevant recent figures – proves that the federal government is not doing enough to fight STIs. “If we take the STD epidemic seriously, there should be regular and timely reporting.” Klausner said he liked the idea of monthly reports, as well as more funding for prevention.
Instead, he noted, the federal government reduce funding for STI prevention by 40% in inflation-adjusted dollars from 2002/03 to 2018/19, according to the National Coalition of STD Directors. “Burying your head in the sand and hoping the problem goes away is not an effective strategy,” he said.
It is not clear whether STI rates are falling due to pandemic restrictions and stay-at-home orders. Surveys suggest that a decline in casual sex early in the pandemic – when most of society shut down – was only temporary, Klausner said.
Kissinger did not disclose any relevant financial relationship. Hoenigl reports research funding via its university of Gilead . Klausner recently provided consulting services to Danaher, Cepheid, Roche, GSK, Talis Bio, SpeeDx and Visby Medical, all manufacturers of diagnostic tests for STIs.