CDC: 3 STDs Reach All-Time High in the U.S. as Cases Increase for 5th Consecutive Year

[Leroy N. Soetoro]

https://ktla.com/2019/10/08/cdc-3-stds-reach-all-time-high-in-the-u-s-as-
cases-increase-for-5th-consecutive-year/

Health officials are raising alarm about a rise in STDs across the United
States.

For the fifth consecutive year, combined cases of gonorrhea, chlamydia and
syphilis have risen in the United States, according to a Sexually
Transmitted Disease Surveillance Report from the US Centers for Disease
Control and Prevention published on Tuesday.

“Combined they total 2.4 million infections that were diagnosed and
reported just in last year alone,” said Elizabeth Torrone, a CDC
epidemiologist who worked on the new report, adding that the combined
number marks “the most cases” ever recorded since monitoring began in the
United States.

A rise in the prevalence and incidence of STDs can come with serious
public health consequences and concerns, including infertility, drug-
resistant gonorrhea and congenital syphilis, which can cause infant death.

“Yet not that long ago, gonorrhea rates were at historic lows, syphilis
was close to elimination, and we were able to point to advances in STD
prevention,” Dr. Gail Bolan, director of the CDC’s Division of STD
Prevention, wrote in the new report’s foreword.

“That progress has since unraveled. The number of reported syphilis cases
is climbing after being largely on the decline since 1941, and gonorrhea
rates are now increasing.

“Many young women continue to have undiagnosed chlamydial infections,
putting them at risk for infertility.”

Possible factors driving this rise in STD cases, which vary depending on
where you live, include a surge in people getting tested and cases being
diagnosed and reported. There’s also a decline in people using condoms.

The new report found that rates of reported cases tended to be highest
among adolescents and young adults.

The new CDC report calls for federal, state and local agencies to employ
strategies that reduce STD incidence and help to improve sexual,
reproductive, maternal and infant health.

“STDs cause a significant burden to the health care system — both in terms
of direct medical costs for treating STDs as well as the personal cost for
people who have an STD,” Torrone said. “As the STD epidemic continues to
grow in the United States, the direct medical costs and the quality of
life lost will just increase as well.”

Where cases are highest and lowest
Four STDs are monitored nationwide and nationally notifiable to the CDC:
chlamydia, gonorrhea, syphilis and chancroid.

The states with the highest rates of cases were:

Alaska for chlamydia
Mississippi for gonorrhea
Nevada for primary and secondary syphilis
For each of those three diseases, rates in the District of Columbia were
higher than all states.

“We’ve seen increases like the nation as a whole has seen increases. We’ve
seen some recently bigger jumps and there’s a number of factors to which
we attribute that,” said Michael Kharfen, senior deputy director of the
HIV/AIDS, Hepatitis, STD and TB Administration at the DC Department of
Health, who was not involved in the new CDC report.

One factor includes that testing services have been more easily
accessible, which likely led to a large prevalence of cases being
identified, Kharfen said. The DC Department of Health is continuing to
invest in screening and testing efforts.

“We have been very aggressive in making STD screening available in lots of
different both clinical and community settings, particularly among young
people, who have a disproportionate number,” he said.

The new report, which analyzed STD data for the year 2018, found that a
total of about 1.8 million cases of chlamydia infection were reported to
the CDC last year, making it the most common notifiable condition in the
United States.

Last year, rates of chlamydia cases by state ranged from 198.2 cases per
100,000 people in West Virginia to 832.5 cases per 100,000 people in
Alaska, according to the new report. The rate for the District of Columbia
was 1,298.9 cases per 100,000, the report found.

The report also found that a nationwide total of 583,405 cases of
gonorrhea were reported to the CDC last year, making it the second most
common notifiable condition in the United States.

Rates of reported gonorrhea climbed 82.6% since a historic low in 2009,
the report found.

In 2018, rates of reported gonorrhea cases by states ranged from 43 cases
per 100,000 people in Vermont to 326.7 per 100,000 in Mississippi,
according to the report.

The gonorrhea rate in Washington, DC, was 611 cases per 100,000 people,
the report found.

The report also found that 115,045 cases of syphilis nationwide were
reported to the CDC last year. In 2018, states’ rates of reported primary
and secondary syphilis cases ranged from 1.8 per 100,000 people in Vermont
to 22.7 per 100,000 in Nevada. The rate of reported primary and secondary
syphilis cases in DC was 40.2 cases per 100,000.

Among other STDs included in the report, there has been overall declines
in reported chancroid cases, in the prevalence of herpes simplex virus
infections and in the prevalence of the human papillomavirus or HPV-
related complications such as genital warts, which may be due to having
access to a HPV vaccine, according to the report.

‘The most tragic consequences of this growing epidemic’
There has been a concerning rise in congenital syphilis cases, increasing
each year since 2013, according to the report. Congenital syphilis is a
severe, disabling and often life-threatening infection that occurs in
infants when a pregnant mother who has syphilis spreads the disease
through the placenta to her baby.

“One of the things that really stands out in this new report is the new
and updated data on congenital syphilis, which is one of the most tragic
consequences of this growing epidemic,” Torrone said.

The STD surveillance report for the year 2017 found that cases of
congenital syphilis have more than doubled since 2013. The new report
found that last year there were 1,306 cases of congenital syphilis among
newborns reported to the CDC.

“Most concerning in that overall case count — there were 94 infant deaths
related to congenital syphilis,” Torrone said.

“All of those cases could have been prevented if pregnant women had been
treated appropriately and in a timely way prior to delivery,” she said.
“We really need to make sure that all pregnant women are screened at their
first prenatal care visit, treated appropriately and that their partners
are treated so that we prevent reinfection.”

‘We have a real threat with drug resistance’
As the United States sees these steep increases in STDs, there also has
been a slow decline in treatment options for one infection in particular:
gonorrhea.

The threat of antibiotic-resistant gonorrhea persists across the United
States and around the world. There have been a growing number of gonorrhea
cases that are resistant to some of the antibiotics used to treat the
infection.

Last year in the United Kingdom, a man was infected with a multidrug-
resistant form of gonorrhea that was resistant to first-line treatment, a
combination of the antibiotics azithromycin and ceftriaxone, according to
Public Health England. The man had to be treated intravenously with the
antibiotic ertapenem.

“With gonorrhea in particular, we have a real threat with drug
resistance,” said Dr. Mark Mulligan, chief of infectious diseases at NYU
Langone Health in New York and director of the NYU Langone Vaccine Center,
who was not involved in the new CDC report.

“For most gonorrhea, we’re down to a single drug and if we lose that it
could potentially become untreatable,” he said. “One need is to develop
new antimicrobials for resistant organisms like gonorrhea. Another need or
another strategy to combat the much broader problem of antimicrobial
resistance is using vaccines to try to prevent the infections and
therefore reduce the impact of drug resistance.”

Why STDs are on the rise
The report had some limitations, including that the data only included STD
cases that had been reported to the CDC.

“In order for a case to be represented in the report, the infection
actually needs to be diagnosed and reported,” CDC’s Torrone said.

“We know that there are many more infections that occur that just are not
getting diagnosed and treated,” she said. “The intervention that we need
is really to be able to increase access to routine screening as well as
quality prevention.”

While the report documents the burden of these infections in the United
States, it doesn’t pinpoint why rates are increasing — but Torrone had
some ideas.

“I think it’s important to remember that part of the increase in cases is
because we’re actually doing a good job getting people screened,” Torrone
said, but the “steep and sustained increases” in cases are unlikely
explained by just increased screening alone.

“Some of that increase in incidence may be due to change in sexual
behaviors,” she said, such as decreases in people using condoms.

For instance, results from the 2017 Youth Risk Behavior Surveillance,
published last year by the CDC, found that among sexually active high
school students, the prevalence of using a condom during a recent sexual
experience increased from 46.2% to 62.8% between 1991 and 2005 but then
decreased from 62.8% to 53.8% between 2005 and 2017.

Condom use among men who have sex with men has also decreased, past
research found.

Socioeconomic factors also can influence whether someone gets tested and
treated in a timely manner.

The National Coalition of STD Directors said in a statement on Tuesday
that “steep increases in STDs are largely due to federal, state, and local
funding cutbacks.”

In 2012, for instance, 52% of state and local STD programs experienced
budget cuts, amounting to reductions in clinic hours, contact tracing and
screening for common STDs, according to the CDC.

“We have an STD crisis in the US because prevention programs were sold
short for years,” David Harvey, executive director of the National
Coalition of STD Directors, said in the statement.

“Our first line of defense is underfunded and overwhelmed, leaving
Americans vulnerable to STD outbreaks, and that’s exactly what we’re
seeing,” he said. “STDs have real health and human costs. Babies dying
from preventable conditions, like congenital syphilis, is not an outcome
we can accept. This is a heartbreaking symptom of our nation’s STD crisis.
Without a radical shift in how we prioritize sexual health in the United
States, we can only expect things to get worse.”

The coalition — as part of the Partnership to End the HIV, STD, and
Hepatitis Epidemics — called for Congress to increase funding for CDC’s
STD prevention services by $70 million. The coalition also called for the
US Department of Health and Human Services to ensure that its Federal
Action Plan on sexually transmitted infections, announced earlier this
year, is finalized and implemented urgently.

The proposed release for the STI Federal Action Plan is 2020.

‘Urgent need’ for new approaches to sexual health
Overall the findings in the new CDC report came as no surprise to NYU
Langone’s Mulligan.

“The reason it’s not a surprise is we’ve been seeing things moving in this
direction for a few years and have known that this has been a challenging
area where we have problems with diagnosis, problems with drug resistance
in treatment, decay or erosion in our public health infrastructure,” he
said, adding that there are possible solutions.

“In order to get this turned around again and get back to the much lower
levels we had several years ago, it will be important to reinvest in the
infrastructure that can enable those improvements.

“Another approach to turn this around is in fact prevention — and for many
infectious diseases, vaccines have been the most important public health
intervention to allow dramatic reductions in infection rates,” he said.
“We don’t have a vaccine for syphilis, for gonorrhea, for chlamydia.
Investment in vaccine development is another approach to help us get
control of sexually transmitted diseases.”

The new CDC report found that rates of reported gonorrhea cases last year
were highest among teens and young adults, as were reported cases of
chlamydia. For primary and secondary syphilis, cases were highest among
adults ages 25 to 29.

It’s estimated that young people ages 15 to 24 acquire half of all new STD
cases and 1 in 4 sexually active adolescent girls has an STD, according to
the report.

“It’s alarming how they’re concentrated among young people, and to me it
really speaks to the need for us to up our game in educating young people
on not only the basics of sex education but sexuality education and
relationship education too,” said Rob Stephenson, a professor and director
of the Center for Sexuality and Health Disparities at the University of
Michigan in Ann Arbor, who was not involved in the new CDC report.

“I think it also speaks to the quite urgent need for us to be a little bit
more inventive in how we meet people where they are in STI testing,”
Stephenson said.

“We should also think about new frontiers in STI testing. It’s now
possible to test people in their own home, with self-collection kits and
provide them with counseling via telehealth,” he said. “We just need to
move away from traditional clinical models and be a bit more creative with
how we reach young people.”



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