Five Figures to Consider
There’s a pink ribbon for breast cancer, red for HIV and purple for opioid addiction. People wear blue for child abuse prevention, orange for multiple sclerosis and green for mental health. But who wears a ribbon for chlamydia, syphilis or gonorrhea? Not me, you snicker. Well, why not? Our unwillingness to talk about these preventable diseases is exacerbating their alarming rise. Last year 20 million new sexually transmitted disease (STD) infections were reported in the U.S. striking sexually active people of all ages. The number of people infected with gonorrhea was 14 times the number infected with HIV, yet who talks about gonorrhea? Since 2013, there has been a 67% increase in gonorrhea infection rates, and experts are worried about its increasing antibiotic resistance. Perhaps we should all be wearing an STD ribbon, one with a condom attached. Twenty million condoms could end the STD epidemic.
According to the Centers for Disease Control and Prevention (CDC), 25% of sexually active adolescent females has an STD. Although half of new STD cases occur in people ages 15 to 24, infections are rising among seniors, too. Between 2013 and 2017, there was a 23% increase in the number of STD infections among people over age 60. (This population also has the lowest rate of condom use.) Blacks and Hispanics of all ages suffer disproportionately. In 2017 the rates of infection from chlamydia, syphilis and gonorrhea among black women were five to eight times that of white women, a phenomenon driven by higher rates of poverty and other barriers to healthcare. The health effects of untreated STDs include pelvic inflammatory disease, ectopic pregnancy, infertility, stillbirths in infants, increased cancer and HIV risk and even death. The annual cost of treating STDs in the U.S. is estimated at $16 billion.
In spite of these alarming statistics, federal funding to combat STDs is not even keeping up with inflation. Since 2003, there has been a 40% drop in inflation-adjusted dollars earmarked for the CDC’s STD prevention programs. Making matters worse are proposed changes to federal healthcare programs in the name of abortion prevention and immigration security. The Trump Administration has put forward changes to Title X (see our report, Remaking Federal Family Planning Policy) that would force the closure of clinics operated by Planned Parenthood, which serves 41% of Title X patients and provided 4.4 million STD tests and treatment to clients in 2017. The Administration has also proposed penalizing legal immigrants for using Medicaid, a threat that experts fear would undermine public health. The Kaiser Family Foundation estimated that 2.1 million to 4.9 million Medicaid and CHIP beneficiaries would dis-enroll due to fear of family members losing legal status in the U.S. One result of both of these policy changes would likely be fewer doctor’s visits, which could contribute to another annual rise in STD infection rates.
STD public awareness campaigns are paramount to controlling their spread. Why? Two reasons. First, like Typhoid Mary, many STD carriers are symptom-free. They don’t feel sick, yet they spread disease. The only way to be certain that you don’t carry an STD is to get tested. In fact, the CDC recommends annual tests for everyone between ages 13 and 64 and more frequent testing for men who have sex with men. (Though given reports of increasing STD infection rates in nursing homes, this age cap might need to be reconsidered.) Second, effective condom use can prevent the spread of STDs. Like sneezing into the crook of your elbow, sex with a condom should be second nature for anyone outside of a monogamous, STD-tested relationship. Unfortunately, condom use among teens may be dropping. According to a 2018 study by the Guttmacher Institute, almost half of high school students did not use a condom at their last sexual intercourse. (More than half of teens have had sex by 12th grade.) Regional public health officials are sounding the alarm. Last month the National Coalition of STD Directors issued an extensive report identifying an “urgent need for a national STD strategy” and a commitment to execute it.
In addition to four successive years of rising STD infection rates, the threat of increasing antibiotic resistance of gonorrhea, which infected 550,608 people in the U.S in 2017 (compared with 38,739 for HIV), is concerning to public health officials. The Neisseria gonorrhoeae bacterium has progressively developed resistance to each of the antibiotics used to treat it, and guidelines now require treatment with both an injection of ceftriaxone and oral administration of azithromycin. The current two-step treatment makes it less likely that patients will properly complete their treatment and more difficult for medication to be administered to sexual partners. (In the past, patients were often allowed to take home antibiotics for partners, but now partners must come in for an injection.)
While laboratory experiments indicate that the gonorrhea superbug will soon overcome ceftriaxone, there is hopeful research from Entasis Therapeutics, whose novel antibiotic Zoliflodacin, was effective against gonorrhea in Phase 2 clinical trials. Meanwhile, researchers at Oregon State University, have published work suggesting a path to a gonorrhea vaccine. But that is years away. In the meantime, we should all practice safe sex, get tested regularly and encourage our partners, family and friends to do the same.
American Hospital Association, Becker’s Hospital Review, Centers for Disease Control and Prevention, Entasis Therapeutics, HIV.gov, Kaiser Family Foundation, National Coalition of STD Directors, Oregon State University, Planned Parenthood