As a physician, of course you know about sexually transmitted diseases (STDs). However, did you know that the rate of STDs in the US is climbing so rapidly that many consider it to be a public health crisis?
The rate of STDs hit the highest rate ever in the US in 2017 (the latest year for which statistics are available), after climbing for four straight years; a climb that some call “steep and sustained”. In its 2018 report, the Centers for Disease Control (CDC) reported that 2.3 million US cases of syphilis, gonorrhea and chlamydia were diagnosed in 2017, an increase of 200,000 cases.
The situation has health leaders alarmed. Dr. Jonathan Mermin, Director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, says we are “sliding backwards” in our fight against STDs. David Harvey, Executive Director of the National Coalition of STD Directors (NCSD) says, “The United States continues to have the highest STD rates in the industrialized world.”
The data reported by the CDC Sexually Transmitted Disease Surveillance 2017 report is alarming, to say the least. The following cases were reported to the agency that year:
- Chlamydia: more than 1.7 million cases, the most commonly diagnosed STD
- About 45% — 771,340 cases — emerged among 15- to 24-year-old women and girls
- Syphilis: 30,644 cases
- Men who engage in sexual activity with men made up 17,736 of those cases
- Gonorrhea: 555,608 cases
- 322,169 cases were among men only
It’s a problem that is not disconnected from other epidemics currently raging in the United States. The NCSDs Harvey says, “There are infectious disease consequences of the opioid epidemic in America, including sexually transmitted infections. We know today that some of what is driving congenital syphilis are women who are trading sex for drugs and that that explains some of the infections we are seeing in babies of syphilis.”
An Expensive Problem
The cost of treating STDs is enormous. In 2013, the journal Sexually Transmitted Diseases published a study estimating that the 19.7 million US cases of sexually transmitted infections that occurred in 2008 equaled $15.6 billion in total lifetime direct medical costs.
If you expand the analysis to include all sexually transmitted infections (STIs), the statistics are even worse. There are eight STIs studied and tracked by the CDC, and in addition to Chlamydia, Syphilis, and Gonorrhea the list includes:
- Hepatitis B virus (HBV)
- Herpes simplex virus type 2 (HSV-2)
- Human immunodeficiency virus (HIV)
- Human papillomavirus (HPV)
- Trichomoniasis
In 2013, the CDC estimated that there are about 20 million new STIs in the US each year and that equals $16 billion in direct medical costs alone.
Short Term Challenges, Long Term Problems
The challenge in the short term is two fold:
1: Finding and treating multiple partners for treatment can be difficult when they may live across state lines and can’t be reached for treatment by any one health system or provider
2: Most STDs are transmitted by people who don’t know they are infected
This is where healthcare professionals come into the picture, and where they can make a difference in stemming the epidemic. The best defense against STIs is proactive education and preventive care.
- Talk with patients in high risk age groups about the dangers of STD/STIs
- Encourage them to be tested
- Discuss safe sex with them as part of wellness
Dr. Edward Hook is the endowed professor of infectious disease translational research at the University of Alabama at Birmingham’s School of Medicine and scientific committee chair of the National STD Prevention Conference. He believes that health care professionals can make a real difference.
“We need to encourage health care professionals to routinely test and evaluate their patients for sexually transmitted infections,” he said. “For every sexually active woman in the United States under age 26, it’s recommended that those women get tested for Chlamydia trachomatis, the most common sexually transmitted infection in our country, every year — and yet current data are that that happens for less than half of women.”
According to the American Sexual Health Association, “even though young people account for half of new STI cases, a recent survey showed only about 12% were tested for STIs in the last year (2015)”. (ref. 1)
The long term challenges of the STD/STI crisis are created by the health implications of the diseases. Left untreated, they can cause infertility and other long term health issues. In some cases the diseases can be passed onto newborn children.
Chlamydia spreads like wildfire. It can be transmitted easily during any type of sexual activity. If not treated, it can cause pelvic inflammatory disease that can result in reproductive problems in women. In men, Chlamydia can spread to the reproductive system, specifically the tube that carries sperm from the testicles, and cause illness.
Syphilis is especially dangerous. Left untreated, it can affect the heart, nervous system and other organs. Most often syphilis is contracted through sexual activity but it can also be passed from mother to baby.
Gonorrhea is not a simple STD either. If left untreated it can adversely affect the prostate and testicles in men. In women, the disease can impact pregnancy and may cause infertility.
The Specter of Drug Resistant Disease
Increasingly, antibiotic-resistant gonorrhea is appearing across the U.S. The CDC recommends a best practice of prescribing two drugs to battle the disease; a single shot of ceftriaxone and an oral dose of azithromycin. So far it seems to be working. However, if gonorrhea becomes resistant to all combinations of antibiotics, it could become untreatable. That’s one more reason to stop its spread in the first place.
Years ago, STDs were the unspeakable diseases, best treated quietly and not discussed with sexual partners unless they exhibited symptoms. Those days are gone and now education must be delivered by physicians to their patients who may be at risk. Public education must increase, and quickly. It must become a loud and clear public health message that says STDs are dangerous, they are spread quickly, and only safe sexual practices and testing can keep individuals safe from their dangers.