In 2013 there were 1,401,906 reported cases of chlamydia, which remains concentrated among young women. This number declined by 1.5%, the first decrease since national reporting began. Gonorrhea cases stood at 333,004. While the overall number fell slightly, there were regional increases including in the western U.S., where drug-resistant gonorrhea is most common.

Syphilis was less common than the other reportable STDs, with 17,357 cases in 2013. But the burden is disproportionately high among men who have sex with men. Three-quarters of all reported primary and secondary syphilis cases were in gay or bi men, and half of gay men with syphilis were HIV positive. In the era of HIV pre-exposure prophylaxis (PrEP), the National Coalition of STD Directors encourages men to continue -- or start -- using condoms to prevent other STDs.

The majority of STD cases are reported in settings other than dedicated STD clinics, including by private physicians and health maintenance organizations. Many infections go undetected and unreported, however, in part because they often have no symptoms. Other common STDs including human papillomavirus (HPV) and herpes simplex are not routinely reported to the CDC. Overall, the CDC estimates that nearly 20 million new sexually transmitted infections occur each year, half of them among young people age 15-24.

Below is an edited excerpt from a National Coalition of STD Directors press release summarizing the report's findings. The full report and a fact sheet are available online.

2013 STD Surveillance Data Shows Continually High STD Rates in the United States

Primary and Secondary Syphilis Rates Increase by Double Digits for Second Year in a Row

Washington, D.C. -- December 16, 2014 -- Today, the Centers for Disease Control and Prevention (CDC) released its 2013 sexually transmitted disease (STD) surveillance data. This annual report of statistics and trends for the three commonly reportable sexually transmitted diseases in the United States (chlamydia, gonorrhea and syphilis) shows that STD rates in the United States continue to be unacceptably high. Most notably, rates for primary and secondary syphilis, which is the most infectious stage of syphilis, increased by an alarming 10 percent in 2013, on top of an 11 percent increase in 2012.

"This second year of double digit increases of syphilis rates is completely unacceptable and also significantly intersects with our HIV epidemic," stated William Smith, Executive Director of the National Coalition of STD Directors (NCSD). "This continues to affect populations already disproportionately impacted by all STDs, including HIV, most notably gay men and other men who have sex with men (MSM)." 

The rate of primary and secondary syphilis in 2013 is the highest recorded rate since 1996. In addition, the 10 percent increase in syphilis rates in 2013 was the result of increases in men, mainly MSM; no overall increase was seen in women in 2013. Syphilis and HIV co-infection among MSM is also very common, with 52 percent of MSM with primary and secondary syphilis co-infected with HIV.

NCSD is greatly concerned that ever-present stigma impacts MSM and other gay men's ability to access health care and the quality of that health care. NCSD has developed, along with the National Alliance of State and Territorial AIDS Directors (NASTAD), a Stigma Toolkit  for health departments, as well as optimal care checklists for health care providers who are providing care to MSM patients and for MSM patients. NCSD also launched a new campaign earlier this year, Condoms (STILL) Work!, that underscores that condoms are still a very strong tool in the prevention of all STDs, including HIV, and they must regain a strong place in the sexual health framework.

Data released today on congenital syphilis also underscores that our national trends on syphilis are going to the wrong direction. Congenital syphilis increased 3.6 percent in 2013, the first increase in congenital syphilis since 2008. This disease can cause infant death, developmental delays, and seizures when a pregnant woman has syphilis and it is not treated before delivering.

"This new data comes on the heels of the Food and Drug Administration's (FDA) approval of a rapid syphilis test for wide use outside of traditional laboratories," continued Smith. "Our efforts to bring our syphilis epidemics under control demands high utilization of this new tool where appropriate."  

Rates for chlamydia decreased slightly between 2012 and 2103, with that reduction seen mostly among young women and men aged 15-19. This is the first time that overall chlamydia case rates have decreased since national reporting began and the second year that rates have decreased among adolescent females. CDC investigated a number of factors that could be impacting trends in reported chlamydia rates, and they encourage close monitoring of the number of young women screened. 

Overall gonorrhea rates were stable from 2012 to 2013; however, for the first time since 2000, the rate of reported gonorrhea cases among men was higher than the rate among women. In fact, during 2009-2013, the gonorrhea rate among men increased 20.3 percent while the rate among women decreased two percent. Regional differences also exist; during 2012-2013, the rate of reported gonorrhea cases in the Western United States, where gonorrhea resistance has been the highest, increased among both men (17.3 percent) and among women (11.8 percent).

While recent data from the Gonococcal Isolate Surveillance Project (GISP) suggest gonorrhea susceptibility has increased, this data on the existing gonorrhea disease burden shows it is critical to continue monitoring as the threat of resistant gonorrhea remains a concern. Gonorrhea resistance continues to be concerning particularly as we are currently on our last drug to treat this STD and there are limited drugs coming in the pipeline.

"As we move to fully understand the trends behind this data, NCSD encourages its own member health departments and private providers to screen every patient at risk for STDs and that screening should occur at every anatomical site," stated Smith. "If we are only doing urine-based screening, we are missing most infections," finished Smith.

NCSD also remains concerned about other common STDs not covered in this report such as, herpes, trichomoniasis and human papillomavirus (HPV). These non-reportable STDs and others have costly and devastating complications, and are also all too common in the United States. 

The full 2013 STD surveillance data can be found on the CDC website at: www.cdc.gov/std/stats13/. The full CDC guidelines for STD screening and treatment can be found here: www.cdc.gov/std/treatment/2010/.

12/17/14

Sources

CDC. Reported STDs in the United States. Fact sheet. December 2014.

CDC, Division of STD Prevention. Sexually Transmitted Disease Surveillance 2013. December 2014.

National Coalition of STD Directors. 2013 STD Surveillance Data Shows Continually High STD Rates in the United States. Press release. December 16, 2014.