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Sexually Transmitted Disease Rates Hit New Highs, CDC Report Says

Cases of chlamydia, gonorrhea, and syphilis are at their highest level ever -- exceeding last year's record levels -- even as STD prevention, testing, and treatment services have eroded, according to the latest Sexually Transmitted Disease Surveillance report, released this week by the Centers for Disease Control and Prevention (CDC). Young people and gay and bisexual men are particularly heavily impacted, and transmission of syphilis from pregnant women to their babies is a growing concern.

According to the report, more than 1,500,000 cases of chlamydia, nearly 400,000 cases of gonorrhea, and nearly 24,000 cases of primary and secondary syphilis were reported in 2015. But these figures do not reflect the full extent of the problem, as many STD cases go undiagnosed and unreported, and other sexually transmitted infections including herpes simplex virus and human papillomavirus (HPV) are not routinely reported.

"We have reached a decisive moment for the nation. STD rates are rising, and many of the country’s systems for preventing STDs have eroded," said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "We must mobilize, rebuild, and expand services -- or the human and economic burden will continue to grow."

Chlamydia

A total of 1,526,658 cases of chlamydia were reported in 2015 -- or 479 per 100,000 people -- up 5.9% from 2014, making it the most common sexually transmitted infection. Young women and men age 15-25 accounted for almost two-thirds of diagnosed cases.

Symptoms of early chlamydia can include discharge from the vagina or penis and a burning sensation during urination, but it may also be asymptomatic. If left untreated it can cause pelvic inflammatory disease, infertility, and pregnancy complications.

Gonorrhea

There were 395,216 reported cases of gonorrhea in 2015 -- or 124 per 100,000 people -- a 12.8% increase from 2014. Youth were again heavily affected, accounting for half of diagnosed cases, and gay and bisexual men of all ages also had a high rate.

Gonorrhea can also cause discharge and burning during urination, as well as rectal or throat symptoms, but it may also be asymptomatic. Left untreated it can cause pelvic inflammatory disease, inflammation of the prostate, infertility, and ectopic pregnancy, as well as increasing the risk of acquiring and transmitting HIV.

Syphilis

There were 23,872 reported cases of primary and secondary syphilis in 2015 -- or 8 per 100,000 people -- up 19% from 2014. Men accounted for more than 90% of all cases, and gay and bi men made up more than 80% of cases among men (based on data from states that report sex of partners).

Primary syphilis, or initial infection, is marked by a chancre or lesion in the genital or anal region.These sores are typically painless and heal on their own. If left untreated the infection progresses to the secondary stage, characterized by a rash and possibly flu-like symptoms. These symptoms also go away without treatment, but the bacteria remain in the body and the latent stage can last for years. A minority of people go on to develop late-stage syphilis, which can involve damage to the heart, eyes, and brain.

New state-level data released at the 2016 STD Prevention Conference in September showed that the nationwide rate of primary and secondary syphilis among men who have sex with men was 309 cases per 100,000 in 2015, compared with 2.9 per 100,000 for heterosexual men. States in the southeast had the highest rates, with a high of 748 per 100,000 in North Carolina compared to a low of 73 per 100,000 in Alaska. Another study presented at that meeting found that only half of gay and bi men had been tested for syphilis within the prio year.

Although fewer than 10% of reported syphilis infections were in women, cases of congenital syphilis -- transmitted from mother to baby during pregnancy -- rose by 6%.

"The health outcomes of syphilis -- miscarriage, stillbirth, blindness, or stroke -- can be devastating," said Gail Bolan, director of CDC’s Division of STD Prevention. "The resurgence of congenital syphilis and the increasing impact of syphilis among gay and bisexual men makes it clear that many Americans are not getting the preventive services they need. Every pregnant woman should be tested for syphilis, and sexually active gay and bisexual men should be tested for syphilis at least once a year." 

Eroding Services

Chlamydia, gonorrhea, and syphilis can all be treated and cured with antibiotics, halting onward transmission and preventing progression to serious complications.

However, drug-resistant gonorrhea is a growing concern worldwide. At the STD conference public health officials from Hawaii reported that they had identified the first cluster of gonorrhea cases with reduced susceptibility to both drugs in the current recommended treatment regimen, ceftriaxone and azithromycin.

Most cases of STDs go undiagnosed and untreated, putting people at risk for severe health consequences, increasing the risk of HIV, and costing the healthcare system nearly $16 billion each year, according to the CDC. 

In recent years more than half of state and local STD programs have seen budget cuts and many health department STD clinics have closed, the CDC noted, resulting in less access to testing and treatment.

"STD prevention resources across the nation are stretched thin, and we’re beginning to see people slip through the public health safety net," Mermin said. "Turning the STD epidemics around requires bolstering prevention efforts and addressing new challenges -- but the payoff is substantial in terms of improving health, reducing disparities, and saving billions of dollars."

The full 2015 STD surveillance report is available online at https://www.cdc.gov/std/stats15. The CDC's latest guidelines for STD screening and treatment can be found at http://www.cdc.gov/std/tg2015.

10/19/16

Sources

CDC. 2015 Sexually Transmitted Disease Surveillance. October 2016.

CDC. Reported STDs in the United States: 2015 National Data for Chlamydia, Gonorrhea, and Syphilis. Fact sheet. October 2016.

CDC. Reported STDs at Unprecedented High in the U.S. Press release. October 19, 2016.