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Record 2.3 million STDs reported in US, CDC says
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Nearly 2.3 million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2017 — more evidence of a steep and sustained increase in these reportable infections and marking another record-breaking year for STDs in the U.S., federal officials announced today.
“We are sliding backward,” Jonathan H. Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a news release. “It is evident the systems that identify, treat and ultimately prevent STDs are strained to near-breaking point.”
Surge of drug- resistant gonorrhea
According to preliminary data released by the CDC at the STD Prevention Conference in Washington, D.C., between 2014 and 2017, diagnosed cases of gonorrhea increased 67% from 333,004 to 555,608. Cases nearly doubled among men, and increased in women for the third year in a row.
The CDC noted concerns beyond the rise in cases, noting that the threat of untreatable gonorrhea persists in the U.S. and is reinforced by reports of antibiotic resistant gonorrhea abroad.
According to the CDC, gonorrhea is resistant to nearly every class of antibiotic used to treat it, except ceftriaxone, the only effective antibiotic used to treat gonorrhea in the U.S. In 2015, the CDC began recommending a dual therapy of IV ceftriaxone with oral azithromycin to treat gonorrhea with the intent of delaying the development of resistance.
But preliminary data for 2017 shows that 4% of gonorrhea isolates in 2017 showed emerging resistance to azithromycin, the CDC said. The concern is that azithromycin-resistant genes in gonorrhea could cross over into strains of gonorrhea with reduced susceptibility to ceftriaxone, leading to a strain that no longer responds to ceftriaxone, according to the agency.
“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” Gail Bolan, MD, director of CDC’s Division of STD Prevention said in the release. “We can’t let our defenses down — we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible.”
‘Public health crisis’
Primary and secondary syphilis — the most infectious stages of the disease — increased 76% from 17,375 to 30,644 cases since 2013. Nearly 70% of those cases where the gender of the sexual partner is known were made up of men who have sex with men.
Chlamydia was the most common condition reported to the CDC, with more than 1.7 million cases diagnosed in 2017. Almost half of those cases were among females aged 15 to 24 years.
The increases are part of a 3-year trend of significant rises in STD cases. In 2016, the CDC reported that a record number of STDs were diagnosed in the U.S. in 2015 — a total of 1,996,576 cases of chlamydia, gonorrhea and syphilis. The following year, the number of cases surpassed 2 million for the first time, continuing the rising trend. At the time, federal health officials attributed the rise to budget cuts in local and state departments, noting that although the diseases are curable with antibiotics, budget cuts in STD programs resulted in more than 20 health departments closing, limiting patients’ access to screening and treatment.
“The public and Congress need to know that the explosion of STDs comes on the heels of cutbacks in federal funding,” David C. Harvey, executive director of the National Coalition of STD Directors, said at the STD Prevention Conference. “State and local health departments, which depend on federal funding, are working with budgets that are effectively half of what they were 15 years ago.”
“It is time that President Trump and [HHS] Secretary [Alex M.] Azar declare STDs in America a public health crisis,” Harvey added. “What goes with that is emergency access to public health funding.”
Additionally, Harvey cited lack of awareness and education about sexual health, clinicians not screening and patients being unaware that they need to ask for testing, as part of the rise in STDs.
Officials also noted improvements in diagnostics which have led to more people being tested, as another possible cause for the rise in reported cases. Screening and treatment are the primary tools for preventing STDs, and with very sensitive nucleic acid amplification tests making it easier to collect specimens, more people are being tested.
According to the CDC, most cases of STDs go undiagnosed and untreated, which can lead to severe adverse health effects including infertility, ectopic pregnancy, stillbirth and increased risk for HIV. The agency is calling for a renewed commitment from health care providers, encouraging them to make STD screenings and timely treatments a standard part of medical care to help reverse current trends.
“It’s a critical time for STD prevention,” Bolan said at the conference. “We need bold ideas and integrated solutions that address STDs along with HIV prevention and substance abuse disorders.”– by Caitlyn Stulpin
Disclosures: Bolan, Harvey and Mermin report no relevant financial disclosures.