Why Are Sexually Transmitted Diseases on the Rise?

According to figures released by the Centers for Disease Control and Prevention (CDC) late last year, total number of cases of syphilis, gonorrhea, and chlamydia in the United States soared to a record high last year, including an alarming jump in the rate of newborn deaths caused by congenital syphilis. In the latest edition of the CDC's annual Sexually Transmitted Disease Surveillance Report, more than 2.4 million syphilis, gonorrhea, and chlamydia infections were reported in the United States in 2018 alone, an increase of more than 100,000 cases from the previous year.

The most common sexually transmitted disease, chlamydia, accounted for 1.7 million of those cases, the highest number ever recorded in one year by the CDC. Gonorrhea accounted for 500,000 cases, also the highest number reported since 1991. As for primary and secondary syphilis, the total number of cases stands at 115,000, also the highest number since 1991.

While all three of the most common sexually transmitted diseases can be successfully treated with antibiotics, the medical consequences of these diseases being left untreated can be devastating. Not only are people with untreated STDs at risk for infecting others, but they are also vulnerable to a wide range of medical problems, including infertility, ectopic pregnancy, and increased HIV risk. When allowed to proceed to its tertiary stage, syphilis can lead to severe neurological problems in older adults while congenital syphilis – syphilis passed from a mother to her baby during pregnancy – can result in miscarriage, stillbirth, newborn death, and severe lifelong physical and neurological problems.

So why are rates of sexually transmitted diseases on the increase after reaching historic lows between 2001 and 2009?

A new commentary published in the journal Health Psychology explores some of the reasons for this sharp rise and what we can expect in future. Written by Sarah W. Feldstein Ewing of the Oregon Health and Science University and Angela D. Bryan of the University of Colorado, Boulder, the commentary points out that adolescents and young adults represent half of all new cases and that minority youths seem particularly vulnerable. In exploring the reasons for this upswing in new cases, Ewing and Bryan view it as a natural progression of the shift in sexual education policies over the past two decades.

Since 2003, for example, funding for the CDC STD Prevention division has been cut by around 40 percent. At the same time, many federal and state health agencies have canceled or reduced programs teaching youths how to engage in safe sex (including use of a condom and education about sexually transmitted diseases and birth control). The current federal administration, as well as many state administrations, have advocated abolishing all sexual education programs that are not focused on abstinence alone despite decades of research demonstrating that such programs are counterproductive.

While organizations such as Planned Parenthood continue to fund developmentally appropriate and evidence-based sex education programs with a proven track record of success, political and religious opposition remains strong in many parts of the country. The shift towards abstinence-based sex education has also highlighted how vulnerable minority groups, including racial and sexual minorities, have become in recent years. Also, not only are men who have sex with men still vulnerable towards HIV, but they are also at increased risk for gonorrhea. As for young women of color, particularly from lower socioeconomic groups, they are showing the highest rates for chlamydia.

In looking at primary and secondary syphilis, 35,063 cases were reported to the CDC in 2018 alone, a 71 percent rise from 2014. The prevalence of syphilis is highest in adults between the ages of 20 and 29 and remains particularly high in men having sex with men. Reported cases of congenital transmission of syphilis from mothers to their children have also risen 40 percent in recent years. While rates of HIV transmission were not addressed in the CDC report, acquiring any non-HIV STD sharply increases the risk of infection and, despite significant gains in HIV prevention in recent years, the rising number of STD infections may lead to a new HIV epidemic in time.

While all of these diseases are preventable through consistent condom use, many young people lack basic knowledge in the use of barrier methods. There has also been a sharp rise in sexual practices such as "stealthing," or the removal of condoms before or during sexual intercourse without the partner’s knowledge and consent.

One recent study found that between 10 to 20 percent of adults between the ages of 21 and 30 admitted to stealthing with with 20–43% having stealthed at least twice times since Age 14. Men who engage in stealthing are 30 percent more likely to be diagnosed with a sexually transmitted disease and represent a major risk of infecting women.

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As Ewing and Bryan point out in their commentary, education and increased funding are the only ways of countering this new health crisis. New resources at the national, state and local levels are desperately needed, including restoring programs aimed at teaching young people about proper prevention, There is also a desperate need for better treatment services to help identify and treat new cases as they develop.

While abstinence-based programs continue to have strong political support in many parts of the country, it is essential that we re-establish the public health initiatives that have proven to be so effective in the past. Along with public health clinics and nonprofit organizations, we also need better outreach methods, including taking advantage of social media and public service announcements, to help young people become better informed.

The rise in new cases of sexually transmitted diseases is not a problem that will go away on its own. Not only will we have to face the financial costs of dealing with untreated cases, but the long-term impact, including infertility, ectopic pregnancy, an increased risk of contracting H.I.V., and congenital damage, may well stay with us for generations to come.