By Melinda Young
Some sexually transmitted infections (STIs) have risen dramatically since the COVID-19 pandemic. But the hope was that public health clinics’ increased screening and treatment and public awareness campaigns eventually would lead to a decrease in STIs.
However there have been recent funding cuts to programs that affect sexually transmitted disease (STD) prevention, screening, and research. These cuts have included closing the Centers for Disease Control and Prevention’s (CDC’s) STD lab and firing its entire staff.1,2 CDC’s lab was among a handful of international reference laboratories that worked with the World Health Organization (WHO) on surveillance of STI infection rates and drug-resistance patterns.1
Wisconsin, for example, has had enormous increases in syphilis cases and congenital syphilis. Wisconsin’s syphilis cases have increased 1,450% since 2019, for instance.2 “Drug-resistant STIs are a growing and significant global public health challenge,” says Erin Duffy, PhD, chief of research and development at CARB-X of Boston, MA. Duffy answered questions via email. “Substantial morbidity, increased risk of HIV [human immunodeficiency virus], and multidrug resistance are the key drivers,” Duffy says.
“In particular, drug-resistant gonorrhea is deeply concerning, as we are now down to just one antibiotic, ceftriaxone, that remains reliably effective,” she adds. “In many ways, this is the poster child for antimicrobial resistance (AMR). This situation underscores the urgent need for innovation across the board — from developing new antibiotics and preventatives to advancing rapid, sophisticated diagnostics.”
People working in the infectious diseases field are concerned about the federal government’s intent to decentralize STI surveillance and data collection from the CDC to states or private entities. This could affect monitoring and reacting quickly to outbreaks and clusters of infectious diseases. “We’re operating in our field in a black hole right now,” says Joseph Cherabie, MD, MSc, assistant professor if medicine in the division of infectious diseases at Washington University at St. Louis in St. Louis, MO.
“We don’t have data send-outs; we don’t have reports; we don’t have any idea of monitoring for multiple infectious diseases, things like bird flu, syphilis, gonorrhea,” Cherabie says. “And we ask the administration what their plans are, and they say, ‘It’s to move it back to the states.’ But this is a huge ask. Some states don’t have great mechanisms for monitoring this stuff.”
State health departments were overwhelmed during the COVID-19 pandemic, often pulling staff from the STI surveillance areas to work on COVID. The result has been high turnover and burnout, Cherabie notes. “It’s something that’s really quite scary, and we’re operating without knowing the situation, context, and environment we’re operating in,” he adds.
The changes in the early months of the administration, as well as the inconsistency of government changes, have created a challenging environment for infectious diseases scientists and physicians. “We cannot do the complex and serious work of protecting Americans from infectious diseases amid this chaos and confusion,” says Tina Tan, MD, FIDSA, FPIDS, FAAP, president of the Infectious Diseases Society of America (IDSA) in a news release on April 1, 2025.
Additional cuts to staff and funding at the U.S. Department of Health and Human Services (HHS) could reverse the nation’s 40-year gains in preventing HIV infection through condoms, antiretroviral therapy, and pre-exposure prophylaxis. These efforts turned HIV infection into a chronic disease and not a deadly one.
Children and young people will be harmed by these cuts, says Lynn M. Mofenson, MD, a pediatric infectious disease physician who worked for the National Institutes of Health on HIV research for more than 26 years. Mofenson is a senior HIV technical advisor at the Elizabeth Glaser Pediatric AIDS Foundation and is an advisor to the WHO. She also is a member of the Infectious Diseases Society of America (IDSA). Mofenson spoke at an IDSA media video conference on April 1, 2025.
The administration — on March 21, 2025 — ended a $17 million per year grant supporting adolescent medicines trials (ATM) for HIV, she says. “The termination letter described the program as research based on artificial and nonscientific categories, does not expand our knowledge of living systems, provides low [return] on investments, and does not enhance health, lengthen life, or reduce illness,” Mofenson says.
“So, let me set the record straight. Since 2001, this network has had more than 30,000 enrollments across more than 150 studies,” Mofenson says. “ATM studies have led to the availability of new biomedical tools and treatment approaches, nationally implemented testing and prevention strategies, and data that informs data licensing, clinical guidelines, public health practice, and federal programming.”
Twenty percent of the 32,000 new HIV infections that occur in the United States annually are in adolescents and young adults, and nearly half of them are in the Southern United States, she says. “Now, HIV is still a problem in the U.S. and around the world, and we can basically stop transmission of HIV in youth if we get them diagnosed and treated with effective drugs, which is the goal of the ATM,” Mofenson says. “And, as discussed, each HIV infection prevented avoids nearly $500,000 in lifetime treatment costs.”
Syphilis infections, including congenital syphilis, have become a huge problem in the past five years. There are 2,000 babies born with syphilis each year in the United States, says Rachel Bender Ignacio, MD, an infectious diseases physician and scientist at the University of Washington School of Medicine. Ignacio, who spoke at the Feb. 14, 2025, IDSA media video conference on changes in public health information, is the advocacy chair at IDSA. “That’s a tremendous increase from prior [periods], and the net number is still going up,” Ignacio says.
The administration has further hampered the work of infectious diseases providers by removing protocols and other information from its government websites, she notes. “Additionally, physician colleagues working overseas, who provide medical and insurance and emergency services to our foreign service, lost access to their protocols [in early February 2025], and this is information that they rely on to keep the people who are serving Americans abroad safe,” Ignacio adds. “This type of information that has been removed represents carefully vetted, evidence-based information meant to keep regular Americans safe.”
The value of such information is especially high in rural areas where physicians and other providers often do not have a nearby specialist they can consult about patients’ symptoms.
In President Trump’s first term, he launched an initiative to end the HIV epidemic in the United States. Six years later, the nation is on a fast-track to undo decades of progress, says Anna K. Person, MD, an HIV and infectious disease physician at Vanderbilt University Medical Center in Nashville, TN. Person also is vice chair of the HIV Medicine Association, and she spoke at the April 1 media video conference of IDSA.
“At the end of [March 2025], following the release of a plan to restructure HHS, the office of infectious diseases’ HIV policy staff were told they were being eliminated,” Person says. “This office oversees the End HIV Epidemic initiative, in addition to important plans to strengthen our response to sexually transmitted infections and viral hepatitis, among other important initiatives.”
It is estimated that elimination of the CDC Division of HIV Funding would lead to 143,000 new HIV infections and 14,000 AIDS-related deaths by 2030 and will cost the nation $60 billion, Person says. “It is far cheaper to fund HIV prevention than treat someone living with HIV,” she adds. “These actions also risk turning a treatable, chronic disease back into a deadly one and will take its toll in human lives.”
These cuts also could affect generations of infectious disease physicians and scientists. “People are not going to enter a field that they cannot see a future in. And the damage that’s been done thus far will likely be felt for many years and decades to come as the pipeline of future researchers turns away and doesn’t enter research,” says Colleen Kelley, MD, MPH, FIDSA, professor at Emory University School of Medicine in Atlanta, and chair of the HIV Medicine Association. Kelley spoke at a March 20, 2025, IDSA video conference on the consequences of funding cuts in health research.
“We are also facing the almost sure loss of the next generation of researchers,” Kelley adds. “We’ve heard of reports in some instances of PhD programs that are rescinding offers or pausing admissions. We are facing the potential loss of leading HIV prevention expertise at CDC that we all look to for guidance.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Branswell H. CDC’s top laboratory on sexually transmitted diseases is shut by Trump administration. STAT+. April 5, 2025. https://www.statnews.com/2025/04/05/cdc-sexually-transmitted-diseases-laboratory-closed-by-trump-administration/
2. Glenza J. Trump administration axes key STI lab amid dramatic rise in US syphilis cases. The Guardian. April 21, 2025. https://www.theguardian.com/us-news/2025/apr/21/syphilis-trump-cuts-cdc-doge?utm_term=Autofeed&CMP=bsky_gu&utm_medium=&utm_source=Bluesky#Echobox=1745243707
Some sexually transmitted infections (STIs) have risen dramatically since the COVID-19 pandemic. But the hope was that public health clinics’ increased screening and treatment and public awareness campaigns eventually would lead to a decrease in STIs.
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