By Melinda Young
The national sexually transmitted infections (STIs) lab that was recently closed by the federal government had been working on drug-resistant gonorrhea, collecting samples, developing new laboratory diagnostic tests, and monitoring antimicrobial resistance. In addition to antimicrobial-resistant gonorrhea, the lab was collecting data on antimicrobial-resistant nongonococcal urethritis (NGU), a lesser-known STI that is difficult to culture, says Joseph Cherabie, MD, MSc, assistant professor of medicine in the division of infectious diseases at Washington University at St. Louis in St. Louis, MO.
“Losing this monitoring is a big deal,” Cherabie says. “When you look at the World Health Organization (WHO) and Centers for Disease Control and Prevention’s (CDC’s) top list of antimicrobial resistance threats, gonorrhea is in the top five in both organizations.”
Gonorrhea has developed resistance to about every antibiotic. “So, now is not the time to pull back on monitoring gonorrhea resistance because we know there is a likelihood that the resistance will increase,” Cherabie says.
A couple of years ago, there was a cluster of antimicrobial-resistant gonorrhea detected in Boston. People with the STI were treated successfully with ceftriaxone, but this was the first sign that something new was occurring, Cherabie says.
“Recent reports in Vietnam show there were large amounts of multidrug-resistant gonorrhea coming out of that country,” Cherabie says. “This crosses borders; people travel to places where they could bring back multi-resistant bacteria like gonorrhea.”
For all of these reasons, the United States needs a central lab to take on the expertise, work, and financial burden of collecting STI samples, monitoring infection rates and clusters, and sharing data with states. CDC was the place respected worldwide for that collection. The uncertainty and seeming end to CDC having this role is causing the infectious diseases community a high amount of anxiety, Cherabie notes. “Who’s going to do this? Who’s going to pay for it? And how will they disseminate the information across the country and the world?” he asks.
The curtailing of government attention on STIs comes at a time when the challenges are greater with antimicrobial resistance, and private industry is working on finding answers to this growing problem. “Rapid diagnostic technologies are critical to combatting the rise of drug-resistant infections,” says Erin Duffy, PhD, chief of research and development at CARB-X of Boston, MA. Duffy answered questions via email.
“We need affordable tools that can quickly identify Neisseria gonorrhoeae and determine whether it is resistant to available treatments right at the point of care,” Duffy explains. “Inappropriate or delayed treatment has fueled resistance over time, and today, we are at a critical juncture with very few therapeutic options left.”
Improving diagnostic capabilities will help providers deliver the optimal treatment from the outset, and it protects individuals as well as public health, she adds. “Early detection and targeted treatment are essential to slowing the spread of resistance,” Duffy says. “We need bold action, including continued investment in products to address drug-resistant STIs, to prevent the rollback of decades of progress in sexual health and disease prevention around the world.”
While private companies can help find innovative solutions to drug-resistant STIs, their work needs the backing of a strong public health effort at both preventing and treating STIs. “At CARB-X, we are tackling the urgent threat of drug-resistant Neisseria gonorrhoeae through a multi-pronged approach,” Duffy says. “Through both broad and targeted funding calls, we are advancing a small portfolio that features two different candidate vaccines, one novel small-molecule antibiotic lacking cross-resistance with current therapies, and four point-of-care rapid diagnostics for Neisseria gonorrhoeae.”
Some of the products could help with other STIs, such as chlamydia, and all have an emphasis on resistance, she adds. “Through a two-year project with the Clinton Health Access Initiative (CHAI), we are conducting detailed assessments to identify which diagnostics, preventatives, and therapeutics are most urgently needed, how they might be used in healthcare settings, and what obstacles could stand in the way of widespread adoption,” Duffy explains.
With a continued focus on prevention by the federal government, as well as states, and with private industry’s innovative solutions, it would be possible to lower STI rates and stop antimicrobial resistant STIs. But current and looming cuts to preventive care access and funding make this seem unlikely to occur anytime soon.
For instance, there is a large, complex case before the U.S. Supreme Court that has the potential to end the Affordable Care Act’s requirement that payers cover a wide range of preventive care, possibly including prenatal services. “This is an indirect way to hurt, and sometimes kill, those most vulnerable populations among us, be it LGBT populations, populations of color, populations with intersectional disparities, and persons who inject drugs,” Cherabie says. “People will die, and all of their deaths [are] preventable if we [invested] in those programs.”
The states most affected by STIs and HIV are in the South, where the public health sector is the weakest. Those same places also will be hit harder by increases in STIs and the costs of treating people for diseases that could have been easily prevented. “The CDC puts out reports about the costs of STIs in the healthcare world, and it’s $1.6 billion,” Cherabie says. “That’s a lot of money that could go elsewhere, and prevention is cheap by comparison.”
The United States has invested in public health departments, clinics, and federally funded programs like Title X family planning clinics. When the Affordable Care Act (ACA) was signed into law by President Barack Obama, one of its most popular features was requiring insurers to pay for people’s preventive care, including cancer screenings like mammograms and colonoscopies, as well as contraception, vaccines, and STI tests.
But the ACA’s ability to continue this requirement for some prevention care, such as pre-exposure prophylactic (PrEP) for people at risk of HIV infection, could end with a case the U.S. Supreme Court heard on April 21, 2025: Robert F. Kennedy, Jr., et al v. Braidwood Management, Inc., et al.1 “This is as scorched earth approach to all preventive care,” Cherabie says. “So, thousands of people will lose things like cancer screening access, access to HIV pre-exposure prophylaxis, and lose things across the spectrum in terms of primary care, and that’s really dangerous and will affect everyone.”
Braidwood Management argued against the way the U.S. Preventive Services Task Force members are selected, saying their appointment is unconstitutional because they were not nominated by the president and confirmed by the Senate. The task force makes recommendations on which preventive treatments should be covered by payers. The U.S. Court of Appeals for the Fifth Circuit agreed with Braidwood’s argument.1
Braidwood’s attorneys selected a technical aspect of the ACA’s requirement to challenge that popular part of the law.
Hashim M. Mooppan, principal deputy solicitor general at the Department of Justice in Washington, DC, said the task force is required to be independent from political pressure, but it is not entirely independent because the secretary of Health and Human Services (HHS) could remove task force members, and this makes their appointments constitutional.1
Jonathan Mitchell, arguing for Braidwood, which brought the case to federal court, said the task force “alone has the prerogative to impose preventive care coverage mandates on insurers regardless of whether the Secretary approves or disapproves a Task Force recommendation.”1
Mitchell also claimed that the statute that requires task force members and their recommendations to be kept independent and protected from any type of political pressure “cannot co-exist with a regime in which the Secretary can overrule the Task Force coverage recommendations or deny them binding effect.”1
Some of the Supreme Court justices found the arguments problematic, saying the case was creating a constitutional problem, not trying to solve one. Justice Ketanji Brown Jackson said to Mitchell, “So I think your argument might be circular, and I’m sitting here trying to figure out how that is happening, and it’s a little frustrating…”1
All of these ongoing and potential changes are putting people’s health at risk from STIs and other diseases, Cherabie says. The Trump administration has proposed cutting one-third of the federal health budget, eliminating many programs, and moving STI prevention over to Kennedy’s Administration for a Healthy America (AHA). CDC would lose 40% of its budget and no longer focus on infectious diseases other than domestic HIV/AIDS prevention. Instead, it would be directed to focus on chronic disease prevention.2 HHS rural health programs also would end, including grants and residency programs for rural hospitals and state offices.2
If their past action is predictive, states will not fill the gap left by decimated federal programs. “In Missouri, we’re very heavily dependent on federal dollars for health infrastructure,” Cherabie says. “If those dollars go away, we’re dependent on a state that is rated dead last in spending per capita on public health.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Robert F. Kennedy, Jr., Secretary of Health and Human Services, et al., v. Braidwood Management, Inc., et al. Supreme Court of the United States. No. 24-316. April 21, 2025. Transcript of hearing. https://www.supremecourt.gov/oral_arguments/argument_transcripts/2024/24-316_e29g.pdf
2. Owermohle S, Tirrell M. Internal Trump administration document reveals massive budget cut proposal for federal health agencies. CNN. April 16, 2025. https://www.cnn.com/2025/04/16/politics/trump-rfk-jr-budget-cut-health/index.html
The national sexually transmitted infections (STIs) lab that was recently closed by the federal government had been working on drug-resistant gonorrhea, collecting samples, developing new laboratory diagnostic tests, and monitoring antimicrobial resistance.
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