STI Epidemic Continues to Escalate in United States, CDC Data Show
September 1, 2023
Syphilis rates surged in 2021, increasing by nearly one-third, and gonorrhea rates and chlamydia rates increased by close to 4%, according to the latest data on sexually transmitted infections (STIs).1
“All reported STIs increased from 2020 to 2021,” says Leandro Mena, MD, MPH, director of the Centers for Disease Control and Prevention’s (CDC’s) Division of STD Prevention. Syphilis is of particular concern because of its 32% surge and the growing number of infants born with congenital syphilis.
Although the CDC has not pinpointed the exact causes of rising STI rates, the COVID-19 pandemic potentially played a role.
“The fact that chlamydia has not returned to pre-pandemic levels indicates to us there are some barriers that started with the pandemic,” Mena says.
During the public health emergency, which officially ended in May 2023, public health resources were shifted to surveillance of COVID-19. Staff who had been working in STI surveillance and prevention were reassigned to other areas to support infrastructure around the pandemic, Mena explains.
Since the public health emergency ended, there has not been enough time to see if STI rates will decrease as public health infrastructure for STI prevention and detection improves.
“The diversion of staffing and resources to the pandemic, and not STIs, is a potential factor [of increased STI rates],” Mena says. The CDC report also revealed that STIs are disproportionately affecting gay and bisexual men, younger people, Black Americans, and Native
Americans.1
Drug-resistant STIs also are raising red flags, particularly with antibiotic-resistant gonorrhea. CDC data show elevated resistance to several antimicrobials when used to treat gonorrhea.2,3
The CDC found that 47% of Neisseria gonorrhoeae isolates collected were resistant to at least one of these three antimicrobials: ceftriaxone, cefixime, or azithromycin. About 12% of isolates were resistant to two antimicrobials and 4.1% were resistant to three antimicrobials tested.2,3
The CDC recommends a single 500 mg dose of intramuscular ceftriaxone for treating gonorrhea.4 If a patient’s gonorrhea is resistant to ceftriaxone, there are no other options. Healthcare providers must do their best to preserve that antibiotic, Mena says.
“We should make sure patients get the proper dose of the antibiotic,” Mena explains. “The other important thing is whenever there’s a failure, and the patient doesn’t get better, you should collect a culture and notify CDC because we can respond to and control outbreaks of resistant gonorrhea.”
The CDC uses a suspected gonorrhea treatment failure consultation form and provides an email address for questions about reporting a suspected treatment failure or resistant case. The CDC’s webpage on gonorrhea also includes information about the CDC’s SURRG — Strengthening US Response to Resistant Gonorrhea project.5
The most common notifiable STIs in the United States in 2021 were chlamydia (1.64 million cases), gonorrhea (710,151 cases), and syphilis (176,713 cases at all stages and including congenital syphilis).2
The syphilis epidemic escalated in 2021, increasing by 28.6% from 2020 to 2021. Rates increased across gender, age, racial/ethnic groups, and in all regions of the United States, the CDC reported.2 For women, primary and secondary syphilis rates increased by 55.3% between 2020 and 2021 and 217.4% from 2017 to 2021.2
Reproductive health providers can do a lot to help prevent STIs, especially congenital syphilis.
“I think congenital syphilis is a tragedy because it can be 100% prevented by making sure pregnant persons are treated at least the day before delivery,” Mena notes. “People who have indications should be tested at 28 weeks.”
The fact that congenital syphilis even exists highlights the broader issue of clinicians not doing enough to screen patients for STIs.
“We have to ask clinicians to do a much better job of including sexual histories in our routine,” Mena says. “When we do that routinely, it will decrease a lot of the stigma associated with talking about STIs.”
Women younger than 25 years of age should be screened annually for STIs. Women whose behaviors place them at greater risk for STIs should be tested three or four times a year, Mena says.
Providers can help with STI prevention efforts by asking about patients’ sexual lives. This opens the conversation for more questions about their sexual practices, which helps them determine which tests to recommend.
“As healthcare providers, we have a role and should not stigmatize sexual health and wellness,” Mena says. “Ask about it routinely, in the same way we ask about smoking, drinking alcohol.”
REFERENCES
- Centers for Disease Control and Prevention. U.S. STI epidemic showed no signs of slowing in 2021 - cases continued to escalate. Page last reviewed April 11, 2023.
- Centers for Disease Control and Prevention. National overview of STDs, 2021. Page last reviewed May 16, 2023.
- Centers for Disease Control and Prevention. National overview of STDs, 2021. Antibiotic-resistant gonorrhea. Page last reviewed May 16, 2023.
- Centers for Disease Control and Prevention. Gonorrhea treatment and care. Page last reviewed Dec. 1, 2022.
- Centers for Disease Control and Prevention. Drug-resistant gonorrhea. Page last reviewed March 2, 2023.
Syphilis rates surged in 2021, increasing by nearly one-third, and gonorrhea rates and chlamydia rates increased by close to 4%, according to the latest data on sexually transmitted infections.
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