In 2019, there were more than 2.5 million reported cases of chlamydia, gonorrhea, and syphilis, according to data from CDC, marking the sixth-straight year of record-breaking numbers of sexually transmitted diseases (STDs) in the United States.
STDs rise in the United States
According to CDC, since the nation hit a record-breaking high of reported STDs in 2014, at 1.4 million, the number has broken new records every year, reaching more than 2.5 million in 2019.
For the latest year of data, CDC found that STD rates among Hispanic and Latino people were one to two times higher than among non-Hispanic white people. Meanwhile, STD rates among American Indian, Alaskan Native, Native Hawaiian, and other Pacific Islanders were three to five times higher than non-Hispanic whites. Rates among Black people were five to eight times higher than non-Hispanic whites.
CDC also reported state-by-state level data for rates of chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis.
Health officials look toward the potential of at-home STD tests
In the wake of the Covid-19 pandemic spurring investment in at-home coronavirus testing, many health officials are looking to track the spread of STDs more accurately via at-home testing.
According to officials, at-home STD tests would be more private and pose less of a burden on already overwhelmed public health clinics. In addition, their convenience—in comparison to in-person tests—may enable experts to track STDs more accurately among people who have not previously been tested or displayed symptoms.
"These are people who wouldn't otherwise know they have an STD," said Michael Kharfen, a senior deputy director at the DC Department of Health. Kharfen cited the 6% positivity rate among the 2,000 at-home STD test kits distributed in the District of Columbia since last summer—a rate significantly higher than in-person clinics reported before the Covid-19 pandemic.
However, obstacles still stand in the way of at-home STD tests becoming the standard of care. For example, most at-home STD tests have not been authorized by FDA. The agency declined to say how it's planning to treat the at-home test market or what applications may be pending, but noted that it will "continue to balance our role of protecting and promoting public health while supporting medical device innovation."
"Regulation has to catch up to clinical practice," Jennifer Mahn, associate director for clinical programs at the National Coalition of STD Directors, said. "The stakes are too high here."
Another obstacle to at-home testing is that patients may not be familiar with how to use the tests correctly, especially since samples that linger too long in the mail or are exposed to extreme temperatures could yield incorrect results, Politico reports.
According to Kelly Wroblewski, director of infectious diseases at the Association of Public Health Labs, some labs have started looking into validating some at-home STD tests that are not yet authorized by FDA and have found that they may have some problems.
"Several of our members who are in the process of validating these tests have found that you lose sensitivity and reliability when you collect samples at home," Wroblewski said. "What kind of a loss in performance are you willing to accept for the convenience of home collection?"
Experts are also concerned about some scam tests, as well as patients who—after receiving confirmation of an STD from an at-home test—may not seek out treatment or inform sexual partners.
For instance, Mahn said that while at-home tests are an "innovative solution," she hopes that cities don't allocate funding to the tests rather than public health clinics, because doing so could risk provider-patient relationships. "A lot of people come in never having seen a doctor, and in addition to an STD test we can refer them to primary care, and we also have insurance navigators who can help them get on Medicaid. So let's not put all of our eggs in one basket" (Miranda, USA Today, 6/15; Ollstein, Politico, 6/17).