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August 30, 2018

The alarming rise in STDs, charted

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    CDC on Tuesday announced that the number of newly diagnosed cases of chlamydia, gonorrhea, and syphilis reached a record high in 2017.

    CDC: Chlamydia, gonorrhea, and syphilis diagnoses hit record high

    CDC announced the data during its National STD Prevention Conference. The data are based on a review of sexually transmitted diseases (STDs) cases reported for 2013, as well as preliminary data for 2017.

    Officials said there were nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis diagnosed in the United States in 2017—"surpass[ing] the previous record set in 2016 by more than 200,000 cases."

    CDC found that there were more than 1.7 million reported diagnoses of chlamydia in 2017, making it the most commonly reported STD that year and marking a 22% increase from 2013. According to CDC, about 45% of the reported cases occurred among women ages 15 to 24.

    In addition, CDC found that the number of reported gonorrhea diagnoses increased by 67% from 2013 to 2017, rising from 333,004 reported cases to 555,608 reported cases. According to CDC, the number of reported cases of gonorrhea among:

    • Men doubled from 2013 to 2017, reaching 322,169; and
    • Women increased from 197,499 in 2013 to 232,587 in 2017, with 2017 marking the third consecutive year reported gonorrhea diagnoses rose among women.

    CDC also found that the number of primary and secondary reported diagnoses of syphilis increased by 76% from 2013 to 2017, rising from 17,375 to 30,644 reported cases. CDC said nearly 70% of reported primary and secondary syphilis cases in 2017 were diagnosed among men who have sex with men (MSM) whose sexual partners' gender was known. According to CDC, "primary and secondary syphilis are the most infectious stages of the disease."

    CDC said chlamydia, gonorrhea, and syphilis typically can be cured with antibiotics, but noted that most cases of the diseases are undiagnosed and untreated. The untreated infections "can lead to severe adverse health effects that include infertility, ectopic pregnancy, stillbirth in infants, and increased HIV risk," CDC said.

    CDC raises concerns about antibiotic-resistant gonorrhea

    CDC also raised concerns about a rise in gonorrhea infections that are resistant to antibiotics.

    CDC said there has been no evidence of emerging resistance to ceftriaxone, "the only remaining highly effective antibiotic to treat gonorrhea in the United States," since the agency "began recommending health care providers prescribe a single shot of ceftriaxone accompanied by an oral dose of azithromycin to people diagnosed with gonorrhea" in an effort "to help delay the development of resistance to ceftriaxone." CDC also said there has not been any confirmed treatment failures of the dual therapy in the United States.

    However, CDC said it has found new evidence that show "emerging resistance to azithromycin is now on the rise in laboratory testing—with the portion of samples that showed emerging resistance to azithromycin increasing from 1% in 2013 to more than 4% in 2017." CDC said the findings raise concerns "that azithromycin-resistant genes in some gonorrhea could crossover into strains of gonorrhea with reduced susceptibility to ceftriaxone—and that a strain of gonorrhea may someday surface that does not respond to ceftriaxone."

    Gail Bolan, director of CDC's Division of STD Prevention, added that the findings highlight the need for new treatments. "We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed," she said, adding, "We can't let our defenses down—we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible."

    CDC said it is vital that health care providers place a renewed focus on making "STD screening and timely treatment a standard part of medical care, especially for the populations most affected."

    Reasons for the increases

    CDC said research suggests several factors could drive STD increases, including drug use and socioeconomic factors such as discrimination, poverty, and stigma.

    According to USA Today, the federal government has not increased funding for STD prevention programs since 2013.

    David Harvey, executive director of the National Coalition of STD Directors, said, "We think there is a direct correlation between the increase in the number of STDs" and the absence of federal funding increases for prevention programs. "The [United States] continues to have the highest STD rates in the industrialized world," he said, adding, "It is time that President Trump and [HHS Secretary Alex] Azar declare STDs in America a public health crisis."

    Further, some experts said a lack of awareness about the severity of STDs, as well as changes in U.S. residents' sexual behavior, have helped drive the increases, USA Today reports. For instance, drugs that help to reduce the risk of HIV transmission and manage the disease have led some individuals to stop using condoms, officials said. According to Vox, there has been a particular increase in the number of MSM who have unprotected sex.

    Public officials also have raised concerns that an increase in use of dating apps could be driving rises in STD transmission. Vox reports, "With the rise of dating apps, sex is more readily available and more anonymous—and that makes it harder for health investigators to track outbreaks."

    In addition, Harvey and others said providers might not be screening for STDs as recommended.

    CDC recommends that providers annually screen all sexually active women younger than 25 for chlamydia and gonorrhea, as well as all men who have sex with men. But Bolan said, "That is a conversation that is not happening in most medical homes these days." She added, "Everyone needs to ask their doctor, 'should I be tested for STDs? I hear they're going up'" (Alltucker, USA Today, 8/28; CDC release, 8/28; Raman, CQ Health, 8/28 [subscription required]; Harris, "Shots," NPR, 8/28; Belluz, Vox, 8/28).

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