The United States recorded over 2.5 million cases of sexually transmitted infections (STIs) in 2021, and some STIs saw a significant jump in rates between 2020 and 2021, according to a new CDC report.
In total, there were over 2.5 million cases of STIs in the United States in 2021, a slight increase from the 2.4 million cases recorded in 2020.
"The U.S. STI epidemic shows no signs of slowing," said Leandro Mena, director of the CDC's Division of STD Prevention.
According to CDC data, chlamydia was the prevalent STI, making up 1.6 million infections. Compared to 2020, chlamydia rates increased by 4% but are still below pre-pandemic levels. Although chlamydia levels are lower than before COVID-19, some experts have voiced concerns about whether screening continues to be disrupted due to the pandemic since chlamydia is often asymptomatic.
Between 2020 and 2021, cases of gonorrhea increase by 4.6%, reaching 710,151 infections. Since a historic low in 2009, gonorrhea cases have increased 118%.
Syphilis saw the highest increase in cases from 2020 to 2021, jumping 32% from 133,954 cases to 176,713 cases. In addition, there was an "alarming rise" in congenital syphilis, in which newborns are infected by their mothers. Between 2017 and 2021, congenital syphilis cases jumped from 941 cases to 2,855 cases, a 203% increase over five years.
According to CDC, STIs continue to disproportionately impact gay and bisexual men, as well as younger people. There were also a disproportionate number of STIs diagnosed among Black and American Indian/Alaska Native individuals.
The agency also reported state-by-state level data for rates of chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis.
According to Politico, federal health officials have expressed concerns about STI rates worsening amid a legal battle over the Affordable Care Act's (ACA) preventive care provision, which covers screenings and the HIV prevention treatment PrEP.
Last month, Judge Reed O'Conner of the U.S. District Court for the Northern District of Texas ruled that the ACA provision requiring health plans to cover care and treatments recommended by the U.S. Preventive Services Task Force (USPSTF) is unconstitutional.
Under the ruling, which went into effect immediately, health plans are not required to cover any of the recommendations for preventive services made by USPSTF since 2010 when the ACA first went into effect. The Department of Justice has filed an appeal against the ruling.
Although insurers have said that there will be no immediate changes to care or coverage, several health experts have voiced concerns that coverage of preventive services will be in jeopardy as health plans create future contracts. Currently, more than 150 million Americans are impacted by changes to ACA's preventive services provision.
"We're winding back the clock," said Rachel Deitch, federal policy director for the National Coalition of STD Directors. "Folks could have to pay for their own testing and screening, and what we're really concerned about is the cost of treating diseases that weren't caught early enough."
According to Deitch, several studies have shown that people will often forego STD services when they're not free.
"So with the threat of no longer having counseling and screening covered at no cost and the threat to PrEP, we're absolutely going to see increased rates of HIV and STIs and people dealing with lifelong consequences," Deitch said.
In addition, Deitch said rolling back preventive care coverage to what was in place in 2010 could be especially "devastating" for efforts to reduce syphilis rates since older guidance doesn't specify how often people could have syphilis testing covered by insurance. Older guidance also recommends covering congenital syphilis testing at a patient's first prenatal visit, even though not everyone may be able to access prenatal care.
"When we didn't have that guidance that dictated what insurers had to cover at no cost, we heard all the time about folks having their claims denied because insurers weren't clear what they have to cover and how often," she said. "The old rules left them too much wiggle room."
And even if the Texas ruling on preventive care coverage is reversed, Demetre Daskalakis, CDC's director of HIV prevention, said that he worries that heightened attention on the case will deter people from seeking necessary care to prevent STIs.
"It's just going to make public health's job harder," Daskalakis said. "We've seen this before. The truth is: Perception of cost is almost as aversive as actual cost." (Weixel, The Hill, 4/11; Chasan, CBS News, 4/11; Ollstein, Politico, 4/11; CDC news release, 4/11; CDC Sexually Transmitted Disease Surveillance 2021, accessed 4/12)
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