National STD Prevalence Hits All-time High -- Again - AAFP News

Posted: 26 Oct 2016 12:00 AM PDT

A new publication from the CDC reveals troubling news about the prevalence of STDs in the United States: For the second consecutive year, numbers of newly diagnosed cases of all three nationally reportable STDs -- syphilis, gonorrhea and chlamydia -- have risen, topping out at an unprecedented combined high.

According to that report, titled Sexually Transmitted Disease Surveillance 2015,(www.cdc.gov) Chlamydia trachomatis infections led the way in terms of sheer numbers, with more than 1.5 million new cases reported last year -- what an accompanying fact sheet(www.cdc.gov) termed "the highest number of annual cases of any condition ever reported to CDC."

Another dubious point of distinction: With eight cases per 100,000 people, primary and secondary syphilis saw the largest rate increase -- 19 percent -- compared with the previous year. And although rates rose among both men and women, men accounted for more than nine out of every 10 cases overall. This statistic can be traced in large part to cases among men who have sex with men, which accounted for 82 percent of all male cases in which the sex of the partner was known.

Sadly, the nation's youngest patients also saw an uptick in STD prevalence, the report shows: The rate of congenital syphilis cases rose to 12 per 100,000 live births -- a 6 percent increase over 2014.

"The health outcomes of syphilis -- miscarriage, stillbirth, blindness or stroke -- can be devastating," said Gail Bolan, M.D., director of the CDC's Division of STD Prevention, in an agency press release.(www.cdc.gov) "The resurgence of congenital syphilis and the increasing impact of syphilis among gay and bisexual men (make) it clear that many Americans are not getting the preventive services they need.

"Every pregnant woman should be tested for syphilis, and sexually active gay and bisexual men should be tested for syphilis at least once a year."

The report also makes note of the fact that teens and young adults bear a disproportionate share of sexually transmitted infections. Specifically, about half of the estimated 20 million new STDs that occur each year are in youth ages 15-24. Included in that figure are 50 percent of the 395,216 new cases of gonorrhea reported in 2015 and 65 percent of the 1,526,658 cases of chlamydia. The upshot: One out of every four sexually active adolescent girls has an STD such as chlamydia or HPV.

Further complicating the picture is the fact that the case totals in the CDC document are limited to diagnosed infections that have been reported through state and local STD programs and various surveillance projects and networks; the majority of STD cases go undetected and unreported, often because they produce no or only minimal symptoms. In addition, national summary data of case reports of other STDs -- such as HPV, genital herpes simplex and trichomoniasis -- are not available because they are not nationally reportable diseases.

Although chlamydia, gonorrhea and syphilis can be cured with antibiotics, undiagnosed and untreated cases put individuals at risk for severe and often irreversible health consequences, including chronic pain and reproductive health complications such as infertility and ectopic pregnancy. STDs are also associated with a heightened risk of contracting HIV infection.

All in all, these infections impose a substantial economic burden, as well: CDC estimates STD cases now cost the U.S. health care system nearly $16 billion each year.

Adding insult to injury is the fact that the prevalence of a number of these diseases had dropped in recent years. In 2009, for example, national rates of gonorrhea hit an all-time low, but then rose steadily for the next three years. And after a slight dip in 2013, the disease has been on the rise ever since.

This upward trend is particularly worrisome given that Neisseria gonorrhoeae has progressively developed resistance to each of the antimicrobials used to treat gonorrhea. Several years ago, declining susceptibility to cefixime prompted the CDC to modify its treatment guidelines, and dual therapy with ceftriaxone and azithromycin now remains the only CDC-recommended treatment regimen for gonorrhea.

But just last month, CDC researchers reported(www.cdc.gov) that even this last bastion of defense is under assault: U.S. health officials have identified a cluster of gonorrhea infections that shows both decreased susceptibility to ceftriaxone and very high-level resistance to azithromycin.

All of this combines to reinforce the critical importance of the recent surveillance report, said one top CDC official.

"We have reached a decisive moment for the nation," said Jonathan Mermin, M.D., M.P.H., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in the agency's release. "STD rates are rising, and many of the country's systems for preventing STDs have eroded. We must mobilize, rebuild and expand services -- or the human and economic burden will continue to grow."

Unfortunately, according to the report, this call to action comes at a time when STD public health programs "are increasingly facing challenges and barriers in achieving their mission."

"In 2012, 52 percent of state and local STD programs experienced budget cuts," the report states. "This amounts to reductions in clinic hours, contact tracing and screening for common STDs."

This also means some STD clinics are being forced to shut their doors. In fact, the CDC estimated that more than 20 such facilities closed in 2015.

Mermin acknowledged that reversing the current disease trend won't be easy.

"STD prevention resources across the nation are stretched thin, and we're beginning to see people slip through the public health safety net," he said. "Turning the STD epidemics around requires bolstering prevention efforts and addressing new challenges -- but the payoff is substantial in terms of improving health, reducing disparities and saving billions of dollars."

Successfully addressing this public health threat will require the combined efforts of multiple stakeholders, the CDC release noted. Here's what the agency recommends for the various groups:

Health care professionals: Make STD screening a standard part of medical care, especially in pregnant women. Integrate STD prevention and treatment into prenatal care and other routine visits.
Public: Talk openly about STDs; get tested regularly; and, if sexually active, reduce risk by using condoms or practicing mutual monogamy.
Parents, caregivers and community service providers: Offer young people safe, effective ways to access needed information and services.
State and local health departments: Continue to direct resources to people hardest hit by the STD epidemic, and work with community partners to maximize their impact.

Related AAFP News Coverage
USPSTF, AAFP: Screen At-risk Adults, Teens for Syphilis
(6/8/2016)

Uptick in Congenital Syphilis Causes Concern
Seize Opportunities to Identify, Treat Disease
(11/23/2015)

Chlamydia Screens Dropped After Cervical Cancer Screening Change
Unlink Chlamydia Screening from Pelvic Exams, Cervical Cancer Tests, Study Suggests
(8/10/2015)

Clinical Preventive Service Recommendation: Gonococcal Infection

Clinical Preventive Service Recommendation: Gonorrhea

Clinical Preventive Service Recommendation: Syphilis

American Family Physician: AFP by Topic: Sexually Transmitted Diseases

Additional Resource
CDC: Sexually Transmitted Diseases: Adolescents and Young Adults(www.cdc.gov)