The Centers for Disease Control and Prevention recently released its annual report on the three reportable sexually transmitted diseases gonorrhea, chlamydia and syphilis. The numbers on their prevalence are alarming, and they highlight the importance of further investigation and intervention.
On its STD Surveillance Report for 2014, the CDC says that all three diseases are on the rise as compared to the previous year:
- Chlamydia 1,441,789 cases reported; 456 cases per 100,000; UP 2.8 percent
- Gonorrhea 350,062 cases reported; 111 cases per 100,000; UP 5.1 percent
- Syphilis (primary & secondary) 19,999 cases reported; 6.3 per 100,000; UP 15.1 percent
- Syphilis (congenital) 458 reported cases; rate 11.6 per 100,000 live births; UP 27.5 percent
The healthcare costs associated with treating STDs are estimated to be $16 billion annually, with 20 million new cases occurring each year in the United States. According to the CDC, these numbers are highest among young people aged 15-24. While both males and females are affected, females tend to fare worse, as STDs portend more serious long-term complications in young women. According to the CDC, more than 20,000 women become infertile each year as a result of undiagnosed STDs.
Gay and bisexual men are experiencing the most substantial increases in rates of syphilis. Men account for 90 percent of all cases of primary and secondary syphilis, and men who have sex with men (MSM) account for 83 percent of cases when sex of the partner is known.
In previous years, we have had some declines in some diseases and increases in others. But we are concerned about the alarming increases we are seeing in chlamydia, gonorrhea and syphilis, stated Gail Bolan, MD, director of the CDC s Division of STD Prevention, and the study s lead researcher. We are concerned that most of the surging rates are among men. Men are driving these increases. There is an urgent need to tackle the increases we are seeing.
The rise in syphilis among MSM can be partially attributed to a decline in the use of condoms. According to the CDC the incidence of unprotected, anal intercourse within the previous 12 months rose from 48 percent in 2005 to 57 percent in 2011. There are several theories that can explain this upswing.
The first is that there's a phenomenon referred to as seroadaptation where HIV-positive partners confer some protective effect when they expose HIV-negative people to HIV. What they also are exposing each other to is not isolated to HIV; over half of men with syphilis in 2014 were also HIV-positive. Additionally, the introduction of Truvada, a medication given for pre-exposure prohylaxis (PrEP) to reduce rates of HIV transmission, could be encouraging MSM to forego using condoms.
Michael Weinstein, president of the AIDS Healthcare Foundation, places the blame on public health officials as well as the CDC, stating, the CDCs ill-advised strategy of mass treatment with Truvada poses a significant risk to the condom culture. He went on to say, I think there s a subtle message that condom use is not that important any longer.
Truvada, while effective at reducing transmission of HIV, does not protect against other STDs.
To expand on that, an HIV diagnosis is no longer a death sentence; instead now it's considered to be just a chronic disease. So long as patients are compliant with their antiretroviral therapy, they can live long and healthy lives. I think that people are less afraid of HIV," Weinstein added. "We re a victim of our own success.
A recent Washington Post article reported on a campaign by Weinstein's Los Angeles-based group that cautions individuals against random internet hookups using dating apps such as Tinder or Grindr. The group purchased billboard advertising implying that using these apps equates to becoming infected with an STD.
Weinstein has stated that the aim of the campaign is to link the rise of dating apps to recent increases in STD rates in some cities. These apps seem to offer sex on demand and encourage random, casual sexual encounters. One study seems to be able to attribute a 15.9 percent rise in HIV cases over a 10-year period to the introduction of Craigslist.
What compounds the problem of increasing rates of STDs is the concomitant rise of antibiotic resistant infections, including those that are sexually transmitted. Whether it is complacency, ignorance or lack of access to adequate healthcare, it must be recognized that what is happening is a serious public health problem -- and that combating the rise of STDs requires a multi-pronged, multidisciplinary approach.