US STD rates continue to soar, breaking all past records

By Liz Meszaros, MDLinx
Published October 10, 2018

Key Takeaways

For the fourth consecutive year, the United States has experienced a sharp increase in reported cases of chlamydia, gonorrhea, and syphilis, according to data released by the Centers for Disease Control and Prevention (CDC) at the National STD Prevention Conference in Washington, DC. In 2017, there were nearly 2.3 million cases of these sexually transmitted diseases (STDs), beating the record set in 2016 by over 200,000 cases.

“We are sliding backward,” said Jonathan Mermin, MD, MPH, director, CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

The breakdown of increased incidence by disease in 2017 is as follows:

  • Gonorrhea increased by 67% overall, from 333,004 to 555,608 cases. The incidence has nearly doubled in men, from 169,130 to 322,169, and increases in women have occurred for the third year in a row, from 197,499 to 232,587. Gonorrhea is the second most common reported bacterial STD in the United States.
  • Primary and secondary syphilis increased 76%, from 17,375 to 30,644. Nearly 70% of primary cases occurred in gay, bisexual, and other men who have sex with men.
  • Chlamydia remains the most common condition reported to the CDC, with over 1.7 million cases in 2017. A full 45% of these occurred in females aged 15 to 25 years.

Contributing factors for the staggering increases include socioeconomic factors—such as poverty, stigma, and discrimination—and drug use. Although all three STDs are curable with antibiotics, most cases are undiagnosed and remain untreated. This can lead to serious adverse effects including infertility, ectopic pregnancy, increased HIV risk, and stillbirth in infants.

Also of concern is the increased number of cases of antibiotic-resistant gonorrhea worldwide, and the door this resistance opens to the possibility of untreatable gonorrhea. Ceftriaxone remains the only highly effective antibiotic to treat gonorrhea in the United States because, over time, gonorrhea has developed resistance to almost every class of antibiotics previously used.

The current recommended first-line treatment for gonorrhea is comprised of dual therapy with ceftriaxone and azithromycin, a regimen first recommended by the CDC in 2015. The addition of azithromycin was specifically chosen to delay the development of ceftriaxone resistance.

Although no confirmed treatment failures with this combination therapy have been reported in the United States, new findings from the CDC—also presented at the National STD Prevention Conference—revealed that, in laboratory testing, researchers are seeing emerging resistance to azithromycin at a rate of 4% in 2017, compared with 1% in 2013.

The fear is that azithromycin-resistant genes may someday crossover into gonorrhea strains that may have developed a reduced susceptibility to ceftriaxone and, perhaps, lead to a strain of gonorrhea that is resistant to ceftriaxone.

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” said Gail Bolan, MD, director, CDC’s Division of STD Prevention. “We can’t let our defenses down—we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible.”

Of further concern is the recent uptick in congenital syphilis, of which nearly 1,000 cases have been recorded in 2017—the highest it has been in 20 years, according to the CDC.

“Newborns are now paying the price for our nation’s growing STD crisis. That we have any cases of syphilis among newborns, let alone an increasing number, is a failure of the health-care system. It is also a symptom of the larger STD crisis in the United States and a sign of a public health system in urgent need of support,” said David C. Harvey, executive director, National Coalition of STD Directors (NCSD).

Up to 40% of babies born to mothers with untreated syphilis may be stillborn or die from the infection as a newborn. Infants who survive often face life-long complications, including deformed bones, blindness, and deafness.

“When a baby gets syphilis, it means the system has failed that mother repeatedly, both before and during her pregnancy. If STD prevention programs had anywhere near the support they need and women were getting quality preventative and prenatal care, no new mom would ever have to cope with this devastating diagnosis,” concluded Harvey.

The record numbers of STD cases call for a renewed commitment from health-care providers to incorporate STD screenings and timely treatment into their standard medical care.

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