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The Numbers Continue to Rise – Summary of 2018 CDC STD Surveillance Report
The Centers for Disease Control and Prevention released the annual STD Surveillance Report for 2018 on October 8 of this year – see https://www.cdc.gov/std/stats18/default.htm.
 
Reported cases of gonorrhea, Chlamydia, and syphilis – including congenital syphilis – were all higher than in 2017. There have been annual increases in gonorrhea since 2009, in Chlamydia since early-mid 2000s, and in syphilis since 2001. See the CDC infographic for a quick summary:

Graph showing the state of STDs in the US

See more infographics:  (https://www.cdc.gov/std/stats18/infographic.htm).
 
Key Points:
  • Young Persons:  half of STDs occur in young people, ages 15-24 years. Specifically, nearly two-thirds of reported Chlamydia infections were among persons in this same age group.
  • Chlamydia is associated with significant complications for females, notably, pelvic inflammatory disease (PID) with possible long-term sequelae of tubal factor infertility, ectopic pregnancy, and chronic pelvic pain.
  • Gonorrhea increased 5%, indicating higher rates as well as likely more screening, including extra-genital and urine-based tests. Gonorrhea continues to demonstrate antibiotic resistance, which limits treatment (cure) efforts. Rates continue to be higher in males, particularly MSM; and higher among African Americans – males and females.  Among MSM, those with relatively closed sexual networks (especially seen with Black and Latinx MSM networks) – are in high prevalence communities, raising the risk of infection, even with less risky individual behavior. For Black and Latinx MSM, social determinants of health (e.g., lower socioeconomic circumstances, low healthcare access) as well as subsequent behavioral determinants (i.e., internalized racism, homophobia, and stigma).
  • Syphilis rates continue to rise, particularly among MSM – many of whom are also HIV positive. In addition, syphilis infections have sharply risen among heterosexual women with the serious complication of mother to child transmission. As a result, there is now a serious problem with congenital syphilis – leading to stillbirth, as well as severe lifelong physical and neurological problems for the children who are born (see Dr. Bolan’s Dear Colleague letter:  https://www.cdc.gov/std/dstdp/2018-SR-DCL_FINAL.pdf).
  • Human Papilloma Virus (HPV) infections have decreased in terms of ano-genital warts among males and females, particularly among younger females, ages 25-29. Anogenital warts have also declined among MSM.  HPV is not a reportable infection; data are based on NHANES and insurance-claim findings) have reduced in terms of ano-genital warts among males and Vaccination rates do not currently meet Healthy People 2020, but there have been good reductions in HPV infections and high-grade cervical lesions among adolescent and young adult females.  Since HPV vaccine has been available since 2007 (and is now 9-valent), the impact of immunizations is clear.
  • Herpes simplex virus (HSV) infections have been waning overall. However, increases in anogenital HSV-1 infection have continued. This likely reflects expanding sexual practices (oral-anogenital contact). Overall, seroprevalence has decreased from 1999-2000 to 2015-16 (Flagg & Torrone, 2018; McQuillan et al, 2018). There is no vaccine.
 
“All Americans should have the opportunity to make choices that lead to health and wellness. Working together, interested, committed public and private organizations, communities, and individuals can take action to prevent STDs and their related health consequences. In addition to federal, state, and local public support for STD prevention activities, local community leaders can promote STD prevention education. Health care providers can take sexual histories as a part of routine preventive exams to assess patients’ risks and identify STD testing and treatment opportunities. Parents can talk to their children about STDs and sexual health. Individuals can discuss ways to protect their health with sexual partners, including using condoms consistently and correctly. As noted in the Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, surveillance is a key component of all our efforts to prevent and control these diseases. This report provides trends in STDs to inform prevention and control strategies. This overview summarizes national surveillance data for 2018 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis.” (https://www.cdc.gov/std/stats18/default.htm, p 1).
 
The Hidden Epidemic:  Confronting Sexually Transmitted Diseases, a 1997 National Institutes of Health Institute of Medicine (IOM) report of the challenges of STDs for the health of the nation. In fact, since that time, the numbers of incident STD cases for gonorrhea, Chlamydia, and syphilis have continued to show a steady rise – almost entirely without exception. The name of this report is so apropos, in that the American public (providers and consumers alike) was largely unaware of the number, type, testing, and transmission routes for the most common STDs. Indeed, studies showed that consumers believed they were being “tested for everything” during routine primary care visits and clinicians generally believed that they knew their patients’ needs for STD screening based on clinical signs and symptoms as well as their risks for acquiring infections.  In addition, many Americans – regardless of their circumstances – do not address sexual health with medical providers, family, and sexual partners. There are many reasons for this, such as actual/perceived social and cultural norms, lack of support for sexual health, concerns about privacy, embarrassment, and potential reactions of others, including medical providers (Eng & Butler [Ed], 1997).
 
Whatever the reasons are – we know that STDs can cause significant suffering and morbidity as well as mortality. The health care costs are enormous, particularly when complications occur (up to “billions annually” [p v]*). Thus, prevention is critical for the health of the nation. In addition, STDs can facilitate sexual transmission or acquisition of HIV and possibly Hepatitis C. The IOM report identified confronting the problem of STDs as a national priority. In addition, over the past several years, Dr. Gail Bolan has carried this torch to raise awareness and affect personal and public health, as did her predecessors. Earlier this year, the Department of Health & Human Services (HHS) has established the STI Federal Action Plan (https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/index.html) to address this “serious public health concern” (p 1). See this website for the overview and more detail, including guidelines and best practices.
 
References:
CDC and HHS web reference citations above (within text).
 
Eng TR, Butler WT (Ed), Institute of Medicine. (1997). Summary: The Hidden Epidemic:  Confronting Sexually Transmitted Diseases. National Academy Press, Washington, DC.
 
Flagg EW, Torrone EA.  (2018). Seroprevalence of herpes simplex virus type 1 and type 2 infections among adults diagnosed with genital herpes: United States, 1999-2016.  Sexually Transmitted Diseases, 45 (Supp 2), p S51.
 
McQuillan G, Kruszon-Moran D, Flagg EW, et al.  (2018). Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49:  United States, 2015-2016. NCHS Data Brief, no 304. National Center for Health Statistics, Hyattsville, MD.
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