New STD Stats, Not Much to Cheer

By Kait Scalisi, MPH

Each year, the CDC’s annual report on sexually transmitted diseases (STDs) gives hard evidence that America isn’t a sexually healthy nation. There are an estimated 20 million new sexually transmitted infections in the U.S. annually—more than the number of cases of diabetes, heart disease, breast cancer, and asthma combined—which can lead to many serious health problems, including infertility, male and female cancers, and fetal illness.

The data included in Sexually Transmitted Disease Surveillance, 2013 are compiled from STD case reports from private and public sources. The report does not provide comprehensive STD information for a variety of reasons, including the fact that some infections are not routinely reported, and nationally reported diseases like chlamydia, gonorrhea, and syphilis often go undiagnosed. Nevertheless, the trends highlighted in the report provide an overall picture of the current state of STDs in the U.S. and help public health professionals see trends, set priorities, and adapt strategies for prevention and control.

The 2013 report shows some wins for sexual health. There was a decrease in chlamydia for the first time since nationwide reporting for the disease began. That the decrease was higher among women is also important given that chlamydia’s long-term impacts are more serious for women. While gonorrhea rates remained practically the same, there was a decrease among adolescents (15-24). Increased availability of urine testing have allowed men to get diagnosed with and treated for chlamydia more regularly. Initial visits for trichomoniasis and other vaginal infections among women declined.*

On the other hand, gonorrhea rates went up for non-adolescents and there was an increase in all forms of syphilis (primary, secondary, and congenital). Initial visits for genital warts and herpes increased.* There continued to be sometimes huge discrepancies in STD rates by race, sexual behavior, location, and age. Men who have sex with men (MSM), adolescents, and blacks continue to carry a disproportionate disease burden. Though chlamydia and gonorrhea diagnoses decreased overall for adolescents, they continue to be diagnosed more frequently than any other age group. Meanwhile, the increase in primary and secondary syphilis diagnoses was only among men, with MSM accounting for nearly three-quarters (75%) of the diagnoses. About half of these men also have HIV/AIDS.

Lastly, the report highlights factors that contribute to the disproportionate distribution of STDs. These include but certainly are not limited to:

The ability to access and pay for any sexual health care.
The ability to receive culturally-sensitive and appropriate care and treatment.
The lack of provider training on and/or adherence sexual health guidelines.
Individual risk behaviors including number of sex partners, condom use, etc.
Distrust of the medical establishment.

This last piece is particularly important as it highlights the need for better provider training as well as more effective outreach to adolescents and MSM. While public health is slowly becoming more sex-positive, the continued inequality in STD diagnoses represents a call to action to do something differently. While the larger picture is a positive one—some of the lowest rates of unplanned pregnancies ever, for instance—these numbers show the continued need for education, outreach, and empathy around STDs.

*Trichomoniasis and other vaginal infection data are not nationally representative.