Why Officials Aren’t Celebrating a Drop in STDs
US health officials are concerned a dip in the overall number of three common sexually transmitted diseases in 2020 was largely driven by a decline in screening and diagnoses, as resources were diverted and access to care was limited during the COVID-19 pandemic.
That slight drop marked the first decline in such cases in seven years, with the total number surging by nearly 20% between 2016 and 2019 alone. Yet the report makes clear it isn’t a sign of progress to be celebrated.
COVID-19 “significantly affected trends in STDs during 2020 – resulting in likely underreporting of infections and possibly increased STD transmission,” it says. “It’s likely that such effects will persist for several more years and we may never know the full impact of the pandemic on STDs.
“What is clear, however, is the state of STDs did not improve in the United States. Prevention and control efforts remain as important as ever.”
The report acknowledges that social distancing measures like shelter-in-place orders may have limited sexual activity and curbed the spread of STDs. Yet it shows as well that the number of reported cases of chlamydia, gonorrhea, and primary and secondary syphilis all declined early in the pandemic, as fewer health care services and personnel were available for STD screening, surveillance and control.
In many cases, the report notes, health care clinics were limited or closed. Resources were diverted to address the mounting number of COVID-19 cases, while a decrease in routine health care visits and laboratory supply shortages may have contributed to the initial decrease as well.
Later, however, reported cases of gonorrhea and syphilis increased, resulting in their ultimately surpassing 2019 levels. Gonorrhea cases were up 10% in 2020 from 2019, at nearly 678,000, while cases of primary and secondary syphilis rose by 7% to close to 42,000, according to the report.
Cases of chlamydia, which historically accounts for the largest proportion of sexually transmitted diseases reported in the US, decreased by 13% in 2020 from 2019, to roughly 1.6 million.
Yet again, the report says the decline was likely not due to a reduction in new infections, but rather to a decrease in screening and diagnosis, since chlamydia is often asymptomatic and identified during routine preventive care. Health departments also prioritized treatment and diagnosis of syphilis and gonorrhea, which may also have led to a dearth in chlamydia cases discovered.
“The COVID-19 pandemic strained our nation’s already crumbling public health infrastructure,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “We’ll be working for some time to document the impact of these disruptions on our nation’s (sexually transmitted infection) epidemics, but we cannot wait for full understanding to act.”
The report also notes that the rate of congenital syphilis cases in the US – which occurs when a pregnant mother passes syphilis to her baby, and can cause miscarriage, stillbirth or infant death – rose nearly 15% in 2020 compared with 2019, to 57.3 deaths per 100,000. That also marked a more than 520% increase over the rate of 9.2 per 100,000 in 2013. Since 2013, the rate of congenital syphilis has increased each year.
Similar to the disproportionate impact of certain populations experienced from COVID-19, the report also found disparities in the incidence of sexually transmitted diseases among certain marginalized populations. More than 30% of all cases of chlamydia, gonorrhea, and primary and secondary syphilis were among Black individuals, for example, despite this group making up only approximately 12% of the US population. Men who have sex with men were also disproportionately affected by gonorrhea and syphilis, according to the report, while young people between the ages of 15 and 24 accounted for more than half of reported STD cases in 2020.
Mermin said curbing STDs in the US will require a “whole nation approach” that involves local health systems, clinics and community-based organizations all responding to emerging STD trends.
He also called for new scientific discoveries that can lead to better disease tracking and the increased development of more vaccines and treatments for STDs.
“We have very few vaccines that are effective for STIs in general, and we need them for gonorrhea, syphilis and chlamydia,” Mermin said. ,