Clinician Alert: STIs Hit High-water Mark
EXECUTIVE SUMMARY
More than 2 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States in 2016, the highest number ever, according to the latest surveillance from the Centers for Disease Control and Prevention.
- Most of the new diagnoses of sexually transmitted infections were attributed to chlamydia (about 1.6 million), with 470,000 cases of gonorrhea and almost 28,000 cases of primary and secondary syphilis.
- While all three infections may be treated with antibiotics, such serious health consequences as infertility, ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission can arise if cases are not addressed.
More than 2 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States in 2016, the highest number ever, according to the latest surveillance from the Centers for Disease Control and Prevention (CDC).1
Most of the new diagnoses of sexually transmitted infections (STIs) were attributed to chlamydia (about 1.6 million), with 470,000 cases of gonorrhea and almost 28,000 cases of primary and secondary syphilis.
During 2011-2013, the rate of reported chlamydial infection decreased to 443.5 cases per 100,000 population, followed by an increase in the rate of reported cases over each of the next three years, the new surveillance notes. During 2015-2016, the rate increased 4.7%, from 475.0 to 497.3 cases per 100,000 population.1
While chlamydia, gonorrhea, and syphilis may be treated with antibiotics, such serious health consequences as infertility, ectopic pregnancy, stillbirth in infants, and increased risk for HIV transmission can arise if cases are not addressed.
Of particular concern to public health officials is the rise in congenital syphilis. The growth in cases of syphilis among newborns between 2014 and 2016 has accelerated: In 2014, there were 461 reported cases of congenital syphilis, while in 2016, there were 628 reported cases. Untreated maternal infection can lead to fetal death, preterm birth, and congenital infection in a proportion of surviving infants, leading to physical and mental developmental disabilities.2 Most cases of congenital syphilis can be prevented if women are screened for syphilis and treated early during their prenatal care visits.
“Every baby born with syphilis represents a tragic systems failure,” said Gail Bolan, MD, director of the CDC’s Division of STD Prevention in a statement. “All it takes is a simple STD test and antibiotic treatment to prevent this enormous heartache and help assure a healthy start for the next generation of Americans.”
Men Also at Risk
Another highlight from the recent report is the growth of gonorrhea in men. While the STI increased among men and women in 2016, the largest increases were seen among men. Men who have sex with men (MSM) may be most affected, research indicates.3
Finding new options for treatment of gonorrhea has become a high priority for public health officials. A cluster of gonorrhea infections that shows both decreased susceptibility to ceftriaxone and very high-level resistance to azithromycin has been identified.4 (Contraceptive Technology Update reported on the incident; see the January 2017 article, “STDs at Unprecedented High in United States,” available at http://bit.ly/2hrYtkh.) Ceftriaxone plus azithromycin is the only recommended treatment for gonorrhea.5
“Because we have seen indications in recent years that drug resistance could soon jeopardize the last recommended treatment for gonorrhea, it is vitally important to strengthen the timeliness of our surveillance efforts to preserve our ability to treat gonorrhea,” says Elizabeth Torrone, PhD, an epidemiologist in the CDC’s Division of STD Prevention. “CDC recently launched a new program ‘SURRG’ — Strengthening the U.S. Response to Resistant Gonorrhea — a system designed to enhance domestic gonorrhea surveillance and infrastructure by working with local and state health departments to detect emerging resistance in the laboratory and stopping transmission through field investigation.”
Be Sure to Screen
What can you do as a provider to stem the tide? The CDC suggests that all clinicians should make STD screening and timely treatment a standard part of medical care, especially for pregnant women and MSM. Look to seamlessly integrating STD screening and treatment into prenatal care and HIV prevention and care services, the CDC recommends.
What are testing recommendations for your patients? The CDC suggests the following:
- All adults and adolescents from ages 13-64 should be tested at least once for HIV.
- Annual chlamydia screening is recommended for all sexually active women younger than 25 years of age, as well as for older women with such risk factors as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
- Annual gonorrhea screening is recommended for all sexually active women younger than 25 years of age, as well as for older women with risk factors (new or multiple sex partners, or a sex partner who has a sexually transmitted infection).
- Syphilis, HIV, and hepatitis B screening is recommended for all pregnant women. Chlamydia and gonorrhea screening for at-risk pregnant women should start early in pregnancy, with repeat testing as needed, to protect the health of mothers and infants.
- Screening should be performed at least once a year for syphilis, chlamydia, and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men. Those MSM who have multiple or anonymous partners should be screened more frequently for STDs, such as at three- to six-month intervals.
- Sexually active gay and bisexual men also may benefit from more frequent HIV testing.
- Patients who have unsafe sex or share injection drug equipment should get tested for HIV at least once a year.6
REFERENCES
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2016. Atlanta: U.S. Department of Health and Human Services; 2017.
- Centers for Disease Control and Prevention. Congenital syphilis — United States, 2003–2008. MMWR Morb Mortal Wkly Rep 2010;59:413-417.
- Stenger MR, Pathela P, Anschuetz G, et al. Increases in the rate of Neisseria gonorrhoeae among gay, bisexual and other men who have sex with men-findings from the Sexually Transmitted Disease Surveillance Network 2010-2015. Sex Transm Dis 2017;44:393-397.
- Katz AR, Komeya AY, Tomas JE, et al. Cluster of Neisseria gonorrhoeae isolates with high-level azithromycin resistance and decreased ceftriaxone susceptibility. Presented at the 2016 National STD Prevention Conference. Atlanta; September 2016.
- Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64 (No. RR-03):1-137.
- Centers for Disease Control and Prevention. STD & HIV Screening Recommendations. Available at: http://bit.ly/2k53BhJ. Accessed Oct. 16, 2017.
More than 2 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States in 2016, the highest number ever, according to the latest surveillance from the Centers for Disease Control and Prevention.
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