EXECUTIVE SUMMARY

New data from the CDC indicate that combined cases of syphilis, gonorrhea, and chlamydia reached an all-time high in the United States in 2018.

• Primary and secondary syphilis cases rose 14% to more than 35,000 cases, the highest number reported since 1991. Cases of syphilis in newborns increased 40% to more than 1,300 cases.

• Gonorrhea rates rose 5% to more than 580,000 cases, the highest numbers that have been reported since 1991.

• Chlamydia numbers moved up 3% to more than 1.7 million cases, representing the most cases ever reported to the CDC.


Public health officials are calling for a full-court press against the rising numbers of sexually transmitted infections (STIs). New data from the CDC indicate that combined cases of syphilis, gonorrhea, and chlamydia reached an all-time high in the United States in 2018.1

The three most common STIs — syphilis, gonorrhea, and chlamydia — all recorded increases from the previous years, statistics show. Figures for primary and secondary syphilis cases rose 14% to more than 35,000 cases, the highest number reported since 1991. Cases of syphilis in newborns increased 40% to more than 1,300 cases. Figures for gonorrhea rose 5% to more than 580,000 cases, the highest number for the STI that has been reported since 1991. Numbers for chlamydia moved up 3% to more than 1.7 million cases, representing the most ever reported to the CDC.

“STDs can come at a high cost for babies and other vulnerable populations,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in a statement. “Curbing STDs will improve the overall health of the nation and prevent infertility, HIV, and infant deaths.”2

Concern for Congenital Syphilis

Public health officials voiced serious concern in the dramatic rise in congenital syphilis cases. While most states recorded at least one incident of congenital syphilis, five states — Texas, California, Florida, Arizona, and Louisiana — accounted for 70% of cases in 2018.1

“There are tools available to prevent every case of congenital syphilis,” said Gail Bolan, MD, director of CDC’s Division of STD Prevention.2 “Testing is simple and can help women to protect their babies from syphilis — a preventable disease that can have irreversible consequences.”

Untreated syphilis infection during pregnancy directly affects the risk of adverse pregnancy outcomes. In a 2013 systematic review, data indicate that untreated maternal syphilis infection during pregnancy was associated with a difference of 21% for stillbirth or fetal loss, 9% for neonatal death, and 5% for prematurity or low birth weight in comparison with pregnancies that did not have infection.3 While infants born with congenital syphilis often are asymptomatic at birth, some babies may develop such signs as rash, hemorrhagic rhinitis, lymphadenopathy, and skeletal abnormalities within the first several weeks.4 Further symptoms include anemia, meningitis, and neurologic impairment such as blindness or deafness.

What Is Driving the Increase?

What factors are contributing to the overall increase in STIs? Drug use, poverty, stigma, and unstable housing affect access to STI prevention and care, according to reports.5

Public health officials also point to a decline in condom use among vulnerable groups, including young people and gay and bisexual men. According to a recent report, while 54% of sexually active high school students in 2017 used a condom at their last sexual intercourse, such use has declined since 2013.6

Budget cuts to reproductive health clinics also have affected care. Health departments that participated in a 2017 survey reported stagnant or declining funds for HIV, STIs, and viral hepatitis services. While not nationally representative, local departments reporting funding cuts noted that the services they reduced were most likely to affect disease surveillance and STI partner services, as well as HIV testing and hepatitis B vaccination. Forty-three percent reported reductions in HIV, STIs, and/or viral hepatitis program staffing levels. The greatest staffing loss was in public health nurses.6

The U.S. Department of Health and Human Services (HHS), which includes the CDC, is developing a STI Federal Action Plan with input from 20 federal agencies and offices, as well as healthcare providers, local and state health departments, community-based and faith-based organizations, national organizations, and tribes and tribal organizations. The plan will include input from six listening sessions hosted by HHS, which included more than 1,000 participants representing nearly every state. More than 300 comments also were gathered following a request for information published in the Federal Register.

“It is time to reverse the worrisome upward trend in sexually transmitted infections, and the STI Plan will help lead the way,” wrote Brett Giroir, MD, Assistant Secretary for Health, in a blog post.7

REFERENCES

  1. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2018. Aug. 27, 2019. Available at: https://bit.ly/2pUCtal.
  2. Centers for Disease Control and Prevention. New CDC report: STDs continue to rise in the U.S. Oct. 8, 2019. Available at: https://bit.ly/316sNXj.
  3. Gomez GB, Kamb ML, Newman LM, et al. Untreated maternal syphilis and adverse outcomes of pregnancy: A systematic review and meta-analysis. Bull World Health Organ 2013;91:217-226.
  4. Kingston M, French P, Higgins S, et al; Members of the Syphilis Guidelines Revision Group 2015. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2016;27:421-446.
  5. National Academy of Public Administration. The impact of sexually transmitted diseases on the United States: Still hidden, getting worse, can be controlled. December 2018. Available at: https://bit.ly/2GYvGV5.
  6. Witwer E, Jones RK, Lindberg LD. Sexual behavior and contraceptive and condom use among U.S. high school students, 2013-2017. Guttmacher Institute; September 2018. Available at: https://bit.ly/35YXMbe.
  7. Giroir BP. HHS federal plan to tackle rising rates of sexually transmitted infections. Oct. 8, 2019. Available at: https://bit.ly/2IyV42q.