EXECUTIVE SUMMARY

Congress recently increased federal funding for sexually transmitted disease (STD) prevention for the first time since 2003, with $3.51 million in additional base funding to the CDC’s STD prevention programs.

Since 2003, STD programs have experienced a 40% decrease in spending power, which have led to staff cuts and clinic closures. Public health advocates are calling for an $82 million increase to ensure programs are equipped with the needed resources and manpower to mount a proper defense against the epidemics.

According to the latest national figures, STD transmission increased for the fifth consecutive year, with nearly 2.5 million combined cases of chlamydia, gonorrhea, and syphilis.


Good news: Congress recently increased federal funding for sexually transmitted disease (STD) prevention for the first time since 2003, with a $3.51 million addition in base funding to the CDC’s STD prevention programs. But is the funding enough to fully address the rise in national STD rates?

David Harvey, executive director, National Coalition of STD Directors (NCSD), calls the increase a “crucial first step, and a down payment toward tackling this growing public health crisis.”

Since 2003, STD programs have experienced a 40% decrease in spending power, which have led to staff cuts and clinic closures. NCSD is calling for an $82 million increase to ensure programs are equipped with the needed resources and manpower to mount a proper defense, Harvey states. While the funding increase is a welcome start, public health advocates will need to build on such momentum.

“Additional funding from Congress will ensure public health STD prevention programs are equipped with the resources they need to address the all-time highs of STDs in the U.S.,” says Harvey. “As rates soar and millions continue to get sick, the time to act is now.”

Added backing comes from the Congressional Caucus for Women’s Issues, a bipartisan membership organization within the House of Representatives. The caucus has issued a letter to the Department of Health and Human Services and the CDC in an effort to develop new initiatives and resources to address the growing STD epidemics, as well as asking the Trump Administration to address these issues.

Public health officials are bracing against rising rates of STDs. According to the CDC’s annual Sexually Transmitted Disease Surveillance Report, STD infections increased for the fifth consecutive year, with nearly 2.5 million combined cases of chlamydia, gonorrhea, and syphilis.1

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, also the highest number for the infection that have been reported since 1991. Numbers for chlamydia increased 3% to more than 1.7 million cases, representing the most ever reported to the CDC.1

Innerbody, an online medical and wellness testing guide, analyzed the CDC’s latest statistics on a city-by-city basis to develop its list of the top 100 cities with the highest STD rates. According to its analysis, the top 10 cities include Baltimore; Jackson, MS; Philadelphia; San Francisco; Montgomery, AL; Augusta, GA; Milwaukee; Killeen, TX; Shreveport, LA; and Indianapolis. The five cities with the highest rates of total STD cases (HIV, syphilis, chlamydia, and gonorrhea) are Los Angeles, Chicago, Houston, Phoenix, and Philadelphia. Nearly half of the top 25 cities with the highest rates of infection are in the South, according to the analysis. California led all states with the most cities in the top 100 with seven cities; Ohio and Texas tied for the second most cities, each with six cities.2

Congenital Syphilis Cases on the Rise

Public health concerns have been raised in light of 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

The New Mexico Department of Health issued a statewide Public Health Order in January 2020, requiring medical professionals to test all pregnant women in their first and third trimesters, and again at delivery for congenital syphilis. In 2018, New Mexico had the eighth highest rate of infants born with congenital syphilis in the United States, with 10 cases reported to the state agency, resulting in two deaths. From 2012 to 2017, New Mexico reported an average of two cases of congenital syphilis per year; however, as of Dec. 30, 2019, 23 cases of congenital syphilis had been reported to the state health department.3

“This order will assure medical practitioners, with patient consent, will make testing for syphilis part of the standard prenatal care provided to their patients,” New Mexico Department of Health Cabinet Secretary Kathy Kunkel, JD, MSW, said in a statement.4

What are some of the factors that continue to drive the increase in STDs? According to the CDC, some of the issues include:

• drug use, poverty, stigma, and unstable housing, which can reduce access to STD prevention and care;

• decreased condom use among vulnerable groups, including young people and gay and bisexual men;

• cuts to state and local STD prevention programs. Statistics indicate that more than 50% of local programs have experienced budget cuts, resulting in clinic closures, reduced screening, staff loss, and reduced patient follow-up and linkage to care services.5

More Funding Needed for STI Research

There are serious gaps in the research pipeline for the development of prevention and treatment options for gonorrhea, chlamydia, and syphilis, according to a 2019 report from Treatment Action Group. However, there are some positive movements on this front. Efforts to develop new gonorrhea treatment options are moving forward, while investigations of doxycycline as pre-exposure prophylaxis for chlamydia and syphilis are underway. Vaccine research funding also has increased: In 2018, the National Institutes of Health made a significant new investment in gonorrhea, chlamydia, and syphilis vaccine research.6

“Despite a few promising advancements, STI research is nowhere near where it needs to be,” says Jeremiah Johnson, MPH, Treatment Action Group’s HIV project director and lead author of the report. “I hope this report is an eye-opener for people working not just on STI prevention, but also other areas of sexual health.”

REFERENCES

  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Available at: https://bit.ly/36qDp5W.
  2. Barclay T, Rodriguez E. These U.S. cities have the highest STD rates. Jan. 13, 2020. Available at: https://bit.ly/35PSRby.
  3. New Mexico Department of Health. Public Health Order of the Cabinet Secretary of the New Mexico Department of Health, Jan. 10, 2020. Available at: https://bit.ly/36V66ZW.
  4. New Mexico Department of Health. Department of Health orders increased screening of syphilis, Jan. 10, 2020. Available at: https://bit.ly/35PPFg4.
  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. Treatment Action Group. Gonorrhea, chlamydia and syphilis: Pipeline Report 2019. Available at: https://bit.ly/37vYtZX.