Research shows a continued trend of increased cases of sexually transmitted diseases (STDs) through 2019. A sharp decline was reported at the beginning of the COVID-19 pandemic in the spring of 2020.1,2

The 2019 STD Surveillance Report noted annual cases of STDs in the United States reached an all-time high in 2019 for the sixth consecutive year. In 2019, there were 2.5 million reported cases of chlamydia, gonorrhea, and syphilis, and a nearly 30% increase in reportable STDs between 2015 and 2019.1

Data from 2020 showed a similar trend of high STD cases in the first 11 weeks of 2020, but reported cases were much lower than 2019 cases for a week in April 2020.2

“According to our study, during March-April 2020, preliminary national case reporting for STDs dramatically decreased, compared to the same time in 2019,” says Melissa Pagaoa, MPH, epidemiologist for the Centers for Disease Control and Prevention (CDC). “However, resurgence in reported gonorrhea and syphilis cases later in the year suggest STDs may have increased during 2020.”

Three factors were the likely cause of the initial decrease in diagnosed and reported cases of STDs:

  • Reduced screening. “Many healthcare clinics either limited in-person visits to symptomatic cases or closed entirely,” Pagaoa says.
  • Limited resources. State and local health department STD staff often were redirected from routine STD responsibilities to COVID-19 activities, reducing staff available to track and report STDs.
  • Stay-at-home orders. The orders were intended to reduce the spread of COVID-19, but also might have influenced sexual behaviors and reduced transmission of STDs.

“The COVID-19 pandemic exacerbated an already-stretched system for STD control in the United States and accelerated the need to deliver accessible, high-quality STD services in new ways,” Pagaoa says.

The CDC identified several innovative ways that STD services can meet people where they are, both during the pandemic and in the future, she notes. These include:

  • STD express clinics. These can provide walk-in testing and treatment without a full clinical exam.
  • Partnerships with pharmacies and retail health clinics. These sites can provide new access points for STD services, including on-site testing and treatment.
  • Telehealth/telemedicine. With telehealth/telemedicine, the healthcare community can close the gaps in testing and treatment, ensuring access to healthcare providers and supporting self-testing or patient-collected specimens.

The key to success is preventing STDs. “While STDs are incredibly common, they’re also entirely preventable,” Pagaoa explains. “Healthcare providers of all kinds can take three simple actions: talk, test, treat.”

Providers should understand each patient’s sexual history and current risk. This helps providers offer tailored counseling, which enables patients to make informed decisions about their sexual health. “Testing and treating for these infections, according to CDC’s clinical guidance, can protect the health of their patients and others,” she says.

For the week of Dec. 6-12, 2020, the preliminary cumulative totals for the year, compared to 2019, were 14% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for primary and secondary syphilis, Pagaoa says.2

As of late October 2021, STD data for 2021 were not publicly available.

“Before the pandemic, reductions in STD screening, treatment, prevention, and partner services contributed to STD increase for many years,” Pagaoa says. “Since the pandemic, large numbers of STD program staff have been deployed to the COVID-19 response. Less staff and resources means more delays in services.”

Also, public health and disease prevention staff report experiencing burnout as they pivot from COVID-19 back to STD intervention and partner services. “STD defenses are down,” she says. “We must prioritize and focus our efforts to regain lost ground and control the spread of STDs.”

On-the-ground support is needed for prevention and surveillance programs at the state and local level, including disease investigation, contact tracing, training, and community engagements and partnerships.

From a provider perspective, communication is essential. “Providing quality care requires providers and patients to have open and honest discussions about sexual health and STDs,” Pagaoa says. “Taking a sexual history of each patient should be a routine part of healthcare and is especially important when there are symptoms or physical exam findings that suggest a possible infection.”

One potential best practice strategy is to read the CDC’s guide to taking a sexual history.3 “It outlines general guidance on creating a welcoming clinical environment, as well as approaching these potentially uncomfortable conversations in a respectful, patient-centered way,” Pagaoa says.

Also, the Sexually Transmitted Infections (STI) Treatment Guidelines, 2021, provides current evidence-based prevention, diagnostic, and treatment recommendations. It serves as an important source of clinical guidance for anyone providing STI-related care.4

“CDC has published a number of resources to help providers leverage the guidance, including an 18 × 24 in. wall chart, as well as a pocket guide, of recommended STI treatment regimens,” Pagaoa adds. “An easy-to-digest table of screening recommendations is available; providers can toggle recommendations by disease or population, whichever is easier for them.”

Providers are the gateway to STD testing and treatment for patients, and they are an invaluable resource for accurate prevention information.

“By working together, patients and providers can help reduce STDs in the United States,” Pagaoa says.

REFERENCES

  1. Centers for Disease Control and Prevention. Reported STDs reach all-time high for 6th consecutive year. April 13, 2021.
  2. Pagaoa M, Grey J, Torrone E, et al. Trends in nationally notifiable sexually transmitted disease case reports during the US COVID-19 pandemic, January to December 2020. Sex Transm Dis 2021;48: 798-804.
  3. Centers for Disease Control and Prevention. A guide to taking a sexual history. Reviewed July 19, 2021.
  4. Centers for Disease Control and Prevention. STI treatment guidelines, 2021. Reviewed July 22, 2021.