For years, experts at the Centers For Disease Control and Prevention (CDC) have claimed that sexually transmitted infections (STIs) are "a hidden epidemic" in America. Now, STIs are becoming a public health crisis, according to David Harvey, executive director of the National Coalition of STD Directors (NCSD), and he's calling on President Trump to officially declare a state of emergency.
Harvey made the statement Tuesday at the National STD Prevention Conference in Washington, D.C. Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017, according to data released at the conference. That number shatters the record high of STI cases diagnosed in 2016 by more than 200,000, and marks the fourth year in a row that STI rates spiked from the year previous. Gonorrhea diagnoses increased 67% (from 333,004 to 555,608 cases) between 2013 and 2017, syphilis diagnoses increased 76%, and chlamydia remained the most common condition reported to the CDC with 1.7 million diagnoses in 2017. Those numbers sound frightening on their own, but they only represent the cases that have been reported. Many sexually transmitted infections go undiagnosed and untreated, according to the CDC.
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"We are sliding backward," Jonathan Mermin, M.D., director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a statement. "It is evident [that] the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point."
Typically, doctors suggest antibiotics to treat chlamydia, gonorrhea, and syphilis. But in the last several years, the CDC and the World Health Organization (WHO) have seen reports of antibiotic resistant gonorrhea. The CDC first detected antibiotic-resistant gonorrhea in the U.S. in the early 2000s. By 2006, 14% of gonorrhea cases were resistant to one out of three of the antibiotics used to treat it and by 2012, the CDC was recommending treatment with only the most highly effective antibiotic, according to the CDC. And the threat of untreatable gonorrhea makes the steadily increasing rates of the STI even more alarming. “We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” Gail Bolan, M.D., director of CDC’s Division of STD Prevention, said in the statement. “We can’t let our defenses down — we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible.”
In addition to NCSD’s ask that President Trump and Health and Human Services Secretary Alex Azar declare STIs a public health crisis — which would not only raise awareness, but also encourage the government to direct funds to address the climbing STI rates — the CDC is asking health care providers to double down on efforts to prevent STIs in the first place. Specifically, the agency is encouraging doctors to make STI screening a standard practice.
But there's a lot more at play here than whether or not every doctor offers a STI test during annual checkups. Plenty of people don't go to or can't afford regular doctor's visits. And many people aren't given the information they need to make safe sex choices. In fact, previous CDC studies have suggested that poverty, stigma, discrimination, and drug use all play heavily into the reasons many people don't get tested for STIs. That shows in the numbers. Gay, bisexual, and other men who have sex with men (MSM) made up 70% of the syphilis cases reported in 2017. And 15 to 24-year-old women make up 45% of the chlamydia diagnoses.
Discrimination, stigma, and lack of communication are all part of the reason these two populations are hit hardest. In its 2015 STI report, the CDC said that the first hurdle to reducing STI rates would be to "confront the reluctance of American society to openly confront issues surrounding sexuality and STDs." In essence: We need to talk about sex, advocate for having sex that makes us feel safe and comfortable, and be open with our partners when we know we have an STI. It sounds like a simple solution, but those kinds of frank discussions about sex actually take a lot of courage in a culture that silences talk about sexual desire and pleasure (especially for women and queer folk). Maybe, a public health warning will help.