Rates of reported cases of primary and secondary syphilis in the U.S. by region, 2009-2018. In 2018, the West had the highest rate of reported P&S syphilis cases (15.0 cases per 100,000 population), followed by the South (11.1 cases per 100,000 population), the Northeast (8.7 cases per 100,000 population), and the Midwest (7.1 cases per 100,000 population). During 2017–2018, the P&S syphilis rate increased 16.4% in the Midwest, 15.6% in the South, 15.4% in the West, and 10.1% in the Northeast. Graphic: CDC
Rates of reported cases of primary and secondary syphilis in the U.S. by region, 2009-2018. In 2018, the West had the highest rate of reported P&S syphilis cases (15.0 cases per 100,000 population), followed by the South (11.1 cases per 100,000 population), the Northeast (8.7 cases per 100,000 population), and the Midwest (7.1 cases per 100,000 population). During 2017–2018, the P&S syphilis rate increased 16.4% in the Midwest, 15.6% in the South, 15.4% in the West, and 10.1% in the Northeast. Graphic: CDC

By Rachel Feltman
10 October 2019

(Popular Science) – Sexually transmitted infections (STIs) are still on the rise in the United States, according to the latest data from the Centers for Disease Control (CDC). On Tuesday the CDC released a report on statistics from 2018, which indicate historic rates of chlamydia and the worst rates of syphilis and gonorrhea since 1991. Most concerningly, the CDC reports a 40 percent increase in congenital syphilis—a potentially fatal and totally preventable condition where infection passes from a parent to a fetus through the placenta—since 2017. This represents the fifth year in a row that STIs have hit all-time highs.

In 2018, Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted that rising infection rates showed we were “sliding backward,” with “systems that identify, treat, and ultimately prevent STDs … strained to near-breaking point.” The latest report makes it clear those systems have all but crumbled. […]

Graph showing rates of reported cases of chlamydia in the United States by sex, 2000-2018. In 2018, a total of 1,758,668 chlamydial infections were reported to CDC in 50 states and the District of Columbia. This case count corresponds to a rate of 539.9 cases per 100,000 population. In 2018, 1,145,063 cases of chlamydia were reported among females for a rate of 692.7 cases per 100,000 females. Among males, 610,447 cases of chlamydia were reported for a rate of 380.6 cases per 100,000 males. Graphic: CDC
Rates of reported cases of chlamydia in the United States by sex, 2000-2018. In 2018, a total of 1,758,668 chlamydial infections were reported to CDC in 50 states and the District of Columbia. This case count corresponds to a rate of 539.9 cases per 100,000 population. In 2018, 1,145,063 cases of chlamydia were reported among females for a rate of 692.7 cases per 100,000 females. Among males, 610,447 cases of chlamydia were reported for a rate of 380.6 cases per 100,000 males. Graphic: CDC

How have infection rates changed?

In 2018 (the CDC’s reports always lag behind by nearly a year, as it takes time to compile and analyze all the data), all three of the most commonly reported STIs saw an increase.

The CDC received 580,000 reports of gonorrhea, which represents a 5 percent increase since 2017 and marks the worst year for the bacterial infection since 1991. Cases have surged by a staggering 63 percent since 2014. Chlamydia broke an all-time record, hitting 1.7 million cases (which amounts to a 3 percent rise since 2017 and a 19 percent rate increase since 2014.

Trichomonas vaginalis and other vaginal infections among females, 1966-2016. Trichomonas vaginalis visits appear to be fairly stable since the 1990’s; the number of initial visits for T. vaginalis infection in 2016 was 222,000. The 2017 and 2018 NDTI data were under review at the time of publication of this report and thus are not included. Graphic: CDC
Trichomonas vaginalis and other vaginal infections among females, 1966-2016. Trichomonas vaginalis visits appear to be fairly stable since the 1990’s; the number of initial visits for T. vaginalis infection in 2016 was 222,000. The 2017 and 2018 NDTI data were under review at the time of publication of this report and thus are not included. Graphic: CDC

Syphilis is a bit more complex, as the bacterial infection presents in several stages if it’s not treated with antibiotics. But cases of the most infectious first and second stages increased by 14 percent, hitting 35,000—the highest number since 1991.

The CDC is most concerned about the large uptick in congenital syphilis in newborns, which can cause serious health problems throughout adulthood. The CDC received reports of 1,300 cases in 2018, representing a 40 percent increase. Related fatalities also increased by 22 percent. Those 94 infant deaths were completely preventable, as syphilis can easily be treated with antibiotics if patients have access to testing and healthcare.

Line graph showing rates of reported cases of gonorrhea in the United States by region from 2009 to 2018. The South had the highest rate of reported gonorrhea cases (194.4 cases per 100,000 population) among the four regions of the United States in 2018, followed by the Midwest (184.5 cases per 100,000 population), the West (179.7 cases per 100,000 population), and the Northeast (138.4 cases per 100,000 population). During 2017–2018, the gonorrhea rate increased in all four regions: 8.5% in the Midwest, 7.4% in the West, 7.3% in the Northeast, and 1.3% in the South. During 2014–2018, the rate of gonorrhea increased by 79.9% (from 99.9 to 179.7 cases per 100,000 population) in the West and by 73.7% (from 106.2 to 184.5 cases per 100,000 population) in the Midwest, while the Northeast and South had lower overall increases during this time period (64.0% and 49.7%, respectively). Graphic: CDC
Rates of reported cases of gonorrhea in the United States by region from 2009 to 2018. The South had the highest rate of reported gonorrhea cases (194.4 cases per 100,000 population) among the four regions of the United States in 2018, followed by the Midwest (184.5 cases per 100,000 population), the West (179.7 cases per 100,000 population), and the Northeast (138.4 cases per 100,000 population). During 2017–2018, the gonorrhea rate increased in all four regions: 8.5% in the Midwest, 7.4% in the West, 7.3% in the Northeast, and 1.3% in the South. During 2014–2018, the rate of gonorrhea increased by 79.9% (from 99.9 to 179.7 cases per 100,000 population) in the West and by 73.7% (from 106.2 to 184.5 cases per 100,000 population) in the Midwest, while the Northeast and South had lower overall increases during this time period (64.0% and 49.7%, respectively). Graphic: CDC

Why are rates of sexually transmitted infections going up?

That’s the million-dollar question, and there are likely several factors at play. One issue, as previously reported by PopSci, is that the immense stigma surrounding STIs prevents people from getting tested, getting treated, and disclosing infections to partners. Recent reports actually show that teens are waiting longer to have sex, but CDC data does suggest that young people, along with gay and bisexual men, are using condoms less reliably. An increase in unprotected oral sex among young people may also be a factor.

But one thing is clear: The above factors are not to blame for our current predicament. According to a report published by the CDC in February, the uptick in heterosexual syphilis transmission seems closely tied to recent drug use epidemics, and could potentially be addressed in tandem by offering better access to counseling and healthcare. The CDC also reports that more than half of local STD-prevention programs have experienced budget cuts in recent years, resulting in clinic closures, reduced screening, staff loss, and reduced patient follow-up. [more]

America’s sexually transmitted disease rates are out of control