These STDs Are the Most Common Infectious Diseases Reported to the CDC - TIME

Posted: 08 Oct 2019 12:00 AM PDT

Sexually transmitted disease diagnoses in 2018 broke a record for the fifth consecutive year, according to new data from the U.S. Centers for Disease Control and Prevention (CDC).

Chlamydia was the most common STD in 2018, with more than 1.7 million cases reported, followed by more than 580,000 cases of gonorrhea—3% and 5% increases over 2017, respectively. Though less common, syphilis diagnoses also rose, topping 115,000 cases in total, according to the CDC.

"These are just infections that were diagnosed and reported," says Elizabeth Torrone, an epidemiologist at the CDC. Since lots of STDs are asymptomatic, "many people have infections that never get diagnosed and reported. This really just gives us the minimum burden of the STD epidemic."

The report says chlamydia and gonorrhea also topped the CDC's most recent list of "nationally notifiable" illnesses, a collection of about 120 infectious diseases and other conditions that local health departments report to the CDC. (Full 2018 data is not yet available; 2017 is the latest year on record.) Other common STDs, like HPV, are not considered nationally notifiable.

Torrone says she's particularly worried about the rise in syphilis, both among adults and babies who contract the infection from their mothers during pregnancy or delivery. About 1,300 cases of congenital syphilis were reported in 2018, a 40% increase over the year before, and the disease contributed to 94 infant deaths.

"All of those cases of congenital syphilis, including those deaths, could have been prevented," Torrone says, if the mothers had been treated during pregnancy. The CDC advises all pregnant women to undergo screening for syphilis and other STDs to prevent transmission to their children.

There are a few possible reasons for persistent increases in STD diagnoses, Torrone says. One could simply be that more people are getting screened, thus leading to more case reports to the CDC. But Torrone says research also suggests fewer people are using condoms, particularly in high-risk populations such as young adults and men who have sex with men. And certain diseases that previously impacted subsets of the national population seem to have spread to new groups, which makes it harder to prevent and contain infections. For example, syphilis historically affected primarily men who have sex with men, but is now also on the rise among women.

The CDC is working on these issues at the public-health level, but Torrone emphasizes that individuals should also do their part by using condoms properly, getting tested regularly and talking about sexual health with their partners and health care providers. "We need to take action to break the cycle of increases," Torrone says.

Write to Jamie Ducharme at jamie.ducharme@time.com.

Public-Health Puzzle: Young People Having Less Sex, Contracting More STDs - The Wall Street Journal

Posted: 18 Oct 2019 02:30 AM PDT

Adolescents and young adults ages 15 to 24 in the U.S. are contracting STDs at... — Adolescents and young adults ages 15 to 24 in the U.S. are contracting STDs at an alarming pace. Photo: iStock

Jo Craven McGinty

Oct. 18, 2019 5:30 am ET

It sounds contradictory: Young people, we're told, are having less sex than older generations did at the same age. But they're also contracting more sexually transmitted diseases than any other group, and the rates of infection are accelerating at an alarming pace.

Last year, combined cases of syphilis, gonorrhea and chlamydia reached an all-time high with half the reported infections occurring in adolescents and young adults ages 15 to 24.

The reason for the increases among younger people is likely a combination of factors, ranging from reduced access to health care to riskier behavior among those who are sexually active.

The findings are part of the annual Sexually Transmitted Disease Surveillance Report published last week by the U.S. Centers for Disease Control and Prevention.

STDs on the Rise

Combined cases of syphilis, gonorrhea and chlamydia reached an all-time high in the U.S. in 2018. Chlamydia was the most prevalent.

2018 rates of reported chlamydia cases, by state

Chlamydia cases, rate per 100,000 population

2018 rates of reported chlamydia cases, by state

Chlamydia cases, rate per 100,000 population

2018 rates of reported chlamydia cases, by state

Chlamydia cases, rate per 100,000 population

2018 rates of reported chlamydia cases, by state

Chlamydia cases, rate per 100,000 population

Among all age groups, chlamydia grew to more than 1.7 million cases in 2018, an increase of 3% over the previous year. Gonorrhea rose to more than 580,000 cases, an increase of 5%. And syphilis climbed to more than 115,000 cases, a 13.3% surge. (The number of HIV diagnoses, which is tracked separately, has been largely stable in recent years.)

It's important to note that the report reflects only a portion of STDs occurring in the U.S. There are at least 35 different sexually transmitted infections, and most—including herpes and human papillomavirus—aren't "notifiable," meaning they aren't tracked by the government.

In addition, the handful of STDs the government does monitor are likely to be undercounted because many people, particularly those who are asymptomatic, may go undiagnosed.

A Common Infection

Based on the number of reported cases, chlamydia was the No. 1 notifiable disease in the country with more than 1.7 million cases.

2018 rates of reported chlamydia cases,

by age and sex, U.S.

Female Rate

According to estimates by the CDC, one in four sexually active adolescent girls has chlamydia or some other STD, and up to 80% of all girls and women who have chlamydia, a disease that can cause infertility, show no symptoms. Based on the number of reported cases, it's the No. 1 notifiable disease in the country, and because of its continuing prevalence, the CDC considers it to be endemic.

But the agency regards the recent surge in syphilis and gonorrhea—the No. 2 notifiable disease—to be epidemic because, until recently, they had been in decline, with syphilis near elimination.

"Something changed starting around 2012," said Gail Bolan, director of the CDC division of STD prevention. "We've seen dramatic increases each year in both males and females."

In 2000 and 2001, the national rate of reported primary and secondary syphilis cases—the most infectious stages of the disease—was the lowest it had been since reporting began in 1941. But by 2018, 35,063 new cases had been recorded. The highest rate was among men ages 25 to 29 with 55.7 cases per 100,000 population. The highest rate for women was among those ages 20 to 24 with 10 cases per 100,000.

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Transmission of syphilis to women of childbearing age is of particular concern because the infection can cause death, preterm birth and physical and mental developmental disabilities. In 2018, there were 1,306 reported cases of congenital syphilis acquired by a fetus in utero. Sixteen infants died, and 78 were stillborn.

Young men also had the highest rates of gonorrhea with 720.9 cases per 100,000 men ages 20 to 24 and 674 cases per 100,000 boys and men ages 15 to 19. But young women weren't far behind. Those ages 20 to 24 had 702.6 cases of gonorrhea per 100,000, and girls and women ages 15 to 19 had 548.1 cases per 100,000.

Gonorrhea is worrisome because it quickly develops resistance to antibiotics. More than half of the infections reported last year were resistant to at least one antibiotic.

The CDC attributes the recent surge in STDs to decreased condom use, increased drug use, poverty and cuts to prevention programs run by state and local health departments. In recent years, the agency reports, more than half of local STD programs have experienced budget cuts that led to clinic closures, as well as reduced screening and patient follow-up.

Federal spending has also been curtailed.

"In the federal government, there is one dedicated STD funding line, and that is the line item in the appropriation bill funding the division of STD prevention at the CDC," said David Harvey, executive director of the National Coalition of STD Directors. "That appropriation has been whittled away over the last 18 years."

That could soon change.

The latest House appropriations bill, if approved, would increase spending on STD prevention by $10 million. Separately, the U.S. Department of Health and Human Services, which includes the CDC, is developing what it calls the nation's first Sexually Transmitted Infections Federal Action Plan to address and reverse the epidemic.

As for how younger people are having less sex but are acquiring more STDs, the answer isn't clear. It may be that those who are sexually active are engaging in riskier behavior. It may have to do with nonmonogamous partners spreading infections widely within their sexual networks. It could have to do with a lack of education and reduced access to health care. Or it could be a combination of factors.

As they say on social media: It's complicated.

Write to Jo Craven McGinty at Jo.McGinty@wsj.com

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