The ‘out of control’ STD situation has US health officials calling for change

NEW YORK — A sharp increase in cases of some sexually transmitted diseases — including a 26 percent increase in new syphilis infections reported last year — has U.S. health officials calling for new prevention and treatment efforts.

“It is imperative that we … work to rebuild, innovate and expand prevention (STD) in the U.S.,” Dr. Leandro Mena of the U.S. Centers for Disease Control and Prevention said in a speech Monday at a medical conference on sexually transmitted diseases. diseases.

Infection rates for some STDs, including gonorrhea and syphilis, have been rising for years. Last year, the rate of syphilis cases reached its highest level since 1991, and the total number of cases reached its highest level since 1948. HIV cases also increased by 16% last year.

And an international epidemic of monkeypox, which spreads mainly among men who have sex with other men, has further highlighted the nation’s worsening problem with primarily sexually transmitted diseases.

David Harvey, executive director of the National Coalition of STD Directors, called the situation “out of control.”

Officials are working on new approaches to the problem, such as home testing kits for some STDs, that will make it easier for people to know they are infected and take steps to prevent spreading them to others, Mena said.

Another expert said a major part of any effort should work to increase condom use.

“It’s pretty simple. More sexually transmitted infections occur when people have more unprotected sex,” said Dr. Mike Saag, an infectious disease expert at the University of Alabama at Birmingham.

Syphilis is a bacterial disease that manifests as genital sores, but can eventually lead to severe symptoms and death if left untreated.

[Alaska had a record number of syphilis cases in 2020; this year is on track to hit similar highs]

New syphilis infections declined sharply in the US in the 1940s when antibiotics became widely available. They fell to their lowest level since 1998, when fewer than 7,000 new cases were reported nationwide. The CDC was so encouraged by the progress that it launched a plan to eliminate syphilis in the US

But in 2002, cases began to rise again, mostly among gay and bisexual men, and they continued. In late 2013, the CDC ended its elimination campaign in the face of limited funding and escalating cases, which that year exceeded 17,000.

By 2020, cases had reached nearly 41,700 and increased even more last year to over 52,000.

The rate of cases is also rising, reaching about 16 per 100,000 people last year. This is the highest level in three decades.

Rates are highest among men who have sex with men, as well as among blacks, Hispanics, and Native Americans. Although the rate for women is lower than for men, officials have noted that it is rising more dramatically, by about 50 percent last year.

This is linked to another problem – the rise of congenital syphilis, in which infected mothers pass the disease to their babies, potentially leading to the death of the child or health problems such as deafness and blindness. Annual cases of congenital syphilis numbered only about 300 ten years ago; they rose to nearly 2,700 last year. Of last year’s tally, 211 were stillbirths or infant deaths, Mena said.

The rise in syphilis and other STDs may have several causes, experts say. Testing and prevention efforts have been hampered by years of inadequate funding, and prevalence may have worsened—especially during the pandemic—as a result of delayed diagnosis and treatment. Drug and alcohol use may have contributed to risky sexual behavior. Condom use is declining.

And there may have been a spike in sexual activity as people came out of the COVID-19 lockdown. “People feel liberated,” Saag said.

The appearance of monkeypox added a great deal of added weight. The CDC recently sent a letter to state and local health departments saying their HIV and STD resources could be used to fight the monkeypox outbreak. But some experts say the government needs to provide more funding for the work on PPB, not divert it.

Harvey’s group and some other public health organizations are pushing for a proposal for more federal funding, including at least $500 million for STD clinics.

Mena, who last year became director of the CDC’s Division of STD Prevention, called for reducing stigma, expanding screening and treatment services, and supporting the development and availability of home testing. “I envision a day when testing (for STDs) can be as simple and affordable as taking a home pregnancy test,” he said.

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