STDs Rising Nationally, CDC Says

April 13, 2022 | ASTHO Staff

To kick off National Sexually Transmitted Diseases (STD) Week, ASTHO spoke with Leandro Mena, CDC’s STD Division Director.

It’s STD Awareness Week, which CDC commemorates each year. What key messages does CDC have for the public?

Sexually transmitted infections (STIs) are very common. CDC estimates that about 1 in 5 people in the U.S. had an STI on any given day in 2018. Although they are common, people should also know these infections are not inevitable. They can be prevented and treated. STD Awareness Week provides the ideal opportunity to raise awareness, ensure people have the tools to prevent, test for, and treat infections, and reduce stigma. During this annual observance and beyond, we encourage people to:

• Choose the prevention strategies that work for them.
• Talk openly and honestly with partners and healthcare providers about STIs and sexual health.
• Get tested and treated per CDC’s recommendations.

This year, CDC is offering three communication campaigns underscoring various aspects of prevention: GYT: Get Yourself Tested; Talk. Test. Treat.; and the newest offering, Prepare Before You’re There.

The latest STD Surveillance Report was just released. How have trends changed this year?

CDC’s annual report shows that STDs persist as a significant public health concern. Even in the face of a pandemic, 2.4 million cases of STDs were reported in 2020. Adult syphilis continues to surge, driving yet another year of increases in congenital syphilis. There were over 2,000 cases of congenital syphilis reported in 2020, reflecting a 235% increase since 2016, and preliminary 2021 data show no indication of a slow-down. Gonorrhea continues to climb, as well. While initial data for chlamydia show a decline in cases from 2019-2020, more information is needed to determine if this is a true decline or a reflection of conditions—such as reduced screening for symptomatic infections—related to the COVID-19 pandemic.

This report offers our first look at STD reporting during the pandemic and, because of pandemic-related influences, it offers an unclear picture. What is clear, however, is that the state of STDs did not improve in the United States during the first year of the pandemic. Our prevention and control efforts remain as important as ever.

Congenital syphilis has more than tripled in recent years. What steps can jurisdictions take to help address rising congenital syphilis rates?

High rates of syphilis, especially congenital syphilis, signal fundamental issues in preventing infectious diseases. While any infection among unborn and newborn babies is tragic, infection with syphilis is particularly heartbreaking given that this infection is preventable with proper testing and treatment. Jurisdictions can encourage action steps that are straightforward and proven:

• Invest in testing, treatment, and prevention services for people of reproductive age.
• Ensure testing of pregnant patients early in pregnancy.
• Repeat testing later in pregnancy and at delivery for pregnant patients if at high risk (lives in a community with high rates of syphilis or is at risk for getting syphilis during pregnancy).
• Quickly and correctly treat infections when they are diagnosed.
• Expand partner services to find and treat the partners of those diagnosed with syphilis to end the cycle of reinfection and stop further spread.

In addition to these “tried-and-true” prevention and control strategies, we also must address the social, cultural, and economic conditions that make it more difficult for some populations to stay healthy. Access to timely and high-quality prenatal care is challenging for many and results in too many missed opportunities for guidelines-based diagnosis and treatment of syphilis. Improving access can have a dramatic impact on congenital syphilis and maternal health. Jurisdictions are positioned to identify innovative and unique solutions and have explored several promising practices, including mobile health care clinics to engage with people at highest risk of a pregnancy with congenital syphilis (including those experiencing homelessness, engaging in drug use, or recently incarcerated). Pharmacy/retail health care partnerships and STD express clinic visits also hold promise.

What role does contact tracing and disease intervention specialists (DIS) play in addressing STI outbreaks?

Disease Intervention Specialists, or DIS, are the backbone of public health in the United States. DIS perform essential actions of our nation’s public health defense by providing highly focused case investigation, contact tracing, and community outreach. They also link people to treatment and additional support and are known for flexible, culturally appropriate responsiveness. DIS have long provided this support to stop infectious disease outbreaks, particularly STIs. Over the past two years, DIS were called to support the COVID-19 response. Now, with added investments, the current and future DIS workforce is poised to better help prevent and contain other emerging health threats.

How has COVID affected STI prevention and control efforts?

COVID-19 has strained an already-crumbling public health infrastructure. As we face an unwavering STI epidemic, program resources have been pulled away to address COVID-19—most jurisdictions have reported some effect on staff and resources. This compounds existing infrastructure stresses. Before the pandemic, reductions in screening, treatment, prevention, and partner services contributed to STI increases for many years.

Despite these challenges, the field remains dedicated, quickly pivoting to offer innovative solutions for meeting people where they are. While defenses are down and adequate public health resources are needed, CDC is committed to prevention and control. We must prioritize and focus effort to regain lost ground to control STDs. On-the-ground support for prevention and surveillance programs at the state and local level is critical and includes support for disease investigation, contact tracing, training, community engagement, and partnerships.

What guidance and support does CDC provide to S/THAs on STI prevention and control?

Reversing these trends will take all of us in every sector of society, as well as those of us in governmental positions. The Department of Health and Human Services’ Sexually Transmitted Infections National Strategic Plan for the United States—the nation’s first-ever plan of its kind for STIs—outlines steps that can be taken to support the public health workforce as we work towards reducing new infections.

CDC continues to publish updated testing and treatment guidance since evidence-based prevention, diagnostic, and treatment recommendations are critical to control efforts. The agency also maintains resources for state/territorial health officials that can inform policy and clinical practice. These include prenatal syphilis screening laws, legal analysis of expedited partner therapy, and guidance and resources during disruption of STD clinical services. In addition, CDC is distributing recent investments in the DIS workforce to health department recipients to help build a sustainable and effective public health workforce in communities across the nation.

CDC also leverages partnerships with organizations like ASTHO to share information and messaging with state/territorial leadership and identify opportunities for collaboration. This year, for instance, CDC is working with ASTHO colleagues to host a congenital syphilis community of practice to facilitate peer-to-peer and social learning.

As we face continued STI increases and an unprecedented public health crisis, our efforts have never been more important. But, with the help of our partners and the STI field, we will continue to rise to the challenge and protect the nation’s health.