STDs on the Rise

The Centers for Disease Control is calling it an “epidemic acceleration” — more than two million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2016, the highest number ever. The CDC tracks the incidence of sexually transmitted diseases (STDs) and is identifying the biggest increases in women, infants, and gay and bisexual men. Unsurprisingly, it is calling for new strategies to stem this surge in disease.

“Increases in STDs are a clear warning of a growing threat. STDs are a persistent enemy, growing in number, and outpacing our ability to respond.” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

About two-thirds of the new cases (1.6 million) of disease were chlamydia. This STD can cause permanent damage to a women's reproductive system from pelvic inflammatory disease (PID) that may prevent her from achieving a normal, full term pregnancy. She may be infertile or she may have an ectopic/tubal pregnancy that can result in a pregnancy loss. When mothers pass chlamydia to their infants during delivery, the baby may develop conjunctivitis or pneumonia.

Chlamydia is often asymptomatic but women may notice an abnormal vaginal discharge or burning with urination. Men may notice an abnormal penile discharge or burning with urination or testicular discomfort. Although it is rare, chlamydia can cause infertility in men.

There were 470,000 cases of gonorrhea in 2016, with the biggest increases being among men who have sex with men. Gonorrhea can cause infections in the genitals, rectum and throat.

While it may be asymptomatic, men may experience burning with urination, a white, yellow or green discharge from the penis, or testicular pain or swelling. If untreated, men may develop pain, swelling and blockage of the epididymis, the tube that transports the sperm. Women are typically either asymptomatic or only mildly symptomatic with pain/burning during urination, increased vaginal discharge or vaginal bleeding between periods. If untreated, women may experience PID resulting in infertility, ectopic/tubal pregnancy, and chronic pelvic pain and inflammation. Rectal infections may cause no symptoms in either men nor women, but they might cause discharge itching, soreness or bleeding.

Gonorrhea can also spread to the blood and joints, as well as cause life-threatening illness. Like chlamydia, it can be passed to a newborn during childbirth. Gonorrhea can be treated with antibiotics, although antibiotic resistant strains are making it increasingly challenging to treat.

There were 28,000 cases of primary and secondary syphilis, a disease that had been on the wane, and more than 600 cases of congenital (passed from mother to infant) syphilis. This represents an 18 percent increase overall from 2015 to 2016, with the majority of cases occurring among men who have sex with men.

Rates of syphilis among women rose 36 percent in 2016 and there was a 28 percent increase in syphilis among newborns (congenital syphilis) during this period, resulting in more than 40 deaths and severe health complications among newborns. Syphilis during pregnancy can result in a premature, low birth weight or stillborn infant. If an infant born with syphilis is not identified and treated immediately, cataracts, deafness, seizures or death may result. The disease is preventable through routine screening and timely treatment for syphilis among pregnant women.

“Every baby born with syphilis represents a tragic systems failure,” said Gail Bolan, director of CDC’s Division of STD Prevention. “All it takes is a simple STD test and antibiotic treatment to prevent this enormous heartache and help assure a healthy start for the next generation of Americans.”

Syphilis has three stages. In the first stage, or primary syphilis, sores develop at the site of the infection. They are typically firm, round and painless and partners can acquire the disease from contact with these sores. However, often the sores go unnoticed on the genitals or rectum. Condoms may not always cover the sores and therefore may not offer protection.

The secondary stage includes skin rash, swollen lymph nodes and fever. Tertiary syphilis is a medically severe condition that can affect the heart, brain and other organs. Untreated syphilis at any stage can spread to the brain and nervous system (neurosyphilis) or to the eye (ocular syphilis).

The risk of STDs can be reduced, although not entirely eliminated, with regular testing and safe sex practices. Immediate medical attention to signs and symptoms and adherence to antibiotic treatment is key, as is follow-up testing to assure a cure.

However, having an STD and being successfully treated does not prevent the possibility of re-infection when exposed to a partner with the disease. Additionally, STDs increase the risk for sexual transmission of HIV.

There can be no treatment without testing. It is recommended that sexually active women under 25 should be tested for STDs yearly. Older women with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested yearly. Gay, bisexual, and men who have sex with men should be routinely tested, as should pregnant women.

The CDC report calls for increased measures to combat the threat of STDs in the U.S. and for strengthening of preventive, educational and treatment programs at the level of state and local health departments with particular attention to high-risk populations of newborns and those living with HIV. Healthcare providers should provide regular screening and prompt treatment to their patients, and state health departments should refocus efforts of STD investigation and clinical services.