Summarizing STI Statistics and Innovations

Lately, it seems like there is a new headline about sexually transmitted infections (STIs) every day. Whether it’s the infection rate or a promising new treatment, STIs are in the spotlight. Although some of the news is grim, there are reasons to be hopeful. Nevertheless, no single strategy can reverse the increase in STIs—a comprehensive approach is needed. This post provides an overview of key facts and recent news about STIs.

Increasing Bacterial STI Rates

In April 2023, the Centers for Disease Control and Prevention (CDC) released the most recent data on bacterial STI rates. The data was striking because it showed a 7 percent increase in reported STIs between 2017 and 2021. Of the three most commonly reported bacterial STIs—chlamydia, gonorrhea and syphilis—chlamydia was the only one that did not see a sustained increase in total cases during this timeframe. Although increases in the total number of STIs are alarming on their own, looking instead at STI rates per 100,000 people highlights the magnitude of the issue. The United States has not seen such high rates of gonorrhea and syphilis since the early 1990s. For chlamydia, the rate of cases per 100,000 people has generally increased each year since the CDC began recording cases in 1984. But 2020 and 2021 were exceptions—most likely the result of decreased testing and diagnoses during the COVID-19 pandemic as opposed to a true decrease in cases.

Since chlamydia and gonorrhea are frequently asymptomatic, testing is often the only way that people become aware they have these infections. For this reason, public education about the importance of regular STI testing and increased access to testing resources are necessary to prevent new infections. In addition, educating the public about prevention can give people the tools to make decisions that decrease their risk of acquiring a bacterial STI.

Congenital Syphilis

In adults, untreated syphilis can have severe health consequences; however, there is particular concern for infants born to a person who has untreated syphilis. In addition to a higher risk of low birth weight, early delivery and stillbirth, infants born with syphilis can develop severe health problems like cataracts, deafness and seizures or—if not treated promptly—can even die.

CDC data released in November 2023 reported 3,761 cases of congenital syphilis in 2022. They note that, if testing and treatment had occurred during pregnancy, nine out of 10 cases might have been prevented. Sadly, adequate treatment was not received in more than half of these cases, despite testing positive during pregnancy. These statistics clearly indicate there is work to be done to remove barriers to prenatal care and increase testing opportunities in order to identify syphilis cases before pregnancy occurs.

Disparities in STI and HIV Diagnoses

Some populations experience a disproportionate number of STIs and HIV. People under 25 made up about half of STI diagnoses in 2021. There are also differences in STI rates by race/ethnicity and sexual identity. Different disparities exist for different STI diagnoses, as well. Once again, differences in access to sexual health care—rather than differences in sexual behavior—are likely responsible for these disparities. (That is to say, disparities likely do not exist because certain groups have more risky sexual encounters than others.)

The Good News: New Treatments and Successes

Although recent trends in STI rates are concerning, there are some success stories and potentially positive innovations. For one, since its introduction in 2008, the human papillomavirus (HPV) vaccine has contributed to a significant decrease in precancerous cervical lesions among young women.

Several other innovations could also help address the rise in STIs. The CDC recently proposed guidelines for use of doxycycline post-exposure prophylaxis (doxy-PEP), which involves taking doxycycline (a common antibiotic) after each potential exposure to bacterial STIs. In clinical trials, doxy-PEP has proven it can decrease the risk of acquiring chlamydia and gonorrhea. The guidelines attempt to balance concerns about the possibility of increasing antibiotic resistance with the promise of a new method for preventing bacterial STIs.

On the topic of antibiotic resistance, results from a multinational clinical trial of a new antibiotic to treat gonorrhea showed that the new drug is as effective as the one currently used to treat gonorrhea. This is positive news because over time, gonorrhea has become resistant to all but one class of existing antibiotics and is showing signs of becoming resistant to the last drug as well. A new class of antibiotic to treat gonorrhea could help slow the spread of antibiotic-resistant gonorrhea and give medical providers a new tool to treat this common infection.

Finally, there is progress in the area of at-home STI testing. Until November, the only Food and Drug Administration (FDA)-approved at-home STI test was for HIV; now, the FDA has approved the first at-home test for gonorrhea and chlamydia. The test requires a person to collect a vaginal swab or urine sample and mail the sample to the designated lab for testing. Test results are delivered online, with follow-up from a medical provider if needed. As an over-the-counter test, people will be able to purchase it without a prescription or medical appointment. Although the test may not be the silver bullet for expanding testing, it does provide a new avenue for people in areas without easy access to STI testing facilities to get tested.

STIs may be common, but there is still a lot of stigma associated with being tested for or diagnosed with one. Although several recent innovations may help decrease surging STI rates, decreasing stigma so that people are more willing to talk about STIs with their sexual partners and pursue regular testing is also necessary. Hopefully, all the talk about STIs in the news will help people feel more comfortable discussing STIs with their medical providers and partners.