Why Do STI Rates Keep Going Up?
Sexually transmitted infections hit record lows earlier in the 21st century. Now, they’re increasing again.
Progress happens incrementally—some might even say slowly. And sometimes, it involves a bit of backpedaling: Transmission rates of sexually transmitted infections are surging, even despite relative improvements to sexual health education in the 21st century.
STIs hit record lows earlier this century, the New York Times pointed out in May; gonorrhea reached an all-time-low transmission rate in 2009, and syphilis was nearly eliminated in the U.S. around 2000. But in 2020—even in spite of the pandemic—the CDC reported 2.4 million cases of chlamydia, gonorrhea, and syphilis (the latter two nearly doubled in prevalence since 2016’s data; rates of chlamydia remained relatively stable). And while finalized data for 2021 hasn’t yet been released, early reports show that rates of STIs are likely to have increased even further.
So what’s to blame for the continued spread of STIs in a time when, even if schools may still be lagging when it comes to STIs, information is plentiful and easily accessed online? It’s an issue, it seems, of testing access.
As the NYT points out, STI testing decreased during the pandemic because, well, people just weren’t going to the doctor if they didn’t have to (and not to mention, the pre-vaccine dating landscape generally meant that more people had fewer sexual partners than they might otherwise). And not only that: STI contract tracers were redeployed to focus on Covid.
But the pandemic isn’t just to blame. There’s also the fact that lawmakers have continually closed sexual health clinics as a part of budget cuts; even in New York City, all but one of eight sexual clinics were shut down at the start of the pandemic, pointing to staffing shortages. As of the end of July, only four are back open and running at full capacity, Gothamist reported.
The opioid epidemic is also a big factor contributing to the rise in STI spread, especially syphilis. Research shows that people with a history of “illicit drug use”—with or without a prescription—are at a higher risk of STIs and could benefit from prevention programs. The NYT points out that syphilis has historically seen its highest rates among gay and bisexual men; in recent years, the rate has jumped for heterosexual women. While antibiotics can successfully treat syphilis in adults, pregnant people with untreated syphilis have an 80% chance of spreading the infection to their fetus; this has led to a jump in rates of congenital syphilis, which can lead to serious birth defects or death, Pew reported.
Some might suggest that dating apps have contributed to the spread of STIs; with hundreds of potential partners just a swipe away, wouldn’t it be more likely for STIs to surge? But that logic would ignore the countless headlines about how people (in the U.S., at least) are having less sex.
STI spread is an infrastructural issue: Without accessible testing and treatment, the transmission rates of STIs like gonorrhea, chlamydia, and syphilis will continue to increase. And without good sex ed for all and with stigmas surrounding STIs, people won’t feel empowered to get tested. It’s more than just an issue of personal decision-making: Public STI services play an important role in reducing transmission.
The World Health Organization, for its part, recently announced the first online portal on vaccine development for sexually transmitted infections, called STI Watch. It aims to increase their profile, which may help vaccine development continue successfully. Right now, vaccine development for gonorrhea is promising, researchers are looking into vaccines for herpes simplex virus (HSV) and HIV, and scientists are in the early stage of research for potential syphilis and trichomoniasis vaccines. A vaccine candidate for chlamydia has entered early clinical trials.