Why Are STD Rates So High In the U.S.?
STDs have been on the rise in the United States for several years now. The rates of chlamydia, gonorrhea, and syphilis are higher than they've ever been before.
It's more than just a scary headline, according to experts. "This should definitely be considered a [public health] emergency," says Adeeti Gupta, M.D., a board-certified ob-gyn in New York. "It is alarming that in this day and age we are sliding backward."
So, why have things gotten so bad? We investigated why STDs have gotten so out of control, and what you need to do to protect yourself in a looming public health crisis.
The Rise of STDs
For the past four years, the number of cases of chlamydia, gonorrhea, and syphilis — the Big Three of STDs — has been steadily creeping up in the U.S., reaching an all-time record high in 2016. In 2018, the Centers for Disease Control and Prevention (CDC) released a report that showed there were 2.3 million cases of the Big Three diagnosed in 2017 — a whopping 200,000 more than the previous record in 2016, the CDC reports. What's particularly concerning? Gonorrhea diagnoses have gone up 67 percent since 2013, and syphilis cases have increased 76 percent. Overall, the report called out "steep, sustained increases" (31 percent since 2013) that have health officials worried.
A more recent study published in the American Journal of Preventive Medicine (AJPM) suggests a concerning rise in chlamydia and gonorrhea, specifically, among young women. The study looked at nearly 18 million lab results for STD infections from women aged 12-30 years old who tested at Quest Diagnostics between 2010 and 2017. The results showed that from 2010 to 2017, the annual chlamydia positivity rate increased by 18 percent overall, and gonorrhea positivity increased by 33 percent overall. While women aged 18-24 were more likely to test positive for either infection, women 25-30 years old experienced a higher increase over the 8-year period of the study compared to women in other age groups. Among women 25-30 years old, the positivity rate for both infections increased by a whopping 50 percent, compared to women in the 18-24 age group, whose positivity rates increased by 21 percent, according to the study's results.
To put those numbers in perspective, the U.S. has the highest STD rates in the industrialized world, NPR reports. (FYI, the rate of unintended pregnancies is also "significantly higher" in the U.S. than in many other developed countries, according to the Guttmacher Institute.) Yikes.
As if the jump in STDs weren't concerning enough on its own, the rise of antibiotic-resistant STD "superbugs" makes these statistics even scarier. Right now, doctors still have enough tools to treat the Big Three, but certain strains of "super gonorrhea" and drug-resistant syphilis are already a thing.
In simpler terms, untreatable STD superbugs are close to becoming reality. "We expect gonorrhea will eventually wear down our last highly effective antibiotic," Gail Bolan, M.D., director of the CDC's Division of STD Prevention, said in a press release about the CDC's 2018 report. "We can't let our defenses down-we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible."
Why Are STDs On the Rise?
There are several factors that have health experts sweating over the rise in STDs.
"What's most concerning to me is that the numbers are going up, and unfortunately in the United States we are having more threats to women's health care than ever before," says Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.
In 2017, the Trump administration cut over $200 million in federal reproductive care funding (which affected programs at Johns Hopkins University, the Children's Hospital of Los Angeles, and the Chicago Department of Public Health, to name a few), jeopardizing programs that helped screen for and treat STDs. "My concern is that if we're doing away with funding for women's health care and threatening places like Planned Parenthood, which provide STD screenings, many women won't have access to screenings and treatment," Dr. Minkin says. (See: All The Ways a Planned Parenthood Collapse Could Hurt Women's Health)
That's not the only way politics are having an effect on rising STD rates — insurance coverage (or lack of it) is often a major factor in whether a patient gets screened or not, says Dr. Gupta. "Some women would like to get tested [for STDs] but they are so scared of unknown out-of-pocket costs that they either don't go or decline testing, even if they have had new partners," she says. "Many of our patients have been getting billed for out-of-pocket costs for gonorrhea and chlamydia testing because it's not considered a part of preventative screening anymore." (For the record, coverage varies by insurance plan, so ask your gyno to check in with your provider. If it's not covered, that doesn't mean you should skip getting tested — many health centers like Planned Parenthood provide free or low-cost screenings.)
Even if you don't have any symptoms, an STD can do serious damage — like causing pelvic inflammatory disease (PID), an infection that occurs when an STD spreads from your vagina up into your reproductive organs. You might not even know you have PID right away, Dr. Minkin says, but it can lead to chronic pain and even infertility, according to the Mayo Clinic.
All of this is compounded by the fact that people just aren't using condoms enough. Only 24 percent of women used a condom during their last hookup and only 18 percent of women said they used one every single time, according to a 2017 CDC report. (Reminder: Condoms are the only way to prevent STDs if you're having sex.)
That 2017 report also found a safe sex red flag for women using another form of birth control — rates of condom use were even lower when women were also using a method like the pill or IUD to prevent pregnancy. This is a major problem, says Dr. Minkin, since IUDs and the Pill — both of which are awesome, and more effective at preventing pregnancy than condoms — don't protect against STDs. "We need to teach people that if they're going to have sex, they need to prevent pregnancy, but they also need to prevent STDs," she says.
Chances are, you *know* this. But before you roll your eyes, the numbers don't lie. Consider this a PSA for the importance of using condoms every damn time. "It only takes a split second for the STD bug to get in your system," Dr. Gupta says. "Be safe, always."
How to Protect Yourself from STDs
The good news here is that gonorrhea, chlamydia, and syphilis are all very simple to detect — and for the moment at least, all three STDs are still treatable. So aside from using condoms, the number-one thing you can do to protect yourself is get tested regularly-"at least once a year, even if you're in a monogamous relationship," Dr. Gupta says.
Current guidelines from the CDC no longer recommend getting screened every year unless you're under 25 or have certain risk factors. But both docs disagree with this and are in favor of yearly STD tests.
"If we had more and better STD screening practices, we'd obviously pick up a lot of this sooner and prevent STDs from spreading further," says Dr. Minkin. "If you don't have widespread screening, there are going to be a lot of people walking around with STDs and no symptoms and not knowing — in view of the increasing numbers, screenings should take on increasing importance." (Related: The Infuriating Reason Young Women Aren't Getting Tested for STDs)
On top of your regular screenings, you should also get tested after every new partner, Dr. Gupta says, adding that "before having a sexual relationship with anyone, you should ask for documented negative HIV, syphilis, hepatitis B and C, gonorrhea, chlamydia and trichomonas and genital herpes results." Asking a date to prove they're clean can definitely be awkward — and kind of a mood killer — but it's worth it when it comes to protecting your health. (Not sure how to ask your partner if they've had an STD test? The experts say, it's best to just be blunt.)
If you do wind up with an STD though, don't panic. Get it treated right away and follow up with your doctor to make sure you're totally cured before your next hookup. (Related: How to Talk to Your Partner About Your STD Status)
