STD situation “out of control” invites to ask for changes

NEW YORK – The sharp increase in cases of certain sexually transmitted diseases – including a 26% increase in new syphilis infections reported last year – has American health officials calling for new prevention and treatment efforts.

“It is imperative that we … work to rebuild, innovate and expand (STD) prevention in the United States,” Dr. Leandro Mena of the US Centers for Disease Control and Prevention said in a speech Monday at the a medical conference on sexuality. communicable diseases.

Infection rates for some STDs, including gonorrhea and syphilis, have been rising for years. Last year, the rate of syphilis cases hit its highest since 1991 and the total number of cases hit its highest since 1948. HIV cases are also on the rise, up 16% from last year .

And an international outbreak of monkeypox, which spreads primarily between men who have sex with men, has further highlighted the nation’s worsening problem with diseases spread primarily through sex.

David Harvey, executive director of the National Coalition of STD Directors, called the situation “out of control.”

Officials are working on new approaches to the problem, such as home testing kits for certain STDs that will make it easier for people to learn they are infected and take action to prevent the spread to others, a Mena said.

Another expert said that an essential part of any effort must be aimed at increasing condom use.

“It’s quite simple. More sexually transmitted infections occur when people have more unprotected sex,” said Dr. Mike Saag, an infectious disease expert at the University of Alabama at Birmingham.

Syphilis is a bacterial disease that presents as genital sores, but can ultimately lead to severe symptoms and death if left untreated.

New syphilis infections dropped in the United States beginning in the 1940s when antibiotics became widely available. They fell to their lowest on record in 1998, when fewer than 7,000 new cases were reported nationwide. The CDC was so encouraged by the progress that it launched a plan to eliminate syphilis in the United States.

But in 2002, cases started to rise again, mostly among gay and bisexual men, and they continued. In late 2013, the CDC ended its elimination campaign in the face of limited funding and an increase in cases, which that year topped 17,000.

In 2020, cases had reached almost 41,700 and they rose again last year, to more than 52,000.

The case rate has also increased, reaching about 16 cases per 100,000 people last year. This is the highest in three decades.

Rates are highest among men who have sex with men, as well as among black and Hispanic Americans and Native Americans. Although the rate for women is lower than for men, officials noted that it has increased more dramatically – up to around 50% in the past year.

This is linked to another problem – the increase in congenital syphilis, in which infected mothers pass the disease on to their babies, potentially leading to child death or health problems like deafness and blindness. Annual cases of congenital syphilis were only about 300 ten years ago; they rose to nearly 2,700 last year. Of last year’s tally, 211 were stillbirths or infant deaths, Mena said.

The rise in syphilis and other STDs may have several causes, experts say. Testing and prevention efforts have been hampered by years of insufficient funding, and the spread may have worsened — especially during the pandemic — due to delayed diagnosis and treatment. Drug and alcohol use may have contributed to risky sexual behavior. Condom use has decreased.

And there may have been an increase in sexual activity as people emerged from Covid-19 lockdowns. “People feel liberated,” Saag said.

The arrival of monkeypox added a heavy additional burden. The CDC recently sent a letter to state and local health departments indicating that their HIV and STD resources could be used to combat the monkeypox epidemic. But some experts say the government needs to provide more funding for STD work, not divert it.

Harvey’s group and other public health organizations are pushing a proposal for more federal funding, including at least $500 million for STD clinics.

Mena, who last year became director of the CDC’s STD Prevention Division, called for reducing stigma, expanding testing and treatment services, and supporting the development and accessibility of home testing. . “I envision a day when getting tested (for STDs) can be as easy and affordable as taking a home pregnancy test,” he said.

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