US STD epidemic fuelled by decline in condom use, fake clinics and fund cuts to local health programs, say experts
There is an urgent need to pay attention to the STD epidemic - sexually transmitted diseases that are at an all-time high in the United States, says the Centre for Disease Control. According to its latest annual Sexually Transmitted Disease Surveillance Report, there is a growing threat of newborn deaths caused by congenital syphilis while syphilis, gonorrhea, and chlamydia saw a spike of 100,000 cases from the previous year amounting to an alarming 2.4 million cases in 2018.
Among newborns, syphilis cases increased 40 percent to more than 1,300 cases. Newborn syphilis cases have been rising since the past couple of years, with cases becoming more than double in four years, reaching a 20 year high in 2017. 2018 saw a further increase of 22 percent from 2017 and the death toll went up from 77 to 94 deaths, says the report.
Gonorrhea and Chlamydia rates are off the charts
The rates at which Gonorrhea and Chlamydia are spiking is also worrying. Gonorrhea affected 580,000 people, the highest number reported since 1991 while Chlamydia affected 1.7 million cases – the most ever reported to CDC.
Multiple factors contribute to the rise of these STDs, said Debra Hauser, President, Advocates for Youth. Lack of health insurance to the closure of clinics, to the way these viruses are transmitted, to the resurgence of abstinence-only-until-marriage programs which do not teach skills around condom use and talking to your partner about condoms are some of the reasons she mentioned to MEA World Wide.
With STDs being easily treatable and prevented, these numbers show a huge lack of commitment. Although the annual report doesn't point out the effects of stigma, they're very much there and aiding this rise, explained National Association of County and City Health Officials (NACCHO)'s senior program analyst Rebecca Horowitz.
Hauser pointed out that it takes dedication from policymakers, health care providers, educators, parents, and the community to put a stop to this growth. "We need to make sure everyone knows how to prevent STDs and is empowered to take the steps to protect their own health," Hauser said.
Screening alone isn't the reason for the spike
This steep rise can be attributed to a somewhat positive change, said Horowitz. "One of the reasons that these two STIs are so high is that we have gotten much better at testing for them—the more you test, the more you will find especially in young people where these two STIs are very prominent," she told MEAWW.
CDC agreed. "In particular, increases in extragenital screening among gay, bisexual, and other men who have sex with men (that is, screening of the throat or rectum; not just the genitals) are helping identify new cases that would have been missed by traditional screening methods," said Jacqueline Petty spokesperson from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.
But it cannot be attributed to screening alone, she said; cases definitely have increased in the past five years. "An example of that would be the growing number of primary and secondary syphilis cases. This is the stage of the disease which reflects recent infections. An increase in P&S syphilis cases may signal that there have been increases in new STD infections," Petty said.
Funds to "Fake" clinics
The new STD infections may be a result of changes in sexual behavior or changes in access to timely STD preventive care, including screening, treatment, and partner treatment, the CDC said.
The factors that attribute to new cases of these infections also have a lot to do with a person’s social, cultural, and economic environment like poverty, unstable housing, drug use, lack of insurance, lack of comprehensive sex education, and a decline in condom use among higher-risk groups like young people and men who have sex with men, Horowitz said. "Those are the same populations we are not providing comprehensive sex ed to and that experience more stigma around their sexuality and therefore may be less likely to seek testing and treatment," Horowitz added.
"The Trump Administration has given funding designated for preventive services to fake clinics, also known as crisis pregnancy centers, which do not provide young people with the information and skills they need to prevent STDs," she said pointing out clinics that are dotted across the map and are typically run by Christian religious groups. They are known to be anti-abortion have been found to provide false or misleading information to pregnant women.
"And, we can't disregard the fact that many young people rely on Planned Parenthood for their reproductive and sexual health care, and now it has been forced by the Administration to turn down government funds. Unless these programs receive funding and we start taking STDs seriously, rates will continue to rise," said Hauser.
Lack of funding to state and local health departments
However, there is a massive lack of funding to state and local health departments that have led to decreased access to quality healthcare for those that need it the most. The fact that Planned Parenthood clinics are shutting down does not make matters any easier, added Hauser. They are trying to do more with less, Horowitz pointed out. "In the past decade, local health departments have lost almost a quarter of their workforce. That means that they often don’t have the staff to do testing, treatment, and prevention of gonorrhea and chlamydia and the outreach needed to reach the populations most at risk," she said.
The lack of funding leads to a lack of trained professionals in the field. When syphilis has not been a part of a doctor’s practice, they may not recognize it and when it is not treated it spreads rapidly through that community. "Public health must also play a role in making sure that private providers are aware of the STI burden in their community and are testing and treating patients, as well as doing things like testing for syphilis during pregnancy and talking to patients who test positive for an STI about their intentions to get pregnant to prevent congenital syphilis," she said,
Prior CDC studies have also found that funding for STD prevention has an impact on the incidence of STDs.