1 in 5 Americans suffer from sexually transmitted infections, about half the cases among 15 to 24-year-olds: CDC
There were an estimated 67.6 million prevalent and 26.2 million newly-acquired sexually transmitted infections in the US in 2018 alone
According to latest reports, nearly one in five people in the US has a sexually transmitted infection (STI), which can have serious health consequences. According to latest estimates by the US Centers for Disease Control and Prevention (CDC), there were nearly 68 million STIs on any given day in 2018 (prevalent STIs) and there were 26 million newly acquired (incident STIs) STIs in 2018. The number of all prevalent and incident STIs was similar among men and women, though this varied by infection.
America’s youth shoulder a substantial burden of sexually transmitted infections. The 15-24-year-old population accounted for nearly one-fifth of all prevalent infections. However, almost half of all incident STIs occurred in people aged 15-24 years. Persons aged 15-24 years comprised 18.6% (12.6 million) of all prevalent infections, but they comprised 45.5% (11.9 million) of all incident infections.
The report, published in the journal Sexually Transmitted Diseasesexternal, included eight common STIs, four of which are easily treated and cured if diagnosed early: chlamydia, gonorrhea, syphilis, and trichomoniasis. Also included in the analyses are four sexually transmitted viruses: human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), and hepatitis B virus (HBV).
The CDC found that most infections among all ages were caused by chlamydia, trichomoniasis, genital herpes and HPV, comprising 98% of all prevalent and 93% of all incident STIs. HPV alone accounted for 63% of all prevalent and 50% of all incident infections.
“Despite uncertainty, the estimates provided illustrate that the STI burden in the US is high, with infections due to chlamydia, trichomoniasis, genital herpes, and HPV accounting for most of that burden. In a population of over 320 million people and a prevalence estimate of 67.6 million STIs, this suggests that about 20% of the total US population had an STI at a given point in 2018,” say authors.
For all individuals who are sexually active – particularly young people and women – STI screening and prompt treatment (if infected) are critical to protect a person’s health and prevent transmission to others, state researchers.
Since prevention can minimize the negative, long-term consequences of STIs and reduce healthcare costs, the CDC recommends that prevention efforts should focus on hard-hit populations such as young people and women. “Nearly one in two incident STIs were acquired by people aged 15 to 24 years old. Focusing STI prevention efforts on the 15-24-year-old population may be key to lowering the STI burden in the US,” recommends the team.
The findings are important as people with these infections do not always experience disease symptoms, and as a result, many infections go undetected and unreported to the CDC.
If left untreated, some STIs can increase the risk of HIV infection or can cause chronic pelvic pain, pelvic inflammatory disease, infertility, and/or severe pregnancy and newborn complications. Accordingly, these estimates are critical to better understanding the vast scope of the STI epidemic and who is most affected, notes the agency.
“The burden of STIs is staggering. At a time when STIs are at an all-time high, they have fallen out of the national conversation. Yet, STIs are a preventable and treatable national health threat with substantial personal and economic impact. There is an urgent need to reverse the trend of increasing STIs, especially in the wake of the Covid-19 pandemic, which has affected many STI prevention services,” says Dr Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
What’s the cost?
STIs cost the US healthcare system billions of dollars every year. According to investigators, HIV and HPV infections acquired in 2018 were the costliest STIs as medical costs for these infections include lifetime treatment for people with HIV and treatment for HPV-related cancers. Other reportable STIs, including chlamydia, gonorrhea, and syphilis, have substantial medical costs as well.
Of the estimated $16 billion in lifetime medical costs from STIs acquired in 2018, $13.7 billion of all costs were attributed to sexually acquired HIV infections, while $755 million were attributed to HPV infections.
More than $1 billion were attributed to chlamydia, gonorrhea, and syphilis combined. About 60% of these combined costs from chlamydia, gonorrhea, and syphilis were among young people ages 15-24 years. Nearly 75% of the $2.2 billion in non-HIV-related STI medical costs were among women.
The total cost of STIs far exceeds the medical cost burden estimated in this study, which did not include costs associated with lost productivity, other non-medical costs, and STI prevention.
“Proven STI prevention – at all levels – is a cornerstone of protecting America’s health, economic security, and wellness. There are significant human and financial costs associated with these infections, and we know from other studies that cuts in STI prevention efforts result in higher costs down the road. Preventing STIs could save billions in medical costs, but more importantly, prevention would improve the health and lives of millions of people,” explains Raul Romaguera, acting director for CDC’s Division of STD Prevention.
What can be done?
The findings highlight the ongoing need for better and more robust data to inform population-level prevalence and incidence estimates, emphasizes the team. According to the researchers, Covid-19 has underscored the underlying effects of systemic health and social inequities that put racial and ethnic minority groups and other populations at increased risk of infection.
Similarly, there is an ongoing disproportionate burden of STIs among certain racial and ethnic groups; among young people between 15 and 24 years old who accounted for nearly half of all new STIs in 2018; and among women, who account for a disproportionate burden of severe STI outcomes and medical costs.
The CDC calls for considering the social, cultural, and economic conditions that make it more difficult for some sexually active people to stay healthy, such as poverty, unstable housing, drug use and lack of medical insurance or medical home.
“CDC’s new estimates are critical to better understanding the scope of STIs in the US. However, the findings also highlight gaps in the scientific literature and the ongoing need for more data. This includes the need for population-based STI screening estimates to provide a better picture of diagnosed and undiagnosed STIs in groups disproportionately affected, including some racial/ethnic minority groups and people who are lesbian, gay, bisexual, transgender, or and queer/questioning LGBTQ,” say experts.
The CDC suggests that strategies used to overcome barriers associated with the Covid-19 pandemic have the potential to help reverse increases in STIs. For example, STI-express clinics that allow walk-in STI testing and treatment without a full clinical exam can be helpful.
The authors advise focusing on telehealth or telemedicine, which can ensure access to healthcare providers, support self-testing or self-collection, and is especially critical in rural areas. Partnerships with pharmacies and retail health clinics, which can provide new access points for STI services, such as on-site testing and treatment, is another recommendation.