— We Asked the Experts

Newly-released data shows infections for certain sexually transmitted infections have jumped tremendously.

Several sexually transmitted infections have increased in the U.S., according to new data from the CDC.
The 7% increase continues an upward trajectory in certain STIs.
Doctors say there are a lot of reasons why this is happening in the U.S.

Sexually transmitted infections continue to climb in the U.S., with syphilis cases in particular skyrocketing in 2021—the most recent year data is available.

The data was shared as part of a report from the Centers for Disease Control and Prevention (CDC) released this week. The report breaks down cases of a range of STIs, including chlamydia, gonorrhea, and syphilis.

The data show that there were 1,644,416 new chlamydia cases diagnosed in 2021—a 4% increase over 2020. There were also 710,151 new cases of gonorrhea diagnosed, an illness that’s been steadily increasing 28% since at least 2017, when 555,608 cases were diagnosed.

But while syphilis cases made up a fraction of overall STI cases, they’re on a sharp upward trajectory: 176,713 new cases were diagnosed in 2021, a significant increase from the 133,954 cases diagnosed in 2020 and 129,818 cases diagnosed in 2019.

Cases of congenital syphilis (which is what happens when the disease is passed from a mom to her baby during pregnancy) also jumped up—from 2,157 in 2020 to 2,855 in 2021.

The CDC notes that case numbers were undercounted in 2020 due to the pandemic and “likely continued in 2021,” but that the impact was the most severe in 2020. “The annual report shows infections continued to forge ahead, compromising the nation’s health,” Leandro Mena, M.D., M.P.H., director of the CDC’s Division of STD Prevention, said in a statement.

Those are a lot of numbers to wade through, but the overall takeaway is this: STIs, which have already been recorded at high numbers across the country, continue to jump up. Here’s what’s going on.

Why are STIs increasing across the country?

The report didn’t specify why these STIs in particular are jumping up—it simply crunched the numbers. However, the CDC noted that certain racial, ethnic, and sexual minority groups are disproportionately impacted by STIs.

Black or African-American people made up a third of chlamydia, gonorrhea, and syphilis cases, but only make up 12% of the U.S. population, the report points out. Nearly 1/3 of all gonorrhea cases were in gay and bisexual men. Congenital syphilis rates increased for most racial and ethnic groups, but the highest rate was in babies born to American Indian and Alaska Native people, the report noted.

“While tried-and-true prevention strategies are key, social inequities often leads to health inequities and, ultimately, manifest as health disparities,” the report says. “We must work collaboratively to address social, cultural, and economic conditions to make it easier for people to stay healthy.”

But…what’s behind all this? “A lot,” says Thomas Russo, M.D., an infectious disease expert at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. “Here’s the thing: 2021 was our breakout year where the COVID-19 vaccine became available and people started playing a lot of social catch-up,” he says. “As a result, there was a whole bunch of interactions, some of which involved sexual activity.”

STI rates “reflect how well our public health infrastructure is,” Dr. Russo says, noting that there was a big shift in resources during the height of the pandemic. “It was all about COVID,” he says. “STI public health clinics and even interactions with physicians probably took a backseat.”

Infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, agrees. “COVID disrupted STI work dramatically,” he says. “Health departments do the bulk of STI work and they were under-resourced to do STIs and COVID.”

The opioid crisis may also play a role, Dr. Russo says. “There’s a lot of activity that occurs to get drugs for sex,” he says. “That usually involves multiple partners and unprotected sexual activity.”

There was also a lack of widespread testing for STIs during the height of the pandemic in 2020, and that may have led to less people getting screened and diagnosed—increasing the odds they spread STIs to others, says women’s health expert Jennifer Wider, M.D. “A drop in screening and testing for all sorts of diseases and conditions [in 2020] has resulted in a jump in diagnoses for many people, particularly in groups with poor access to healthcare to begin with,” Dr. Wider says.

here is also inconsistent and “inadequate sex education” in the U.S., which lowers the odds that someone will know prevention strategies for STIs and recognize symptoms, if they happen to develop them, Dr. Wider says.

Why are syphilis cases jumping up so quickly?

Syphilis cases hit “historic lows” in the early 2000s, the report says, but they’ve since surged, increasing a jaw-dropping 781% since 2001. Some states—California, Texas, Arizona, Florida, and Louisiana—have been disproportionately impacted, making up 58% of reported cases of congenital syphilis. The larger syphilis epidemic was also mostly concentrated to within 100 counties—they made up 60% of all reported cases in 2021.

A lot of the reasons why chlamydia and gonorrhea are spreading in the U.S. applies to syphilis as well, Dr. Russo says. But he also points out that syphilis “spreads reasonably well” through oral sex. “People often think that oral sex is relatively safe when it comes to STIs but, with syphilis, that’s not the case,” he says. “That’s one of the factors that can drive it.”

The CDC stressed in the report that syphilis is “completely preventable and treatable,” adding that “timely screening, diagnosis, and treatment can save lives, but if left untreated, the infection can cause serious health problems and increase the risk of getting an HIV infection.”

How to lower your risk of getting an STI

You’ve likely heard all of this before, but it never hurts to do a refresher. The CDC offers the following advice to lower your risk of getting an STI:

Practice abstinence. The CDC points out that the most reliable way to avoid STIs is to avoid having anal, vaginal, or oral sex.
Get vaccinated against HPV and hepatitis B. The vaccines won’t protect against everything, but the HPV vaccine in particular can help lower the risk of contracting certain strains of HPV that are linked to the development of cancer.
Reduce your number of sex partners. Less sex partners means a lowered risk, the CDC says. However, the agency still recommends that both you and your partner get tested and share your results with each other.
Be mutually monogamous. That means both you and your partner only have sex with each other.
Use condoms. The CDC recommends that you use a male latex condom every time you have anal, vaginal, or oral sex. Non-latex condoms can be use, the agency says, but they have higher breakage rates than latex condoms.

The CDC also stresses the importance of using STI testing and treatment, noting that there some pharmacy and retail health clinics allow people to get tested on-site.

Unfortunately, Dr. Russo expects things to get worse before they get better, given the state of reproductive care in the U.S. and lack of access to sexual health clinics for people in some states. “We need to do better and make a commitment to this important area,” he says.

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