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America's STD increases 'steep and sustained,' CDC says

Pedestrians walk past the entrance for the U.S. Centers for Disease Control and Prevention on the third day of the government shutdown in Atlanta, Monday, Jan. 22, 2018. (AP Photo/David Goldman)
Pedestrians walk past the entrance for the U.S. Centers for Disease Control and Prevention on the third day of the government shutdown in Atlanta, Monday, Jan. 22, 2018. (AP Photo/David Goldman)
David Goldman, Associated Press

SALT LAKE CITY — Cases of syphilis, gonorrhea and chlamydia — sexually transmitted diseases monitored by public health agencies — have risen since 2013, according to the Center for Disease Control and Prevention's 2017 surveillance report that calls the increase "steep and sustained."

Chlamydia cases have increased 22 percent to 1.7 million, gonorrhea by 67 percent to 555,608 cases and syphilis a whopping 76 percent to 30,644 cases — a dramatic reversal of a yearslong trend of declining cases.

"Yet not that long ago, gonorrhea rates were at historical lows, syphilis was close to elimination and we were able to point to advances in STD prevention, such as better diagnostic tests and more screening, contributing to increases in detection and treatment of chlamydial infections. That progress has since unraveled," writes Dr. Gail Bolan, director of the center's Division of STD Prevention.

Officials are also worried about the appearance of an antibiotic-resistant strain of gonorrhea and a dramatic rise in congenital syphilis, indicating pregnant women are not being screened or treated in time to prevent its transmission to their babies.

Aaron Thorup

Half the diagnosed STDs are found among those ages 15-24. That's especially problematic, the CDC notes, because those young people are entering their prime age to have children and for sexual activity. Sexually transmitted infections can cause infertility and make it easier to transfer HIV to unborn children and partners, among other problems.

The increase in STDs has happened while the CDC, The National Campaign and others suggested that the number of teens engaging in sex has decreased and those using contraceptives have increased to explain why teen pregnancy had decreased in the United States. The figures from the U.S. Department of Health and Human Services' Office of Adolescent Health for 2016 showed 209,809 babies were born to females ages 15-19. That was a record low birthrate in the age group, 20.3 per 1,000 women, down from 22.3 in 2015 — and a whopping 67 percent drop from the all-time high of 61.8 births per 1,000 in 1991.

But women's health nurse practitioner Katie Ward says the increase in STDs "reflects a lack of education and maybe a little complacency." It reflects "some lost momentum in preventive care," including inability of some people to access care, said Ward, an associate professor and specialty director of the Women’s Health NP Program at the University of Utah.

She said that all three STDs can be treated and usually cured at the early stages. Antibiotic-resistant gonorrhea and advanced syphilis are more problematic.

Reporting in Utah

The Beehive State follows the national trends, with the notable exception of congenital syphilis. No babies were born with that condition last year, says Carmen Drury, STD/HIV epidemiologist for the Utah Department of Health's Division of Disease Control and Prevention.

Syphilis is potentially devastating for babies. Those who live may be blinded or have bone malformation, among other things, Drury said.

She credits the high rates of prenatal care and the fact that Utah practitioners follow CDC and Utah public health guidelines for screening of pregnant women during their first pregnancy-related visit. In other states, where cases are found, "prenatal care may not be optimal or accessible and clinicians may not be adhering to CDC guidelines."

If a pregnant woman has not had prenatal care, a blood test will be done at the hospital, said Ward.

Because syphilis is one of the diseases that crosses the placenta and can be passed on during development, finding it early is very important to minimize harm, said Ward. "Fortunately, the placenta is remarkably good at protecting a fetus against a lot of things."

Not all STDs cross the placenta. Some infect a baby in the birth canal, for instance. So it's important that women be aware and get screened for harmful diseases and infections.

Overall, Utah's STD news wasn't great, Drury said. Health care providers have to report chlamydia, gonorrhea and syphilis within three days of detecting infection — and she said Utah in 2017 had the highest number of reported cases in the last 10 years.

"Still, we are one of the lowest states" for reportable STD rates, she added.

"Access to health care is also a huge factor," Drury said, adding amassing an accurate count requires people have access to care. She believes all STDs are undercounted.

Aaron Thorup

In 2017, Utah had 10,134 chlamydia cases, 43 percent of the national rate. Its 2,542 cases of gonorrhea reported were 41 percent of the national rate. For syphilis, the 117 cases were 24 percent of the national rate.

U.S. breakdown

There are other sexually transmitted diseases, but reporting is not required. Human papillomavirus (HPV) and herpes, for example, don't trigger an automatic report. Reporting is mandated for chlamydia, gonorrhea and syphilis because of their serious complications.

Untreated chlamydia can cause infertility and, in women, pelvic inflammatory disease. Gonorrhea can also cause infertility. Syphilis is complex and can causes different problems, including a neurological disease, Drury said.

The national report includes a breakdown of each of the reportable STDs and the impact and reach. Among the findings:

Chlamydia: Between 2016 and 2017, rates increased in both males and females throughout the country, as well as among all racial and Hispanic ethnic groups. It's highest among adolescents and young adults, nearly two-thirds of the cases involving those ages 15-24. Rates are lower for men, but increased by 40 percent over the last four years.

Gonorrhea: Gonorrhea cases were at a historic low less than a decade ago, but just last year they climbed almost 19 percent — up for males and females, in every part of the country and among all racial and Hispanic ethnic groups.

Syphilis: This hit its record low in 2000 and 2001, but has increased ever since among males and females, all racial and Hispanic ethnic groups and in nearly three-fourths of the states and the District of Columbia.

Congenital syphilis: This has increased each year since 2013, with nearly 1,000 cases nationwide in 2017. Of those, 64 were stillborn and 13 infants died.

Experts emphasize that STDs are treatable and also largely preventable.

The rise in STD numbers are a stark reminder, Ward said, that "we've lost some momentum in preventive care."

The CDC's list of strategies to prevent or reduce the risk of sexually transmitted diseases includes abstinence, vaccination (for hepatitis B and human papillomavirus), mutual monogamy and safe sex practices such as use of condoms.

Correction: An earlier version of a graphic accompanying this story incorrectly stated the number of chlamydia cases in Utah. The correct number is 10,134, not 368.