Rates of sexually transmitted diseases (STDs) reached a record high in 2018, resulting in more babies born with syphilis, according to a report released Tuesday by the Centers for Disease Control and Prevention (CDC).
Combined cases of syphilis, gonorrhea and chlamydia increased for the fifth consecutive year, partly due to cuts to STD programs at the state and local levels and decreased condom use among young people and gay and bisexual men, the CDC said.
More than 1,300 babies were born with syphilis last year, a 40 percent increase from 2017. That parallels with an increase in syphilis among women of childbearing age.
“This is a failure of the public health system and private health care system, and we have the tools to prevent it,” said Dr. Gail Bolan, director of the CDC's STD Division.
In all, there were nearly 2.5 million cases of chlamydia, gonorrhea and syphilis in 2018, a 30 percent increase from 2013. Rates were highest among men who have sex with men and people of color.
STD rates were highest in southern states including Georgia, Louisiana and Mississippi, and rural states like Alaska and South Dakota.
“Most people have no signs of symptoms so they don’t know they’re infected, and it becomes a challenging problem to identify everyone infected and get them treatment,” said Bolan.
Many STD clinics that were effective at treating diseases closed during the 2007-2009 recession and never reopened. Local health departments are also increasingly short staffed. For state governments strapped for money, public health funds are often the first to be cut during economic downturns.
“We’ve seen the erosion of the public health infrastructure,” Bolan said.
Patients who are uninsured or underinsured often struggle to find care in the private health care system and at times are unable to get appointments for treatment until weeks after testing positive for STDs.
That raises the risk of patients falling through the cracks, not following up on appointments and potentially spreading the infection.
A record-high 1.8 million chlamydia cases were reported to the CDC in 2018, an increase of 2.9 percent from the previous year, making it the most common STD in the U.S.
Rates increased 19.4 percent between 2014 and 2018.
Chlamydia rates are highest among adolescents and young adults, particularly women, with two-thirds of cases among people between the ages of 15 and 24.
The CDC recommends women younger than 25, and women who are at greater risks for infection, be screened annually for the disease.
And more than 115,000 cases of all stages of syphilis were reported to the CDC last year, a 13 percent increase from 2017 and the highest number since 1991.
That includes more than 35,000 cases of primary and secondary syphilis, the most infectious stages of the disease. In 2018, rates of primary and secondary syphilis increased nearly 14 percent from the previous year.
Most of those cases were among men who had sex with other men, according to the report.
But rates also rose among women by 30 percent from 2017 to 2018. That increase is linked to a spike in the number of babies born with syphilis, with Texas, Nevada and Louisiana seeing the highest rates.
If pregnant women aren’t treated for syphilis, the baby can be born with it, resulting in stillbirths, preterm birth and physical and mental disabilities.
Congenital syphilis is treatable, but the CDC said it suspects some health care providers are failing to screen pregnant women for the disease early in pregnancy, or women are not getting prenatal care.
“The resurgence of syphilis, and particularly congenital syphilis, is not an arbitrary event, but rather a symptom of a deteriorating public health infrastructure and lack of access to health care,” Bolan wrote in her report.
“It is exposing hidden, fragile populations in need that are not getting the health care and preventive services they deserve. This points to our need for public health and health care action for each of the cases in this report, as they represent real people, not just numbers.”
Meanwhile, gonorrhea rates are rising fast, with an 83 percent increase in cases from 2009 to 2018. Rates are highest among men, particularly those who have sex with other men.
In 2018, more than 583,000 cases were reported to the CDC, an increase of 5 percent from the previous year.
Public health groups have sounded the alarm on increasing STD rates for years.
The National Coalition of STD Directors is urging Congress to increase funding for STD prevention services by $70 million, calling it the “bare minimum” it will take for the CDC to support an effective response to an ongoing public health crisis.
“We have an STD crisis in the U.S. because prevention programs were sold short for years,” said David Harvey, executive director of the group. “Our first line of defense is underfunded and overwhelmed, leaving Americans vulnerable to STD outbreaks, and that’s exactly what we’re seeing.”
The government funding bill passed by the Democratic-controlled House included an increased in funding for STD services but it’s unclear if the Senate bill will follow suit.
“STDs have real health and human costs. Babies dying from preventable conditions, like congenital syphilis, is not an outcome we can accept,” Harvey said. “This is a heartbreaking symptom of our nation’s STD crisis. Without a radical shift in how we prioritize sexual health in the United States, we can only expect things to get worse."