In April this year, the Centers for Disease Control and Prevention reported that the United States had recorded its sixth consecutive year of a high number of cases of sexually transmitted infections, including syphilis, chlamydia, and gonorrhea, in 2019.
CDC's Division of STD Prevention wrote in a report that the country was close to eliminating syphilis 20 years ago, and advances in diagnosing chlamydia have also helped. However, that progress has been lost partly because of the public health system.
Micrograph showing Treponema pallidum, the spirochete that causes syphilis. Dieterle stain.
STD Cases in the US is on the Rise
The data from the CDC showed that there was a 20% increase in chlamydia cases from 2015 to 2019, which is totaled to over 1.8 million. Meanwhile, gonorrhea cases increased by more than 50% in the same period, totaling 616,000 cases in 2019. Syphilis cases in the US also increased, wherein health officials have recorded 130,000 cases in 2019, or a 70% increase since 2015.
This data showed that sexually transmitted infections had infected more than 2.6 million individuals in 2019, increasing from the 2.5 million in 2018.
According to US News, another concerning matter regarding this surge in STDs is the increase in congenital syphilis. This condition is passed from the mother to her baby during pregnancy. In 2019, the US recorded a 279% increase of cases since 2015, wherein 128 infants died of congenital syphilis from the 2,000 reported cases.
Moreover, the report noted significant disparities in the reported STDs among adolescents and young adults aged 15 to 24 years old, who make up 55% of cases in 2019.
Approximately 31% of chlamydia, gonorrhea and primary and secondary syphilis were non-Hispanic Black individuals despite only making up 12.5% of the country's total population. The report also said that men who have sexual intercourse with other men were disproportionately affected by STDs.
But CDC says that disparities such as these reflect the differential access to quality sexual health care and differences in sexual network characteristics and not by differences in sexual behavior.
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Missed Opportunity to Stop Syphilis From Spreading
Syphilis is also known as the Great Imitator because it resembles other diseases. According to NPR, syphilis has been shrouded with stigma even from its earliest days, perhaps due to it being a sexually transmitted disease.
Former Surgeon General Thomas Parran wrote in the book Shadow on the Land that an estimated 680,000 people in 1937 were under treatment for syphilis, and 60,000 babies were born annually with congenital syphilis. Unfortunately, there was no cure, and the stigma was so strong that even public health officials feared properly documenting cases.
But through Parran's ardent advocacy, the National Venereal Disease Control Act was passed in 1938 that grants the states to set up clinics and support testing and treatment for syphilis patients.
Moreover, the Public Health Service also launched an effort to record the natural history of syphilis properly. A few years later, in 19402, penicillin became widely available and was used as a reliable cure, and cases began to plummet. The CDC has even announced twice, first in the 1960s and then in 1990, that efforts to wipe out the disease were successful.
But it was considered to be a missed opportunity as cases started climbing again. Some infection cases were first reported in gay men, then in heterosexuals. More so, cases in women also rose, followed by congenital syphilis. The failure is complex, including being too relaxed in practicing safe sex, increased methamphetamine, and explosion in online dating that made it hard to track and test sexual partners.
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