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On any given day in 2018, one in five people had a sexually transmitted infection (STI), according to the US Centers for Disease Control and Prevention’s (CDC) recently released Sexually Transmitted Disease (STD) Surveillance Report, 2018. There were nearly 68 million infections in the US—and 26 million STIs were acquired in that year.
“The CDC report is an important reminder that infectious diseases continue to do what they do best, which is to cause illness and spread from person to person,” says David Aronoff, MD, director, Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center. “Sexually transmitted infections are persistent threats to human health.”
Most of the infections on the CDC’s watchlist were due to the human papillomavirus (HPV), herpes simplex virus-2 (HSV-2), and trichomoniasis. Chlamydia, gonorrhea, HIV, hepatitis B virus, and syphilis followed. Although lower on the list, gonorrhea and syphilis numbers are on the rise to a disquieting degree. Since 2014, gonorrhea cases have increased 63% and syphilis cases, 71%.
Syphilis is still treatable with penicillin. But “the tragedy of poor STI [sexually transmitted infection] control is compounded by the fact that many of the germs that cause STIs are gradually developing more and more resistance to available treatments,” Dr. Aronoff says.
The rise in gonorrhea cases is particularly concerning to many health care providers. “There’s a very limited pipeline of new antibiotics to use if we’re confronted with antibiotic-resistant STIs,” says Ina Park, MD, assistant professor at University of California San Francisco School of Medicine; medical director, California Prevention Training Center; and author of Strange Bedfellows: Adventures in the Science, History and Surprising Secrets of STDs. In the case of gonorrhea, she warns, we’re down to one class of antibiotics. When all conventional therapies fail in cases of multidrug-resistant gonorrhea, patients have to be hospitalized and treated with broad-spectrum IV antibiotics, such as ertapenem. “We really don’t want to have to resort to that for an infection as common as gonorrhea,” she says.
Syphilis’ resurgence in new populations also is a concern. In the ’80s, says Michelle Collins-Ogle, MD, there was an epidemic of syphilis in pregnant women and newborns. Then it “sort of quieted down,” she says, in part because obstetricians and gynecologists and other health care providers did a better job of screening, diagnosing, and treating in that demographic. The latest resurgence is in young men of color who have sex with men—“we didn’t see that coming.”
Women and babies are still vulnerable, though. In one year, according to the CDC, syphilis cases among women of childbearing age leaped 36%. And, alarmingly, since 2014, cases of congenital syphilis have increased 185%. Between 2017 and 2018 alone, newborn deaths due to syphilis increased 22%—a “startling” number, says Gail Bolan, MD, the CDC director of STD prevention, in a release about the surveillance report. “Too many babies are needlessly dying. Every single instance of congenital syphilis is one too many when we have the tools to prevent it.”
Can all STIs be prevented? Can the rising tides be turned? Dr. Aronoff says, “As with the COVID-19 pandemic, STIs provide an important opportunity for us to understand how multiple factors can contribute to their spread and difficulty controlling.” Drug use, poverty, unstable housing, and stigma can all reduce access to STD prevention and care, he says. “And, as we’ve seen with COVID-19, under-resourced public health programs can also foster epidemics and pandemics of STIs.” Moreover, he adds, many public health programs at the state and local level have been subjected to budget cuts, which translates into less control of disease.
Some STI rates have been reduced with, for instance, antiretrovirals for HIV/AIDS and the HPV vaccine. But there’s still ground to cover, and new patient groups to protect. Nearly half of all new infections in 2018 were in young people aged 15 to 24 years. Not only is it another dangerous trend, it is an expensive one. Chlamydia, gonorrhea, and syphilis combined accounted for $1.1 billion in direct medical costs in 2018, the CDC report says, and care for young people aged 15 to 24 made up about 60% of those costs.
“Low or decreasing rates of condom use among vulnerable groups, including young people and gay and bisexual men, play important roles in driving ongoing STI rates,” Aronoff says. In part, that’s due to lack of comprehensive sex education, a lack that’s taking a huge toll.
“Remember now, we basically cut out a lot of the sex education. It doesn’t exist,” says Dr. Collins-Ogle. She has run clinics for several decades, and says she continually sees young male patients who don’t know how to use a condom. We know more now, though, she points out. “Back in the ‘80s, we didn’t have a direct correlation between STIs and AIDS. Now we know that having syphilis, for example, predisposes you to HIV acquisition. We also know that having HSV2, for example, predisposes you to HIV.”
It’s an ongoing battle, though, with each new generation of pathogens—and people. And as the CDC report shows, it’s like fighting a Hydra: When one infection is wrestled to the ground, another rears its head. There’s no time to rest on laurels. “Having highly contagious infections caused by difficult or impossible-to-treat microbes,” says David Aronoff, “is not a future I would wish on anyone
On any given day in 2018, one in five people had a sexually transmitted infection (STI), according to the US Centers for Disease Control and Prevention’s (CDC) recently released Sexually Transmitted Disease (STD) Surveillance Report, 2018. There were nearly 68 million infections in the US—and 26 million STIs were acquired in that year.
“The CDC report is an important reminder that infectious diseases continue to do what they do best, which is to cause illness and spread from person to person,” says David Aronoff, MD, director, Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center. “Sexually transmitted infections are persistent threats to human health.”
Most of the infections on the CDC’s watchlist were due to the human papillomavirus (HPV), herpes simplex virus-2 (HSV-2), and trichomoniasis. Chlamydia, gonorrhea, HIV, hepatitis B virus, and syphilis followed. Although lower on the list, gonorrhea and syphilis numbers are on the rise to a disquieting degree. Since 2014, gonorrhea cases have increased 63% and syphilis cases, 71%.
Syphilis is still treatable with penicillin. But “the tragedy of poor STI [sexually transmitted infection] control is compounded by the fact that many of the germs that cause STIs are gradually developing more and more resistance to available treatments,” Dr. Aronoff says.
The rise in gonorrhea cases is particularly concerning to many health care providers. “There’s a very limited pipeline of new antibiotics to use if we’re confronted with antibiotic-resistant STIs,” says Ina Park, MD, assistant professor at University of California San Francisco School of Medicine; medical director, California Prevention Training Center; and author of Strange Bedfellows: Adventures in the Science, History and Surprising Secrets of STDs. In the case of gonorrhea, she warns, we’re down to one class of antibiotics. When all conventional therapies fail in cases of multidrug-resistant gonorrhea, patients have to be hospitalized and treated with broad-spectrum IV antibiotics, such as ertapenem. “We really don’t want to have to resort to that for an infection as common as gonorrhea,” she says.
Syphilis’ resurgence in new populations also is a concern. In the ’80s, says Michelle Collins-Ogle, MD, there was an epidemic of syphilis in pregnant women and newborns. Then it “sort of quieted down,” she says, in part because obstetricians and gynecologists and other health care providers did a better job of screening, diagnosing, and treating in that demographic. The latest resurgence is in young men of color who have sex with men—“we didn’t see that coming.”
Women and babies are still vulnerable, though. In one year, according to the CDC, syphilis cases among women of childbearing age leaped 36%. And, alarmingly, since 2014, cases of congenital syphilis have increased 185%. Between 2017 and 2018 alone, newborn deaths due to syphilis increased 22%—a “startling” number, says Gail Bolan, MD, the CDC director of STD prevention, in a release about the surveillance report. “Too many babies are needlessly dying. Every single instance of congenital syphilis is one too many when we have the tools to prevent it.”
Can all STIs be prevented? Can the rising tides be turned? Dr. Aronoff says, “As with the COVID-19 pandemic, STIs provide an important opportunity for us to understand how multiple factors can contribute to their spread and difficulty controlling.” Drug use, poverty, unstable housing, and stigma can all reduce access to STD prevention and care, he says. “And, as we’ve seen with COVID-19, under-resourced public health programs can also foster epidemics and pandemics of STIs.” Moreover, he adds, many public health programs at the state and local level have been subjected to budget cuts, which translates into less control of disease.
Some STI rates have been reduced with, for instance, antiretrovirals for HIV/AIDS and the HPV vaccine. But there’s still ground to cover, and new patient groups to protect. Nearly half of all new infections in 2018 were in young people aged 15 to 24 years. Not only is it another dangerous trend, it is an expensive one. Chlamydia, gonorrhea, and syphilis combined accounted for $1.1 billion in direct medical costs in 2018, the CDC report says, and care for young people aged 15 to 24 made up about 60% of those costs.
“Low or decreasing rates of condom use among vulnerable groups, including young people and gay and bisexual men, play important roles in driving ongoing STI rates,” Aronoff says. In part, that’s due to lack of comprehensive sex education, a lack that’s taking a huge toll.
“Remember now, we basically cut out a lot of the sex education. It doesn’t exist,” says Dr. Collins-Ogle. She has run clinics for several decades, and says she continually sees young male patients who don’t know how to use a condom. We know more now, though, she points out. “Back in the ‘80s, we didn’t have a direct correlation between STIs and AIDS. Now we know that having syphilis, for example, predisposes you to HIV acquisition. We also know that having HSV2, for example, predisposes you to HIV.”
It’s an ongoing battle, though, with each new generation of pathogens—and people. And as the CDC report shows, it’s like fighting a Hydra: When one infection is wrestled to the ground, another rears its head. There’s no time to rest on laurels. “Having highly contagious infections caused by difficult or impossible-to-treat microbes,” says David Aronoff, “is not a future I would wish on anyone
On any given day in 2018, one in five people had a sexually transmitted infection (STI), according to the US Centers for Disease Control and Prevention’s (CDC) recently released Sexually Transmitted Disease (STD) Surveillance Report, 2018. There were nearly 68 million infections in the US—and 26 million STIs were acquired in that year.
“The CDC report is an important reminder that infectious diseases continue to do what they do best, which is to cause illness and spread from person to person,” says David Aronoff, MD, director, Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center. “Sexually transmitted infections are persistent threats to human health.”
Most of the infections on the CDC’s watchlist were due to the human papillomavirus (HPV), herpes simplex virus-2 (HSV-2), and trichomoniasis. Chlamydia, gonorrhea, HIV, hepatitis B virus, and syphilis followed. Although lower on the list, gonorrhea and syphilis numbers are on the rise to a disquieting degree. Since 2014, gonorrhea cases have increased 63% and syphilis cases, 71%.
Syphilis is still treatable with penicillin. But “the tragedy of poor STI [sexually transmitted infection] control is compounded by the fact that many of the germs that cause STIs are gradually developing more and more resistance to available treatments,” Dr. Aronoff says.
The rise in gonorrhea cases is particularly concerning to many health care providers. “There’s a very limited pipeline of new antibiotics to use if we’re confronted with antibiotic-resistant STIs,” says Ina Park, MD, assistant professor at University of California San Francisco School of Medicine; medical director, California Prevention Training Center; and author of Strange Bedfellows: Adventures in the Science, History and Surprising Secrets of STDs. In the case of gonorrhea, she warns, we’re down to one class of antibiotics. When all conventional therapies fail in cases of multidrug-resistant gonorrhea, patients have to be hospitalized and treated with broad-spectrum IV antibiotics, such as ertapenem. “We really don’t want to have to resort to that for an infection as common as gonorrhea,” she says.
Syphilis’ resurgence in new populations also is a concern. In the ’80s, says Michelle Collins-Ogle, MD, there was an epidemic of syphilis in pregnant women and newborns. Then it “sort of quieted down,” she says, in part because obstetricians and gynecologists and other health care providers did a better job of screening, diagnosing, and treating in that demographic. The latest resurgence is in young men of color who have sex with men—“we didn’t see that coming.”
Women and babies are still vulnerable, though. In one year, according to the CDC, syphilis cases among women of childbearing age leaped 36%. And, alarmingly, since 2014, cases of congenital syphilis have increased 185%. Between 2017 and 2018 alone, newborn deaths due to syphilis increased 22%—a “startling” number, says Gail Bolan, MD, the CDC director of STD prevention, in a release about the surveillance report. “Too many babies are needlessly dying. Every single instance of congenital syphilis is one too many when we have the tools to prevent it.”
Can all STIs be prevented? Can the rising tides be turned? Dr. Aronoff says, “As with the COVID-19 pandemic, STIs provide an important opportunity for us to understand how multiple factors can contribute to their spread and difficulty controlling.” Drug use, poverty, unstable housing, and stigma can all reduce access to STD prevention and care, he says. “And, as we’ve seen with COVID-19, under-resourced public health programs can also foster epidemics and pandemics of STIs.” Moreover, he adds, many public health programs at the state and local level have been subjected to budget cuts, which translates into less control of disease.
Some STI rates have been reduced with, for instance, antiretrovirals for HIV/AIDS and the HPV vaccine. But there’s still ground to cover, and new patient groups to protect. Nearly half of all new infections in 2018 were in young people aged 15 to 24 years. Not only is it another dangerous trend, it is an expensive one. Chlamydia, gonorrhea, and syphilis combined accounted for $1.1 billion in direct medical costs in 2018, the CDC report says, and care for young people aged 15 to 24 made up about 60% of those costs.
“Low or decreasing rates of condom use among vulnerable groups, including young people and gay and bisexual men, play important roles in driving ongoing STI rates,” Aronoff says. In part, that’s due to lack of comprehensive sex education, a lack that’s taking a huge toll.
“Remember now, we basically cut out a lot of the sex education. It doesn’t exist,” says Dr. Collins-Ogle. She has run clinics for several decades, and says she continually sees young male patients who don’t know how to use a condom. We know more now, though, she points out. “Back in the ‘80s, we didn’t have a direct correlation between STIs and AIDS. Now we know that having syphilis, for example, predisposes you to HIV acquisition. We also know that having HSV2, for example, predisposes you to HIV.”
It’s an ongoing battle, though, with each new generation of pathogens—and people. And as the CDC report shows, it’s like fighting a Hydra: When one infection is wrestled to the ground, another rears its head. There’s no time to rest on laurels. “Having highly contagious infections caused by difficult or impossible-to-treat microbes,” says David Aronoff, “is not a future I would wish on anyone