What’s driving the surge in STDs?

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New data released by the Centers for Disease Control show that, in spite of public health efforts and education campaigns to combat them, sexually transmitted diseases continue to rise, with 19 million new cases costing the U.S. health care system some $15.9 billion annually. But what exactly is driving this surge—higher levels of reporting, better screening techniques, a reduction in protected sex? To better understand the national trends, TIME spoke with Dr. John Douglas, director of the CDC’s Division of STD Prevention.

Nationwide there were roughly 2,000 more cases of syphilis in 2008 compared with the year before, a particularly grim finding considering that the disease had reached historically low levels at the end of the 1990s and into the early 2000s, Douglas says. “It had gotten so low that we had launched the national syphilis elimination program,” he says. In fact, the nearly 13,500 cases reported in 2008 reflect the highest reported number of syphilis infections since 1995. Unfortunately, after making such inroads against the disease a decade ago, little by little syphilis began to make a comeback, beginning with gay males, who still suffer the highest rates of the disease, Douglas says. According to this most recent data, nearly two thirds of syphilis cases are among men who have sex with men, compared with just 4% of all cases in 2000, figures that are particularly alarming as gay men are also a high risk population for HIV, and syphilis infection can make it easier to contract HIV. Douglas suggests that improvement in HIV medications may in part be reflected in the higher rates of syphilis infection among men who have sex with men—as people who were possibly too ill or taking caution to avoid HIV transmission may be engaging in riskier sex. “The HIV medications have really changed that picture dramatically,” he says.

Yet it isn’t only gay men who are suffering from higher rates of syphilis infection, Douglas underscores. Women have been showing steady increases since 2004 as well, with a 36% jump from 2007 to 2008 alone. And rates of infection vary dramatically by race as well, Douglas stresses. Syphilis rates were nearly eight times higher among blacks than whites in 2008—or 17.3 cases per 100,000 people, compared with 2.2.

Whereas syphilis is clearly increasing, gonorrhea rates are slightly decreasing, much to the approval of health officials. (With more than 330,000 new cases last year, however, it remains the second most commonly reported STD in the country.) Meanwhile, national data showing continued increases in chlamydia—with a record-breaking 1.2 million new infections in 2008—may reflect increased screening more than actual increases in cases, Douglas says. In reality, chlamydia cases have likely plateaued or even begun to go down, he points out, but increases in screening, including a new, less invasive urine test for men, show larger overall numbers of reported cases. “The national level data are important, but they’re mostly telling us that we’re testing more,” Douglas says. Still, that’s not to say chlamydia isn’t a serious problem—it continues to be the most commonly reported STD, and like syphilis and gonorrhea, if left untreated can lead to serious pelvic infections and even infertility.

And with chlamydia, like syphilis and other STDs, the burden of infection isn’t spread equally across the population. Women, and more specifically younger and minority women, are hardest hit by the disease. And, once again, whites suffer lower rates of chlamydia infection than other ethnic groups: blacks have the highest rates with more than 1,500 cases per every 100,000 people; American Indians/Alaskan Natives had roughly 800 cases per 100,000; Hispanics had 510 cases per every 100,000; and whites had fewer than 200 cases. Those disparities, Douglas says, are not a reflection of personal choices but rather societal factors. “This has got nothing to do with personal risky sexual behavior,” he says. “This has everything to do with communities having higher rates of infection for a variety of factors, including lack of access to health care.”

So where do we go from here in the battle against STDs? Douglas is hopeful that for the human papillomavirus (HPV), for example, the emergence of a vaccine and accompanying awareness campaign will help diminish rates of infection. (HPV is the most common sexually transmitted disease, experts say, and though they’re isn’t comprehensive reported data, official estimates suggest there are 6.2 million new cases each year.) But across the board, he says, continued efforts to promote education and healthy discussion are paramount. “I personally believe that we’ll do a better job if we are guiding people through a health-focused approach toward prevention, as opposed to a fear based approach,” he says. And to that end, he encourages people to learn more about sexually transmitted diseases (you can read a summary of the report here, and download the entire report here), engage in discussion with sexual partners and peers, and get tested. By visiting the CDC’s National HIV and STD Testing Resources page, you can simply plug in your zip code and find a testing facility nearby.

It’s going to be an uphill battle, Douglas concedes, and open discussion of sex has long been a difficult sell, but for the benefit of public health spreading information is key, he says. “What we would really like to do is see a substantial societal shift toward more open and informed discussion about sexuality,” he adds. “We’d like to get this into the dialogue and conversation from the earliest stages of adolescence and adulthood.”


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