Syphilis, chlamydia, gonorrhea: it seems the big bad supervillains of sexual transmitted diseases (STDs) have returned. Perhaps you thought – you hoped! – that people were becoming smarter and dating safer. But the news in the last few months has peppered us with stories of STDs on the rise.
The Ups & Downs
If you thought we were in the clear from these diseases, you weren’t imagining things. A few years ago, gonorrhea rates had reached historic lows and syphilis seemed almost eliminated. We can treat all three STDS with antibiotics.
But in October 2019, the Centers for Disease Control raised the alarm. The agency issued a press release calling for “urgent action” because “cases of syphilis, gonorrhea, and chlamydia reached an all-time high in the United States in 2018.”
Should we be afraid? I talked to Patrick Jackson, MD, a self-described fanatic about STDs (which is how you want your doctor). Jackson sees patients at the Ryan White HIV Clinic. There, he and the other infectious disease experts screen, test and treat for STDs rigorously. He’s also a researcher, so we spoke at his lab.
STDs on the Rise: Who’s to Blame?
“There’s a bunch of potential issues,” Jackson explained. “This continued increase has been going on for a few years, but there’s not just one clear answer.”
Potential Culprit #1: New STDs Screenings & More Testing
It’s possible, Jackson says, that the “rise” in STDs reflects an increase in reported data, not of the actual disease numbers themselves.
“It could be due to increased awareness and testing,” he explains. “Which is good. You can’t solve something if you don’t know it exists.”
He points out that, “Until recently, there weren’t tests to check for oral and rectal gonorrhea and chlamydia.” Standard urine tests only catch when these diseases live in the genitals only. With the ability to find more versions of these diseases, the numbers go up.
Potential Culprit #2: Condom Use Down
“We know that in certain populations, young people and gay and bisexual men specifically, condom use is decreasing,” Jackson adds.
One disturbing finding of the CDC report: “Young people ages 15 to 24 acquire half of all new STD cases, and 1 in 4 sexually active adolescent girls has an STD.”
Potential Culprit #3: Low Funding
In the mid-2000s, Jackson says, outreach programs providing education and resources for safer sex lost funding. These funds haven’t been restored, and many experts believe they’ve seen a residual impact.
The CDC reports that “more than half of local programs have experienced budget cuts, resulting in clinic closures, reduced screening, staff loss, and reduced patient follow-up and linkage to care services.” The public health infrastructure that had worked so well to combat these diseases has been depleted.
Potential Culprit #4: Those Millennials
They get blamed for everything these days, it seems, so it’s no surprise they’re getting fingered for this one, too.
“There’s debates about whether it’s the generation, the users of Grindr and Tinder, and a little bit of evidence that these apps may be associated with the incidence rates,” says Jackson. “But there are confounding variables.”
Potential Culprit # 5: Shifting Structures of Sexual Networks
It’s at this point in our conversation that Jackson jumps up and begins drawing on the whiteboard. He’s excited. Jackson wants to explain how sexual networks – the patterns of sexual activity between people – could hold the key to the spread of sexual infections.
It’s not about the total numbers of sexually active people. “You can have the same number of partners with the same numbers of partners,” he says. “But different patterns show up in populations with higher rates of STDs.”
He contrasts two different patterns, where dots represent people. In the first pattern, an STD requires two connections or sexual encounters in order to pass from one group of sexual partners to another.
In the second pattern, however, the STD can transmit from one group of people to another through just one connection. That is, the STD spreads easier and faster in the second model.
Incarcerated populations, for instance, and certain tight-knit communities, may just be “passing things back and forth.” And certain sex acts, specifically anal sex, have the tendency to transmit infection higher than others.
The Syphilis Surprise
Jackson notes that, at UVA, he’s definitely seen a noticeable increase in syphilis cases.
But patients don’t know they have an STD. They come in for eye problems.
“People are shocked,” Jackson says. Most people don’t know that syphilis can manifest in your vision.
Syphilis, Jackson explains, has earned the nickname “The Great Pretender.” It can cause just about any kind of condition, from neurological disease to stillbirths. “Neurosyphilis can show up as benign as headaches or changes in personality. You look for nuance with memory changes.” But providers can miss the signs and easily misdiagnose.
Why now? Syphilis also can live silently in the body for decades. “So, people acquired it many years ago, and now they feel like their misspent youth has come back to bite them,” Jackson says.
The other problem with syphilis: It can transmit in utero, from mother to child. “Among newborns, syphilis cases increased 40 percent.” This infection can lead to miscarriage, stillbirth, newborn death, and severe lifelong physical and neurological problems.
Without proper healthcare, including prenatal screenings, this preventable disease can lead to tragedy.
Gonorrhea Upping its Game
Gonorrhea, on the other hand, “has started to develop antimicrobial resistance. There’s no all-oral options anymore. And we’re getting down to very few options.”
Normally, gonorrhea “only persists for a couple of weeks. If you have symptoms, it burns when you pee. Then it naturally goes away.”
In the few cases where gonorrhea doesn’t disappear on its own, where the genetics of the bacteria have changed, the consequences can be severe. It affects fertility, causes heart infections and hurts joints.
Research trying to understand how the immune system naturally fights the disease hopes to help.
Chlamydia can make its presence known by causing burning when you pee. But often, the infection lurks in the female genital tract, causing no symptoms at all.
Undiagnosed and untreated, chlamydia infections in women can result in infertility. This fact underscores how socioeconomic factors that affect health access can play a role in the spread of disease. Without symptoms and screenings, women can pass on chlamydia unknowingly.
Mostly, the cases seen at UVA constitute the “run-of-the-mill STDs.”
But in developing countries, chlamydia shows up as one of the leading causes of blindness in children, spreading through hand to eye contact and flies.
In men who have sex with men, chlamydia can show up as intense inflammation and feature destructive lesions.
Researchers at UVA are studying how chlamydia grows in the body, looking to get treatment insights for all three types.
Get Screened for STDs
With STDs on the rise, you should consider getting tested. Find a primary care provider near you.
The Big Bad Unknown
All in all, whatever the culprits causing the recent rise in STDs, Jackson worries most about the emerging diseases.
“More and more bugs are showing up, causing more infection than we realized, because we haven’t routinely tested for them. They have a lot of resistance to the usual antibiotics. Some people are failing the initial therapies.”
Which is why he wants everyone he knows to get screened for STDs – often. “There’s a lot more stuff out there. If we’re not looking and doing effective surveillance, they’ll continue to grow without us knowing. It’s a big concern.”
“Use condoms. Get tested. Be honest with your doctor about your sexual history,” Jackson says.