Foreword – Sexually Transmitted Disease Surveillance, 2019

Reported cases of chlamydia, gonorrhea, and syphilis have increased for the sixth consecutive year – reaching a new, all-time high. These infections remain common, costly, and challenge the health and wellness of millions of people across the United States.

In 2019, U.S. health departments reported:

  • 1.8 million cases of chlamydia, an increase of nearly 20 percent since 2015;
  • 616,392 cases of gonorrhea, an increase of more than 50 percent since 2015; and
  • 129,813 cases of syphilis (all stages), an increase of more than 70 percent since 2015.

Congenital syphilis has increased a staggering 279 percent since 2015. In 2019 alone, there were nearly 2,000 cases of congenital syphilis reported, including 128 deaths. Syphilis among newborns can result in lifelong physical and neurologic problems; meaning bone deformity, severe anemia, and brain and nerve problems, including blindness, can become reality for affected infants.

In addition to infant morbidity and mortality, STIs can also lead to long-term health consequences, like infertility, and they can facilitate HIV transmission.

Social inequity often leads to health inequity and, ultimately, manifests as health disparities. Historically, health disparities have persisted because access to, and routine use of, quality health care, including STI prevention and treatment, have not been equitably distributed. Currently, many Americans, particularly racial and ethnic minority populations, and adolescent and young adults, have limited access to these services. In 2019, racial and ethnic minorities had STI rates several times higher than Whites, and youth aged 15-24 comprised significant proportions of reported cases across all groups. Gay, bisexual, and other men who have sex with men continue to experience higher rates of syphilis and gonorrhea than heterosexual men.

Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination, and advances in chlamydia diagnostics made it easier to detect infections. That progress has been lost, due in part to challenges to our public health system.

The 2019 numbers and trends presented here do not yet reflect the impact of the COVID-19 pandemic on STDs in the United States. Many STD prevention staff have been called to the front lines of the nation’s public health response to COVID-19, and health departments have had to adjust resources accordingly. Fewer STI tests are being performed in health care clinics as people heed safe-at-home guidance and clinics have reduced hours, or even temporarily closed, as a result. The recently published National Academies of Sciences, Engineering, and Medicine (NASEM) consensus study report, Sexually Transmitted Infections: Adopting a Sexual Health Paradigmexternal icon, highlights that the “COVID-19 pandemic has exposed weaknesses in public health preparedness due to weak infrastructure, an under-capacitated and under-resourced workforce, and limited surge capacity.” These are challenges STD prevention efforts have faced for many years. Preliminary 2020 data suggest we likely will see continued concerning trends which demand immediate attention, even in the current environment. We must continue to meet the challenges by finding new solutions; adapting quickly to meet the ever-changing landscape of the healthcare system; and collaborating to share information, strategies, and science.

Fortunately, this is also a time of momentum in our field. HHS’ Sexually Transmitted Infections National Strategic Plan for the United Statespdf iconexternal icon – the nation’s first-ever plan of its kind for STIs – has provided a roadmap for public health, government, community-based organizations, and other stakeholders to develop, enhance, and expand STI prevention and care programs at the local, state, tribal, and national levels. In addition, STI prevention partners across the nation are leveraging innovative approaches, like telehealth/telemedicine; partnerships with pharmacies and retail health clinics; and STI express clinics, to meet patients where they are with the testing and prevention services they urgently need.

While these times may be unprecedented, with the help of our partners and the STI field, we will continue to rise to the challenge – and protect the nation’s health. It is our sincere hope that the latest national data on reported STDs will create a sense of urgency around this escalating problem and mobilize resources so that future reports can highlight renewed progress.

Raul Romaguera, DMD, MPH

Acting Director, Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
US Centers for Disease Control and Prevention