Dear Partners in Prevention,
Today, during the third annual STD Awareness Week, CDC released Sexually Transmitted Disease (STD) Surveillance, 2020. The annual report shows STDs continued to increase during the first year of the coronavirus disease 2019 (COVID-19) pandemic.
In 2020, the COVID-19 pandemic abruptly interrupted the world. STD program resources were not sparedpdf icon, shifting to help control the disease. Many jurisdictions reported critical effects on staffing and testing and treatment supplies, straining an already crumbling public health infrastructureexternal icon. COVID-19 significantly affected STD surveillance and prevention efforts, and these challenges are reflected in this new report.
What we know about reported STDs in 2020
“The COVID-19 pandemic increased awareness of a reality we’ve long known about STDs. Social and economic factors – such as poverty and health insurance status – create barriers, increase health risks, and often result in worse health outcomes for some people. If we are to make lasting progress against STDs in this country, we have to understand the systems that create inequities and work with partners to change them. No one can be left behind.”
– Leandro Mena, MD, MPH, Director, CDC’s Division of STD Prevention
Even in the face of a pandemic, 2.4 million cases of STDs were reported in the U.S. in 2020. The syphilis epidemic continued to surge, driving another year of increases in congenital syphilis. Jurisdictions reported more than 2,100 cases of congenital syphilis, an increase of almost 15 percent since 2019 and a 235 percent increase since 2016. Gonorrhea and primary and secondary (P&S) syphilis cases increased by 10 percent and 7 percent from 2019 to 2020, while reported cases of chlamydia declined 13 percent. However, chlamydial infections are usually asymptomatic and identified through screening. Therefore, this decline is likely due to decreases in STD screening and underdiagnosis during the pandemic, rather than a reduction in new infections. The 2020 STD data also show that some racial and ethnic minority groups, gay and bisexual men, and our nation’s youth continue to experience high rates of STDs.
Congenital syphilis continues to be a consequence of the U.S. syphilis epidemic
Focused attention is needed to combat the surge in congenital syphilis, which has dramatically increased in the past five years. In 2020, there were 149 stillbirths and infant deaths, reflecting a startling 210 percent increase since 2016. Data show that 47 states reported at least one case of congenital syphilis is 2020, compared to only 24 states in 2011. The most common missed congenital syphilis opportunity occurred when mothers did not receive timely prenatal care or syphilis testing (41 percent). Fueling this national trend are parallel increases in P&S syphilis (i.e., most infectious phases) among women aged 15-44 years by more than 156 percent from 2016 to 2020. Early 2021 data indicate P&S syphilis and congenital syphilis continued to increase, with congenital syphilis cases already surpassing 2020 counts.
COVID-19 affected STD surveillance
Although 2020 data ultimately point to continued STD increases in the U.S., during the early months of the year – at the start of the COVID-19 pandemic – nationally reported cases of STDs drastically decreased.
Several factors likely contributed to the initial decline in all reported STD cases, as well as the overall drop in reported cases of chlamydia seen at year’s end:
- Reduced screening at healthcare clinics, facility closures, and CDC guidance to prioritize diagnosis and treatment of syphilis and gonorrhea cases;
- Limited resources, including shortages of STD test kits and laboratory supplies, and health department staff shifting to COVID-19 work (affecting STD contact tracing and reporting);
- Enforced stay-at-home orders that may have delayed routine healthcare visits;
- Increased unemployment resulting in a lapse of health insurance coverage for many; and
- Increased use of telemedicine practices to treat symptomatic patients without a confirmed laboratory test result.
COVID-19 continues to impact our healthcare system and STD program resources. It is unclear how the pandemic will affect future STD surveillance data. However, there is no reason to believe we will be back to “business as usual” with STD case reporting anytime soon.
STDs are not patiently waiting for the pandemic to end, and neither can we
There is much to be done to rebuild, innovate, and expand STD prevention in the U.S. to close gaps and create lasting change. We must prioritize and focus our efforts to regain lost ground to control the spread of STDs. Despite many challenges, the field remains dedicated to the work by offering innovative solutions to meet people where they are.
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.
Thank you for your continued support,
Leandro Mena, MD, MPH
Director, Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
US Centers for Disease Control and Prevention