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Sexually transmitted diseases (STDs) have long been an underestimated opponent in the public health battle. A 1997 Institute of Medicine (IOM) report described STDs as, “hidden epidemics of tremendous health and economic consequence in the United States,” and stated that the “scope, impact, and consequences of STDs are underrecognized by the public and healthcare professionals.”1 Since well before this report was published, and nearly two decades later, those facts remain unchanged.
It is estimated that there are 20 million new STDs in the U.S. each year, and half of these are among young people ages 15 to 24 years. Across the nation, at any given time, there are more than 110 million total (new and existing) infections.2 These infections can lead to long-term health consequences, such as infertility; they can facilitate HIV transmission; and they have stigmatized entire subgroups of Americans.
Yet not that long ago, gonorrhea rates were at historic lows, syphilis was close to elimination, and we were able to point to advances in STD prevention, such as better chlamydia diagnostic tests and more screening, contributing to increases in detection and treatment of chlamydial infections. That progress has since unraveled. The number of reported syphilis cases is climbing after being largely on the decline since 1941, and gonorrhea rates are now increasing. This is especially concerning given that we are slowly running out of treatment options to cure Neisseria gonorrhoeae. Many young women continue to have undiagnosed chlamydial infections, putting them at risk for infertility.
Beyond the impact on an individual’s health, STDs are also an economic drain on the U.S. healthcare system. Data suggest the direct cost of treating STDs in the U.S. is nearly $16 billion annually.3 STD public health programs are increasingly facing challenges and barriers in achieving their mission. In 2012, 52% of state and local STD programs experienced budget cuts. This amounts to reductions in clinic hours, contact tracing, and screening for common STDs. CDC estimates that 21 local health department STD clinics closed that year.
It is imperative that federal, state, and local programs employ strategies that maximize long-term population impact by reducing STD incidence and promoting sexual, reproductive, maternal, and infant health. The resurgence of syphilis, and particularly congenital syphilis, is not an arbitrary event, but rather a symptom of a deteriorating public health infrastructure and lack of access to health care. It is exposing hidden, fragile populations in need that are not getting the health care and preventive services they deserve. This points to our need for public health and health care action for each of the cases in this report, as they represent real people, not just numbers.
We also need to modernize surveillance to move beyond counting only those cases in persons who have access to diagnosis and treatment, to develop innovative strategies to understand the burden of disease in those who may not access care, and to improve our surveillance systems to collect the information needed to target prevention activities. Further, it will be important for us to measure and monitor the adverse health consequences of STDs, such as ocular and neurosyphilis, pelvic inflammatory disease, ectopic pregnancy, infertility, HIV, congenital syphilis, and neonatal herpes.
It is my hope that a decade from now, we will be reporting on progress, instead of more health inequity in our society. This is our challenge and our call to effectively respond to the information shared in this report.
Gail Bolan, M.D.
Director, Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
U.S. Centers for Disease Control and Prevention
2. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40(3):187–193. DOI: 10.1097/OLQ.0b013e318286bb53. Review.
3. Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis 2013; 40(3):197–201. DOI: 10.1097/ OLQ.0b013e318285c6d2