STD rates are surging. Are common myths to blame?

Dr. Michael Daignault, USA TODAY
·5 min read
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Public health experts were alarmed to see a surge of common sexually transmitted diseases – now referred to as sexually transmitted infections (STIs) – during the last two years of the COVID-19 pandemic. Even more concerning, those rates have continued to rise.

On a global level, more than 131 million people are infected with chlamydia, 78 million with gonorrhea, and 5.6 million with syphilis each year.

In the U.S. alone, there has been a significant increase in the rate of almost all STIs according to recent data from the CDC. Between 2016 and 2020:

  • Gonorrhea cases increased by 45%

  • Syphilis cases increased 52% – new syphilis infections were at their highest level since 1991

Only cases of chlamydia declined, by 1.2%, during that timeframe. However, this is likely due to underreporting since chlamydia infections can be asymptomatic and go can unnoticed; whereas both gonorrhea and syphilis cause painful symptoms prompting patients to seek medical care and be tested.

Why are STDs on the rise?

Overall declining use of condoms, a laissez-faire attitude about the danger of STIs like HIV and years of inadequate funding for STI prevention and testing programs prior to the pandemic certainly played a key role in the current surge of infections.

The stress of the pandemic was a catalyst in a number of ways:

The recent monkeypox outbreak further stretched our limited public health infrastructure and resources.

There are also many common myths surrounding STIs that are to blame for the recent rise in cases.

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Myth: I would know if my partner had an STI

Most of my ER patients are aware that they can get a genital herpes (HSV-1 or -2) viral infection from a sexual partner who is not showing any symptoms. This is key information, given a study found that in 70% of the cases of herpes transmission among heterosexual couples, infection occurred at a time when there were no symptoms present. And they also know that while correct and consistent condom use is highly effective, it may not 100% protect against contracting a herpes infection.

But chlamydia infection in both men and women can also go unnoticed. Both chlamydia and gonorrhea are assumed to be associated only with penile or vaginal discharge, but this STI often presents with nonspecific symptoms like urinary frequency, burning with urination or feeling of incomplete urination. Chlamydia is caused by a bacterium and is the most frequent reported STI in the U.S.

The big difference between herpes and chlamydia is that chlamydia can be treated and cured with a round of antibiotics. A herpes outbreak can be treated but there is no cure; those affected can opt for a daily preventative anti-viral treatment or an as-needed treatment for flare-ups.

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Myth: I can only get an STI once

This is a big one. There's no long-term immunity from bacterial STIs such as chlamydia, gonorrhea and syphilis. You can contract these again even if you've been treated.

Myth: I don't need to be retested after being treated

The CDC actually recommends retesting 3 months after treatment for bacterial STIs like chlamydia, gonorrhea and syphilis. The concern is that reinfection is quite common, especially if the initial infections occurred within a couple. This is because couples often do not abstain from sex during and after when they were both treated to ensure clearance of the virus; it's uncommon but the bacteria could spread back and forth in this situation and cause reinfection.

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Myth: I shouldn't be worried about antibiotic resistance

We all should be concerned. Treatment for gonorrhea is under the highest threat of antibiotic resistance such that older medications are no longer effective. In recent years, the CDC removed the common antibiotic azithromycin as an option for treating uncomplicated gonorrhea, noting increasing levels of resistance of the bacteria to the drug. Now, the CDC only recommends single dose ceftriaxone for urogenital or rectal gonorrhea.

Fortunately, syphilis remains highly susceptible to a single dose of benzathine penicillin and chlamydia can be treated with either a single dose of azithromycin or a 7-day course of doxycycline.

Another STI that has been popping up on the radar more frequently since the FDA approved the first test in 2019 is mycoplasma genitalium, or M. gen. It's similar to chlamydia in that it can cause an asymptomatic infection, but can also cause urethritis in men and cervicitis, pelvic inflammatory disease and fertility problems in women.

M. gen has already developed rapid resistance to azithromycin in multiple studies. There has been some reported resistance to fluoroquinolone antibiotics as well. For now, the CDC recommends a two-antibiotic treatment regimen guided by resistance testing, however this is not commonly available.

What's the bottom line about STIs?

Rates of common bacterial-caused STIs have been steadily rising. These STIs remain highly treatable, but antibiotic resistance is becoming an issue for some of them. We urgently need to reinvest public health resources into increasing awareness around asymptomatic spread and testing.

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Michael Daignault, MD, is a board-certified ER doctor in Los Angeles. He studied Global Health at Georgetown University and has a Medical Degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps Volunteer. Find him on Instagram @dr.daignault

This article originally appeared on USA TODAY: STD rates are surging: Myths about chlamydia, gonorrhea, syphilis