Today the Centers for Disease Control and Prevention (CDC) released their 2020 Sexually Transmitted Disease (STD) Surveillance Report which looks at STD infection rates in the United States during the first year of the COVID-19 pandemic.
CDC data shows that reported cases of STDs drastically dropped during the early months of the COVID-19 pandemic in 2020 nationally. However, by the end of that year, reported cases of gonorrhea, syphilis, and congenital syphilis surpassed their 2019 levels, indicating continued surges in STDs. Concurrently, local health departments across the country were forced to limit or shutter services and divert staff time and resources to respond to the pandemic exacerbating an already difficult situation, according the National Association of County and City Health Officials (NACCHO) representing the country’s nearly 3,000 local health departments. Without those shutdowns/limitations to services, the numbers from 2020 could be even higher.
STDs by the Numbers
At the end of 2020, reported cases of gonorrhea and primary and secondary syphilis cases were up 10% and 7% respectively, compared to 2019 cases. The highest reported increase was in congenital syphilis cases, up nearly 15% over 2019, and 235% in just five years (2016-2020).
Reported cases of chlamydia declined 13% from 2019. Because chlamydia historically makes up the largest proportion of reported STDs in the U.S., the overall number of reported STDs dropped (from more than 2.5 million in 2019 to 2.4 million in 2020). However, because chlamydial infections are usually asymptomatic and identified through screening, the decline in reported chlamydia cases is likely due to decreased STD screening and underdiagnosis during the pandemic, rather than a reduction in new infections.
Factors Contributing to Increased STD Cases
COVID-19 strained an already crumbling public health infrastructure. Because of the pandemic, STD program resources were diverted to address COVID-19 with state and local STD staff, laboratories, and other resources heavily affected. Among jurisdictions that received direct CDC funding for STD prevention over half (51%) reported STD test kit and treatment shortages in April 2020 and over half (53%) discontinued critical disease intervention specialists field work for most of 2020.
NACCHO’s 2020 Report from the Field also shows the coronavirus pandemic wreaked havoc on STI prevention and care across the country—with STI clinics closed or operating at limited capacity, while partner notification had to be conducted virtually, and mobile outreach for testing significantly limited, if not stopped all together. Additionally, staff were redirected to the COVID-19 response that continues to significantly challenge the capacity of local health department STD programs.
STDS and Health Disparities
The CDC’s Report also highlighted that some groups continue to be more affected by STDs. Long-standing social and economic factors such as poverty and health insurance status create barriers, increase experiences with health risks, and often result in worse health outcomes for some people and COVID-19 shone a light on that fact.
While STDs are increasing across many groups, the 2020 STD data show that some racial and ethnic minority groups, gay and bisexual men, and our nation’s youth continue to experience higher rates of STDs – illustrating a failure to provide access to quality sexual healthcare to everyone who needs it.
CDC’s Recommendations to Expand STD Prevention in the United States
The CDC recommends prioritizing and refocusing efforts to stem infection rates. They advocate on-the-ground support for prevention and surveillance programs at the state and local level (e.g., disease investigation, contact tracing, training, community engagements, and partnerships).
The CDC is also calling on local healthcare systems, clinics, and community-based organizations to reduce STD rates as they are uniquely situated to respond to emerging STD trends. These groups can play a critical role in promoting STD prevention at the local level and empower individuals to prioritize their sexual health.
Healthcare, industry, and private sector players also have a role and responsibility to develop and deliver new STD testing and treatment innovations.
Lastly, the CDC notes healthcare providers can play a pivotal role in reducing stigma by integrating STD prevention and sexual health into their routine practice and creating a welcoming environment for all people.
