By OB-GYN Kyle Garner, MD, & Infectious Disease specialist Manual Gordillo, MD
Gonorrhea, chlamydia and syphilis infections have been on the rise for five straight years in the US, according to a new report on the incidence of sexually transmitted diseases (STDs). The report, which the federal Centers for Disease Control and Prevention released last month, analyzed 2018 data nationwide for these diseases and chancroid.
Not too long ago, gonorrhea rates were at historic lows, syphilis was close to elimination and many advances had been made in STD prevention. The CDC report, however, shows that infections have now reached an all-time high; there were more cases of gonorrhea, chlamydia and syphilis in 2018 than any other year since monitoring began in the US. In the 2018 CDC survey: 1.8 million cases chlamydia were reported in the US, a 19% increase over 2014 statistics; 583,405 cases of gonorrhea were reported, a 63% increase over 2014; 35,063 cases of primary and secondary syphilus, a 71% increase over 2014; and 1,306 cases of newborns with syphilus, a shocking 185% increase over 2014.
While the findings come as no surprise to OB-GYNs, primary care doctors or others in healthcare, the statistics are still troubling. These STDs have real public health and human costs, including infertility, drug-resistant gonorrhea and congenital syphilis, which can cause infant death.
Women are more vulnerable than men to the long-term health effects of STD infections. Women who have contracted an STD are at a higher risk for ectopic pregnancies and miscarriages. STD infections also can damage a woman’s reproductive organs and lead to pelvic adhesions, pain and infertility.
STDs on the Suncoast
Sarasota has continued to see rising rates of sexually transmitted diseases, mirroring the trend seen in Florida and across the nation. As treatments for diseases like HIV have improved — and the fear and stigma of this disease has waned — people are participating in more risky sexual behaviors and are less likely to use barrier protection such as condoms, despite increased awareness and the ready availability of protection.
While the teen and young adult population still have the greatest risk of STD infection, we are also seeing an increase in cases among older patients.
Many older adults have the misconception that STDs are a young person problem. So, when entering a new relationship (often after divorce or the death of a partner), they may not ask about the new partner’s sexual history and may not be vigilant in using condoms for protection. As a result, local physicians are seeing increasing numbers of infections of primary herpes and other traditional STDs, like gonorrhea and chlamydia, in this senior population as well.
An increase in some sexual practices (oral and anal) is resulting in more cases of cancers associated with human papillomavirus (HPV ). We now know that HPV not only causes cervical cancer, but it increases the risk of developing other diseases, including anal-rectal cancers, head and neck cancers, and even some GI malignancies. This highlights the need for HPV vaccination, which is now recommended for men and women up to age 45.
Another concerning STD that making a resurgence on the Suncoast is “nongonococcal urethritis/cervicitis,” or mycoplasma and ureaplasma. Mycoplasma and ureaplasma can contribute to pelvic inflammatory disease and infertility. In the past, these infections were notoriously difficult to detect, and healthcare providers did not routinely test for them.
With the advent of DNA-based testing, screening for these STDs is easier and more cost effective. Often present in patients who have recurrent benign infections, the mycoplasma and ureaplasma actually alter the body’s flora, making a person more susceptible. Treatments are relatively easy, but we are also seeing more antibiotic resistance in treating these STDs.
What Can We Do?
The best way to consistently prevent the transmission of sexually transmitted diseases is to practice consistent condom use and to have a frank and open conversation with sexual partners about each of your sexual histories. While condoms do not prevent all STDs, they do provide some protection and greatly reduce transmission risk. Some STDs, like HPV/genital warts, herpes and even syphilis, can still be transmitted sexually when using condoms. Condom use also may increase the efficacy of other contraceptive options and reduce rates of unintended pregnancy.
Prevention for Teens & Young Adults
Teens, who are at the greatest risk of STD infection, should be empowered to always use condoms, even when pressured by a partner not to do so.
By having honest and open conversations about STDs and safe sex practices with teens, parents encourage condom use and prevent the propagation of false information. If you’re uncomfortable having those conversations with a teen in your care, ask their physician to talk to them about the health implications of STD infection.
Once they become sexually active, teenagers and young adults should see their physician yearly to be screened for sexually transmitted diseases such as chlamydia and gonorrhea. Women should begin receiving HPV testing and Pap smears for cervical cancer screening at age 21.
If you or your child have symptoms of STD infection — abnormal discharge or itching, painful urination, an abnormal rash, fever or pelvic pain — see a physician immediately.
Other Recommended Resources
CDC’s “Get the Facts” on STDs
American College of Obstetricians & Gynecologists’ FAQ on STDs
American Academy of Pediatrics on STDs / STIs
A board-certified Obstetrics and Gynecology / Family Medicine specialist, Dr. Kyle Garner also is certified in laparoscopic and daVinci robotic-assisted minimally invasive surgery. He has served as SMH’s chief of staff and chief of Obstetrics and Gynecology.
Dr. Manuel Gordillo leads Sarasota Memorial’s Infection Prevention and Control Department as medical director and is a specialist with Infectious Disease Associates of Sarasota.