We’re seeing more sexually transmitted infections (STIs) now than ever before. As the Centers for Disease Control and Prevention (CDC) announced in August, rates of syphilis, gonorrhea, and chlamydia have climbed in the U.S. for the fourth year in a row. Let’s break down some of the most notable findings from the 2017 STI report (which is the most recent data available):
- 1,708,569 cases of chlamydia were reported in 2017. The chlamydia rate has gone up 6.9 percent from 2016, making it the most common notifiable STI in the U.S. Almost two-thirds of all cases were in people between the ages of 15-24. Because chlamydia testing is recommended annually for young women, and chlamydia is often asymptomatic and not detected in men, most cases that get reported are among women.
- 555,608 cases of gonorrhea were reported to the CDC in 2017; the gonorrhea rate is up 18.6 percent from 2016. Gonorrhea is evenly split between men and women.
- 30,644 cases of infectious syphilis were reported in 2017, a rate increase of 10.5 percent from the previous year. Nearly 90 percent of cases were in men.
All of this sounds bad, but does it mean that STIs are out of control? Not necessarily. The dramatic rise in infections is actually a two-pronged issue made up of both increased disease and better detection of disease. As STI experts, we see a few possible contributing factors for each part of the equation that deserve attention. Here are a few things to keep in mind when looking at the rising STI rates:
1. We’re getting better at understanding STIs and providing culturally competent care that identifies these infections in more people.
It took a while, but the medical community is starting to acknowledge all the various ways that people have sex and what that means for STI transmission. Recent studies have reported that oral and anal sex is prevalent among sexually active adolescents and adults. Since STIs can absolutely be spread through these sexual acts, there’s been an increasing emphasis on the necessity for culturally competent medical care. In other words, providing comprehensive care (and testing) that addresses all aspects of a patient’s sexual experiences and exposures.
In practice, this means that the medical and public health communities are acknowledging that, in addition to traditionally tested sites (urethra for men, cervix for women), the throat and rectum can also be infected with chlamydia and gonorrhea. So, clinicians are doing a better job of asking patients about all their sexual behaviors and testing for STIs at all exposed sites. While not all health care providers offer the full array of testing, the fact that more providers are taking steps beyond just the traditional vaginal/cervical or urethral STI screening means that we’re going to find more STIs.
2. With more options than ever before, it’s possible that more people are actually getting tested and more disease is getting reported.
Getting tested for STIs these days is about as easy as it gets. There are home test kits, free or sliding-scale testing at local health clinics, and, of course, testing at your doctor’s office. But even in-office testing has gotten easier in the past decade. For instance, urethral gonorrhea and chlamydia infection testing can be performed using a urine test now instead of having to insert a swab into the penis, which understandably may have been a deterrent to testing. Additionally, self-collected vaginal, oral, and rectal swab specimens have comparable efficacy to clinician collected specimens and allow patients to take control of their sexual health.
Plus, because more health and lab records are kept in electronic systems, reporting of STIs to the national disease reporting system is better, leading to overall more reports.
3. We may be having more sex partners.
It has been suggested that the rise of dating apps may lead to people having more sex partners. While that has not been proven for all groups, recent research does demonstrate more sex partners among men reporting sex with men. Logic suggests that the rise of dating apps breaks through some of our old barriers to meeting sex partners (like, you know, leaving your house). Obviously not everyone using dating apps is using them to find casual sex partners, but it does track that they’ve made it a little easier to do just that, if that’s what you’re looking for.
4. People aren’t using condoms as much as they should be.
Let’s be honest, a healthy sex life is what we all strive for, and protecting yourself from STIs is critical to achieving that goal. Barrier methods of protection like condoms and dental dams are the only proven way to reduce your risk of getting STIs—outside of just not having sex, of course. There is a pill called HIV pre-exposure prophylaxis (or PrEP) which, when taken daily, can reduce your risk of acquiring HIV by more than 90 percent; but PrEP doesn’t protect against other STIs.
Studies show that condom use is lackluster among both women and men. According to the 2011-2015 National Survey of Family Growth, which surveyed 11,300 women and 9,321 men in the U.S. between the ages of 15-44, just 24 percent of women and 34 percent of men reported using a condom during their last sexual encounter. Survey questions like this don’t give us all the details (for instance, it’s possible that some of these people had recently been tested together with their partners and were not at risk for STIs, or that they were trying to conceive). While condom use was higher among people reporting sexual risk behaviors (46 percent of single men and 32 percent of single women), it was still much less than optimal.
This lack of urgency to wrap it up may come from the knowledge that sex is less dangerous than it used to be. Gonorrhea, chlamydia, and syphilis are all curable and HIV can be prevented by taking daily PrEP. Additionally, the available treatments for HIV infection are so effective that, when the medication regimen is taken as prescribed by their HIV clinician, people living with HIV can live long healthy lives and cannot transmit HIV to others. Under the Affordable Care Act, we also have better access to birth control methods, which could make people feel safer when it comes to the potential implications of unprotected sex.
But it’s important to remember that condoms and dental dams are still necessary to stop the spread of STIs (some STIs—like herpes and HPV—can still be spread even while wearing condoms, but they’re the best option we have). If you’re not 100 percent sure of your or your partner’s STI status (which can only be known after testing, since many STIs come with zero symptoms), you should be taking steps to protect each other.
So, the good news is that we are better at identifying infections in order to treat them. The bad news is that there is more infection to catch.
Ultimately, the resounding message from health providers should be: Enjoy yourself and protect yourself.
Everyone has the right to a happy, healthy sex life, and that includes respectful communication and protection using condoms, if appropriate.
Protecting yourself from sexually transmitted infections can be an incredibly empowering thing. As STI researchers and sex educators, the following are our three most important tips for staying safe and protected, no matter your sexual habits and preference.
Talk to your partner(s). There is absolutely no way to tell someone’s STI status based on appearance or even general trustworthiness—they may not even know they’re infected. Unless they’ve been tested recently and haven’t had sex with anyone else since then, there’s no way of knowing. If there’s ever any doubt about status, that’s okay—that’s what condoms are for!
Use condoms and other barrier methods to protect yourself, if appropriate. Consistent condom use requires effort and commitment, but it doesn’t have to be unsexy and awkward. We’re willing to bet that the risk of chlamydia is way more of a downer than wearing a condom. Just saying.
Get regular testing for STIs. Again, STIs are often symptomless, so the only way to know your status for sure is by getting tested. If you and your partner are in a mutually monogamous relationship and want to stop using condoms, go get tested together so that you can make that decision with your results in hand. Remember: An STI diagnosis isn’t the end of the world. Most are curable, and all are treatable. You can ask you clinician about getting tested or visit your local health department. The CDC also offers a search box to find local providers and guidelines for testing here.
Erika Samoff, Ph.D., M.P.H., is the HIV/STD surveillance manager and Victoria Mobley, M.D., M.P.H., is the HIV/STD medical director at the North Carolina Division of Public Health.