On October 19th, the Centers for Disease Control and Prevention (CDC) released an annual report stating that the United States reported a record number of sexually transmitted infections in 2015. The report indicates that approximately 1.5 million chlamydia cases, 400,000 cases of gonorrhea, and 24,000 cases of primary and secondary syphilis were reported last year, reaching a cumulative all-time high for sexually transmitted infections in the U.S. It’s important to note that while the specific STIs did not individually reach all-time highs, the case counts for syphilis, gonorrhea, and chlamydia all reported an increase between 2014 and 2015. The largest increase in reported STI cases came from primary and secondary syphilis, which increased by 19%. This was followed by an increase in reported gonorrhea cases by 12.8%, and a 5.9% increase in reported cases of chlamydia .
Nationally, primary and secondary (P&S) syphilis rates increased in every age group among those aged 15-64 years, as well as in almost every racial and ethnic group during 2014-2015. The P&S syphilis rate among Blacks in 2015 was 21.4 cases per 100,000, which was 5.2 times the rate among Whites (4.1 cases per 100,000). In addition, the P&S syphilis rate increased among both men (18.1%) and women (27.3%) . These rates increased among both sexes in every region of the country during 2014-2015 .
Gonorrhea hit its ultimate lowest rate in 2009, with a reported incidence of 98.1 cases per 100,000. Unfortunately, that number has steadily increased since. During 2014-2015, gonorrhea rates increased in 80% of states, and the District of Columbia. The rate of gonorrhea increased 18.3% among men, and 6.8% among women .
The approximately 1.5 million cases of chlamydia reported in 2015 represents the highest number of annual cases (among nationally notifiable diseases) ever reported to the CDC . There is an apparent disparity in reported chlamydia cases between racial groups. The rate of transmission among Black women was 5.4 times the rate among White women (1,384.8 and 256.7 cases per 100,000 females, respectively) .
Overall, the CDC estimates that STI cases cost the U.S. healthcare system nearly $16 billion each year . The cost will likely increase as the prevalence of antibiotic-resistant STIs becomes greater. Gonorrhea specifically, has been linked to dramatic increases in antibiotic-resistant strains. Between 2013 and 2014, the percentage of gonorrhea samples that showed decreased susceptibility to azithromycin, a common antibiotic, increased by more than 300%, from 0.6% to 2.5% . These dramatic increases in sexually transmitted infections come at a time when health care expenditures are continually increasing, now reaching 17.5% of U.S. GDP. Only 3% of the total healthcare expenditure is spent on prevention efforts . In fact, in recent years more than half of state and local STI programs have had budget cuts, and in effect more than 20 health department STI clinics have closed in one year alone. It is evident this issue will not be disappearing any time soon, which highlights the need for a shift in thinking, from treatment to prevention, in order to effectively combat sexually transmitted infections in the U.S.