Sexually Transmitted Diseases (STDs) Are Skyrocketing. Lack of Testing Under COVID Hasn’t Helped

Americans, it seems, are more sex-crazed than ever. And it’s not just men. Rates of pornography use have reached new heights, especially among women.? One study estimates that more than 30% of American women now consume pornography weekly, including 15% that download porn at work. Porn is also getting rougher and wilder, with a growing number of triple-X web sites offering images of “taboo” sex -- including bestiality, incest and rape. There’s even a boom in “yoga porn,” which features mind-body classes that degenerate into veritable sex orgies.

Americans aren’t just fantasizing about their sex-capades -- they’re also indulging them. As a result, there’s been a veritable explosion of sexually-transmitted diseases (STDs) over the past decade. Experts attribute this trend to a rise in unprotected sex, including “hook-ups” with multiple partners, easily arranged through dating websites like Tinder and Grindr. Gay men and straight married men having sex with other men “on the down low” are chiefly to blame. But heterosexual Baby Boomers above the age of 55 are also recording unprecedented rates of chlamydia and gonorrhea (“the clap”). In fact, no single demographic group remains unaffected by the latest STD trends.

Skyrocketing STDs

Consider the latest data for chlamydia -- more than 1.7 million cases in 2018, a 17% increase since 2010. And gonorrhea reached nearly 600,000 cases in 2018, the highest number of cases recorded since 1991. But the most striking example is syphilis, which rose by a whopping 15% in 2018 alone. About 35, 000 of the deadliest forms of syphilis were reported in 2019 -- the highest number since 1991. Overall, syphilis cases have doubled since 2015.

In some cities, syphilis rates have reached near-epidemic proportions. In early June 2021, Milwaukee, WI reported a 300% increase in syphilis cases over the pre-pandemic period. Most of the cases were reported among African American women over the age of 29.

"There are communities in Milwaukee that are medically underserved, don't have access to the screening treatment and preventative care that many other residents do and racial disparities in sexually transmitted infections is one of the problems that we dealt with for a long time," a local public health official says.

Taken together, STDs increased 30% between 2015 and 2019. This is a sharp reversal of past trends which saw nearly all STDs on the decline.

Disturbing Rise in Syphilis

The meteoric rise in syphilis is especially concerning because the disease, left untreated, can cause damage to the liver, heart and brain. It is also the most difficult to detect in its earliest stages when it typically manifests in the form of sores but then disappears and can lie dormant for years – and become more lethal -- without any obvious sign of infection

Presently, the overall number of syphilis cases is still relatively small, compared to other STDs. But the growing number of cases of “congenital syphilis” -- up nearly 300% since 2015 -- is especially troubling. Mothers with syphilis can leave their children with birth defects - or worse. In 2019, 128 infants died from the disease.

As with other STDs, the biggest challenge with syphilis is overcoming the stigma that surrounds it and raising public -- and institutional -- awareness of the health risks.

Aware of their transgressive sexual behavior, some people don’t want to get tested for syphilis, fearing the worst. They also assume -- wrongly - that without symptoms, there is nothing to worry about.

While current medical guidelines call for pregnant women to be routinely screened for syphilis, many never get tested, or they’re tested too infrequently, even while receiving tests for HIV and HPV.

"You have to screen women in the third trimester. You can't just do it in the first trimester because people do have sex when they're pregnant," says epidemiologist Patricia Kissinger of the Tulane University School of Public Health & Tropical Medicine.

Chlamydia also poses a special risk to women. Left untreated, it can spread upward to the uterus and fallopian tubes and result in a condition known as pelvic inflammatory disease, or PID. In fact, PID can become extremely dangerous, even life-threatening, if the infection spreads to a woman’s blood. But as with syphilis, public awareness of the dangers of PID remains extremely low.

More risky behaviors

Pornography, which typically features unprotected sex, may be one factor fueling a rise in risky sexual behavior. Another is a sharp decline in sex education in the schools. The share of schools providing sexual health education declined between 2000 and 2014, across topics ranging from puberty and abstinence to how to use a condom. In 2014, 88% of schools allowed parents to exempt their children from sexual health education. As a result, many sexually active teenagers aren’t getting the disease prevention messages they need to practice sex safely.

Among gay men the problem may not be lack of education but simply a growing resistance to safe sex. Thanks to the availability of retroviral drugs, many older gay men no longer fear that contracting the HIV virus will inevitably lead to AIDS – and eventual death. As a result, in some gay circles, “bare-backing,” or unprotected anal sex, is now celebrated while condom use is down-played, even disparaged – a turnaround from the 1980s when the AIDS virus was killing gay men in large numbers.

Many public health specialists are reluctant to admit – largely due to “political correctness” -- that a real change in sexual behavior among gay men is helping to drive the STD trend. And some gay rights organizations despite growing criticism and pressure are still reluctant to address the issue, fearing more stigma and discrimination

The issue is complicated by substance abuse. At special risk are young gay men that inject drugs and often share their needles. Research shows that these men are also indulging in risky sex, contracting both HIV and STDs, at alarmingly high rates.

There is also considerable denial in popular culture about the phenomenon of straight men, many of them married, having sex with other men. The “down low” phenomenon is also a source of great stigma, especially in Hispanic and African American communities, where homosexuality is still highly frowned upon. Recent estimates of the percentage of American men that engage in sex with other men have reached 8% -- about the same percentage of men that self-identify as gay.

Men on the “down low” are more likely to have unprotected sex and less likely to get tested for HIV/AIDs, or STDS, generally, according to researchers. That means that the spread of diseases like syphilis is likely to remain undetected for a longer period, adding to the health risk, researchers say. Down low men also expose their spouses and heterosexual partners to increased risk. Without advance warning of the possible long-term effects, these partners often face debilitating infections that may be too far advanced to treat and reverse.

Effect of COVID-19

With so much of the country focused on COVID-19, public health officials worry that the sharp rise in STDs, especially syphilis, is going unnoticed.

“It’s clear there have been mass disruptions to testing, surveillance and clinical care and that’s likely making sexually transmitted infections worse than ever,” says David Harvey, executive director of the National Coalition of STD Directors, which represents state and local health workers.

“Many STD clinics shut their doors or slashed their hours during the lockdowns last spring. Staffers who previously helped track the infections were reassigned to focus on COVID-19. And labs that process most STD tests were forced to ration supplies to focus on the flood of incoming COVID-19 samples,” notes a report in Modern Health Care.

In Minnesota, a report released just this week found a 27% increase in gonorrhea during the 2020 pandemic period, which accompanied two distinct HIV outbreaks in the Twin cities and Duluth areas. In addition, there were two major syphilis outbreaks reported in two rural counties. Other US cities have reported similar disturbing patterns.

Last September, the CDC admitted that tests for chlamydia, gonorrhea and syphilis were down between 30% to 50% nationwide compared to the prior year.

Because of reduced testing, STDs appear to be falling in some official health statistics. In Minnesota, statistics for chlamydia suggest a slight decrease in chlamydia infections and STDS overall do not appear to have increased.

But if anything, because of lack of treatment, public health officials say these decreases are likely due to lack of reduced reporting not to actual decline. In fact, STDs of all kinds are continuing to rise sharply, officials say.

What’s the solution?

Financing for STD testing had already begun to decline prior to the pandemic. But with so many hospitals and clinics now overwhelmed, public health officials are recommending the adoption of stop gap measures to try to reverse the STD trend.

One possible measure -- albeit controversial -- is the use of Expedited Partner Treatment or EPT. EPT would allow health care providers to give medications to STD-positive patients to distribute to their sexual partner(s) without those partner(s) needing an examination by a medical professional. EPT allows for greater confidentiality about sexual practices. It also utilizes a diagnosed sex partner as an advocate for and facilitator of STD infection control.

There is strong evidence supporting the use of EPT, and some jurisdictions have passed legislation to facilitate its wider use. Even the CDC has endorsed the idea. However, most health care providers and clinics throughout the US do not offer EPT because of legal, administrative, and medical barriers. These barriers may need to be relaxed to facilitate more testing and treatment during the pandemic. It is up to the CDC to make a stronger public stand on the issue, and if necessary try to convince the White House to issue an executive order allowing greater use of EPT.

Beyond stopgap measures, there is also a pressing need for expanded sexual health education. Surveys suggest that public awareness of syphilis and its dangers is abysmally low. In addition, more aggressive crackdowns on some of the most egregious websites advertising taboo -- and often, illegal -- sex acts might be considered. Many businesses and government agencies voluntarily restrict access to these sites in public settings; however, the number of these sites is growing by leaps and bounds.

Ultimately, the desire of a large minority of Americans to indulge in transgressive and risky sex is the real source of the problem. Were such impulses confined to mere fantasy, the problem might be manageable -- and tolerated. But skyrocketing STDs pose a growing public health threat that our nation can no longer afford to ignore.