September 4, 2018 at 2:29 pm PDT | by Christopher Kane
Californians, gay and bisexual men overrepresented in rising STD rates

 

(Photo via Bigstock)

As recently as ten years ago, the number of reported cases of chlamydia, gonorrhea, and syphilis had fallen to historic lows. In the past four years, however, data show “steep and sustained increases” in rates for all three diseases, according to the Centers for Disease Control and Prevention (CDC). 

Nearly 2.3 million patients were diagnosed with chlamydia, gonorrhea, and syphilis just last year in the United States, marking the highest incidence rates of these STDs since a record-breaking number of cases were reported in 2016.  Health experts warn that America is now contending with a public health crisis.

“We are sliding backward,” said Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in an Aug. 28 press release on preliminary 2017 data presented at the National STD Prevention Conference in Washington, DC.  “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

STDs are treatable with antibiotics but the emergence of new drug-resistant strains of gonorrhea has challenged lines of defense that have traditionally and reliably curbed the rate of new infections. The number of new gonorrhea cases in men nearly doubled from 2016 to 2017, disproportionately among men who have sex with men (MSM).

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” said Gail Bolan, M.D., director of CDC’s Division of STD Prevention.

What happened? Across the board, rising rates of all three STDs can be attributed to factors that include the corresponding increase in unprotected sex among MSM, eroding public health infrastructures, clinic closures, and—to a limited extent in some groups—improved rates of STD screening. 

National Coalition of STD Directors (NCSD) Executive Director David Harvey said state and local STD clinic budgets have been halved since the early 2000s. “It is time that President Trump and Secretary (Azar) declare STDs in America a public health crisis,” he said. “What goes along with that is emergency access to public health funding to make a dent in these STD rates and to bring these rates down and to ensure that all Americans get access to the health care that they need.” 

While their access to sexual health resources has dwindled, research has also found gay and bisexual men are engaging in riskier behaviors, including condom-less “bareback” sex—which helps explain the rising incidence rates of chlamydia, gonorrhea, and syphilis. Experts say several factors are at play. Progress in the treatment of HIV, which is no longer considered a death sentence, may have effectively made unprotected sex “less scary.” And the introduction of pre-exposure prophylaxis (PrEP)—approved in 2012 as a once-daily regimen to reduce by as much as 99 percent the risk of contracting HIV—may have had the same effect. 

Importantly, PrEP remains a valuable tool that can help reduce the number of new HIV infections, despite possible associations between use of the drug and increased risk behaviors/rates of STDs. While HIV diagnoses in the US have dropped consistently since 2010, 39,782 new cases were reported in 2016, and one of every seven patients is unaware they are HIV positive. Public health officials consider PReP a crucial resource in fighting HIV disease, and expanded access to the drug remains a core focus area in National HIV/AIDS Strategy. 

To fight the STD crisis, officials have called for an approach that includes input from local stakeholders. “We don’t want to take a one-size-fits-all approach to STD prevention,” said Michael Fraser, Ph.D., executive director of the Association of State and Territorial Health Officials (ASTHO). “The techniques you might use in the MSM community are really different from what you might use with pregnant women…And I think that’s another place where states have a lot of expertise because they know their population and they know some of the stuff that works well in some of those areas.”

State-specific data will be made available after the CDC publishes the full surveillance report in September. But public health workers in California have already reported spikes this year in the number of diagnosed cases of STDs, particularly of syphilis among gay and bisexual men.

Overall, according to CDC data from 2016, California has the third-highest number of reported syphilis cases in the country. Compared with the national rate, about 8.7 cases per 100,000 people, California—at 15 cases per 100,000—is more than 72 percent higher. And in San Francisco County, 60.4 cases were diagnosed for every 100,000 people, which exceeds by nearly seven times the national rate.

In May 2018, the Riverside County Department of Public Health also reported the number of cases in the Coachella Valley had risen dramatically—mostly in populations of MSM. And Palm Springs exceeded by more than 10 times the national incidence rate.

The Riverside University Health System has started hosting community meetings with key stakeholders to address the county’s syphilis outbreak. Program Coordinator Tad Berman told the Los Angeles Blade the third and fourth meetings are scheduled for Sept. 10 and 11. “The general public is welcome to come and provide input,” he said. “It’s important to get their feedback to make sure that, in our messaging, that we are speaking the language of the public.”

Spotlight on Syphilis

Monday Sept. 10, 2018, 1:30 p.m.

UCR Palm Desert Building B

75080 Frank Sinatra Drive

Palm Desert, CA 992211

Spotlight on Syphilis

Tuesday Sept. 11, 2018, 1:30 p.m.

Community Action Partners (CAP)

2038 Iowa Avenue, B 101

Riverside, CA 92507

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