US health agency warns of worsening sexual health crisis

More funding is needed for sexual health services along with innovative testing and prevention tools to tackle an “alarming” rise in sexually transmitted infections across the US, the nation’s top public health agency has warned.

Dr Leandro Mena, director of the division of STD prevention at the Centers for Disease Control and Prevention, told the Financial Times that new data showing the number of syphilis cases surged by more than a quarter last year highlighted the “crisis” unfolding in the sexual health of America.

The rise in cases of syphilis and other bacterial STDs — such as gonorrhoea and chlamydia — is being fuelled by a combination of underfunding of sexual health services, reduced condom use among certain groups and stigma surrounding sexual diseases and access to treatment, he said.

“We find these [statistics] pretty alarming. For six or seven consecutive years STI rates have been increasing in the US and last year’s 26 per cent jump in syphilis cases was one of the largest year-to-year increases that we have ever seen,” he said.

The resurgence of STIs in the US and elsewhere is causing concern among health officials, who warn services are already overstretched owing to Covid-19 and monkeypox. Last year the CDC estimated one in five Americans had an STI at some point during 2018 and the lifetime cost of treating new infections acquired during that single year would be up to $16bn.

Mena said US prevention and treatment services for sexual health had been underfunded for more than two decades, resulting in a more than 40 per cent reduction in per capita purchasing power when inflation is taken into account. This had resulted in a decrease in testing and screening services in many communities, he said.

“To address the crisis that we recognise that we have in the sexual health of America I think we really need innovation,” said Mena. “We need to improve access to stigma-free, discrimination-free, affordable sexual health services . . . we need more tools to fight the national spike in bacterial STIs.”

Preliminary data released last month by the CDC shows 2.5mn bacterial STI infections were reported in 2021, a rise of 4.4 per cent on the previous year. The number of gonorrhoea and chlamydia cases grew by about 3 per cent year-on-year while reported cases of syphilis, a potentially life-threatening disease when not treated, increased significantly faster.

Infection rates for syphilis reached a historic low in 2000-2001, according to CDC data, but have steadily increased since then. Over a five-year period reported cases of syphilis have surged almost 70 per cent while the number of congenital cases — when a mother passes a syphilis infection to her baby during pregnancy — has surged by 184 per cent since 2017.

“Congenital syphilis can have devastating outcomes that affects perhaps the most vulnerable individuals in society, newborns. It is also 100 per cent preventable, so it represents in many ways failures in our systems,” said Mena.

He said there had been a decline in use of condoms among some groups, including young people, and men who have sex with men as the availability of antiretroviral treatments for HIV expanded in recent years. Substance abuse and the opioids epidemic is linked to increases in risky sexual behaviour and stigma played a role in keeping people away from accessing screening services and treatments, said Mena.

He said people needed access to “stigma-free and affordable” sexual health screening services to tackle increasing infection rates. The development and rollout of home test kits and point of sale testing in pharmacies or locations other than health clinics could also help, added Mena.

He said the CDC is evaluating “exciting” research published in July which showed that a single pill of a common antibiotic taken up to the three days after sex could significantly reduce infection rates from bacterial STIs.

“We’re very encouraged by these initial data in an NIH funded study for the use of doxycycline as post-exposure prophylaxis to prevent infection,” said Mena.

He said the agency wants to review the full data set from the study before issuing guidance to doctors on use of doxycycline among high-risk groups. This would consider the issue of anti-microbial resistance and whether prescribing the antibiotic in this manner could cause other pathogens to build resistance against doxycycline, said Mena.