Issue:  Vol. 48 / No. 11 / 15 March 2018

The future of the STD epidemic

Guest Opinion

According to the AIDS Healthcare Foundation, condom use has stagnated in the U.S.
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The Centers for Disease Control and Prevention published its latest sexually transmitted diseases surveillance report late last month, documenting nearly 470,000 new gonorrhea infections in 2016 alone – an 18.5 percent increase from the previous year. Public health departments simply cannot keep up with these numbers and have estimated that hundreds of thousands of additional cases have ultimately gone unreported. If left untreated, gonorrhea can cause serious health problems such as chronic pelvic pain, ectopic pregnancy, infertility, and an increased risk of HIV acquisition.

To compound the seriousness of this epidemic, the World Health Organization reported on rising rates of antibiotic-resistant gonorrhea, which makes the infection "much harder, and sometimes impossible, to treat." In the CDC's newest STD report, 3.6 percent of gonorrhea infections tested for antibiotic resistance were found to be resistant to one of the two antibiotics used as our last-resort dual therapy treatment. This percentage is only going to increase.

In response to this soon-to-be untreatable epidemic, public health prevention efforts against gonorrhea and other STDs have been met with budget cuts, clinic closures, and limited contact tracing of positive cases. In addition, testing gonorrhea for antibiotic resistance is now becoming an essential component of STD testing and treatment services – but most clinics are not outfitted to test for drug resistance.

Condom use – the most cost-effective prevention method available against gonorrhea and other STDs – has stagnated in the United States. The CDC has all but abandoned the promotion of condoms, instead choosing in 2015 – on short notice and with little stakeholder input – to change the term from unprotected sex to condomless sex. While this may appear to be a simple alteration, the alarming implication is now that one could still be protected while not using condoms. There is little doubt that the CDC's demotion and limited advocacy of condom use play a role in skyrocketing STD rates, particularly among adolescents and young adults.

We have become complacent to the $16 billion annual burden of this STD epidemic. We dismiss gonorrhea infections as easily curable, ignoring the fact that antibiotic-resistance will have a detrimental effect on our nation's health.

We are losing control of this epidemic. We need public health officials to double-down on prevention, testing, and treatment efforts to stop this modern catastrophe. The best time to address this STD epidemic was 20 years ago, the second-best time is now.


Adam Cohen, PhD, MPH, is the director of advocacy and policy research at AIDS Healthcare Foundation.


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