A recent press release by the Centers for Disease Control and Prevention (CDC) reported a rise in sexually transmitted diseases (STDs) in the United States (US) during 2020, i.e., the first year of the coronavirus disease 2019 (COVID-19) pandemic, after a brief decline during the early months of 2020.
The CDC released the 2020 STD surveillance report showing an initial decrease in STDs cases, including gonorrhea, syphilis, and chlamydia, during the early months of 2020; however, eventually, case numbers surpassed 2019 levels by the end of the year.
The report mentioned reasons for the initial decline in the reported STD cases in the US, such as reduced STD screening at healthcare clinics, shortages of STD test kits, and delays in routine healthcare visits due to lockdown-imposed restrictions. Apparently, a lapse in health insurance coverage due to unemployment and increased telemedicine practices also contributed to an initial decline in the cases of STDs.
The reported cases of primary & secondary (P&S) syphilis and gonorrhea were up by 7% and 10%, respectively, whereas congenital syphilis cases surged up by approximately 15% from 2019; however, cases of chlamydia, having the highest share of reported STDs in the US, declined by 13% from 2019.
Since chlamydial infections are usually asymptomatic, clinicians identify these cases through screening. Thus, a decline in chlamydia cases pointed toward reduced STD screening and underdiagnosis during the pandemic, not a decrease in new infections.
Importantly, a reduction in chlamydial infections decreased the cumulative STD cases in the US from a startling 2.5 million in 2019 to 2.4 million in 2020. Notably, preliminary data shows that cases of P&S syphilis and congenital syphilis continued to surge in 2021.
The COVID-19 pandemic put enormous pressure on an already strained public health infrastructure. There were moments in 2020 when it felt like the world was standing still, but STDs weren’t. The unrelenting momentum of the STD epidemic continued even as STD prevention services were disrupted.”
-Jonathan Mermin, M.D., M.P.H., Director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
U.S. STD cases data: 2019 vs. 2020
For gonorrhea, the aggregated reported cases were higher in 2020 than in 2019. For January and until the end of February 2020, the gonorrhea cases were higher vis-a-vis the same time in 2019. Then, for a brief time, between the end of February and May 2020, gonorrhea cases declined. Finally, gonorrhea cases continued to resurge till December 2020.
The month-on-month trajectory of the P&S syphilis cases was different from the gonorrhea cases; for P&S syphilis, aggregated reported cases were higher in 2020 than in 2019. Accordingly, the number of P&S syphilis cases was higher between January and February 2020 than during the same period in 2019. The cases dipped from the end of February until April 2020 and surged again from May through June 2020. After a brief decline in July, finally, P&S syphilis cases continued to resurge till December 2020.
However, for chlamydia, the aggregated reported cases were lower in 2020 than in 2019. The reported cases were higher from January through February 2020 than during the same time in 2019. For the remainder of the year, i.e., from February 2020 to December 2020, reported cases of chlamydia declined and remained lower than in 2019.
With a startling 210% increase in reported cases since 2016, syphilis in newborns (congenital syphilis) continued to surge in the US. Unfortunately, congenital syphilis caused 149 stillbirths and infant deaths in 2020 in the US.
Accordingly, the reported cases of congenital syphilis increased between 2016 and 2020 from 641 to 941, 1323, and 2148, respectively. In 2011, only 24 states reported at least one case of congenital syphilis, whereas, in 2020, 47 states did, most likely because 41% of mothers did not receive timely prenatal care or syphilis testing.
There was a parallel increase in the cases of P&S syphilis in women in the age group of 15-44 years; subsequently, P&S syphilis cases surged by more than 156% from 2016 to 2020.
The COVID-19 pandemic increased awareness of a reality we’ve long known about STDs. Social and economic factors – such as poverty and health insurance status – create barriers, increase health risks, and often result in worse health outcomes for some people. If we are to make lasting progress against STDs in this country, we have to understand the systems that create inequities and work with partners to change them. No one can be left behind.”
– Leandro Mena, MD, MPH, Director, CDC’s Division of STD Prevention
Conclusions
The STD surveillance report released by the CDC provided a clear picture of the adverse impact of the COVID-19 pandemic on the prevalence of STDs in the US.
With more than 2,100 cases of congenital syphilis, jurisdictions reported an increase of 15% in congenital syphilis cases since 2019 and a 235% increase since 2016. Likewise, gonorrhea and P&S syphilis cases increased by 10% and 7% from 2019 to 2020; however, reported cases of chlamydia dropped to 13%. STD data also showed that some ethnic minority groups, as well as some bisexual and gay individuals, continued to experience high STD rates even in 2021.
To summarize, focused attention is needed to combat the expansion of STDs in the US, with a special focus on congenital syphilis,the case counts of which have radically increased since 2016. Successful prevention of STDs will require persistent and coordinated efforts by public health workers, public and private sector clinics, and community-based organizations to ensure that every individual has access to high-quality STD care and treatment without any discrimination.
