Public Health Workers Taking Action on Rising US STD Rates

By Krisberg, Kim | The Nation's Health, April 2019 | Go to article overview

Public Health Workers Taking Action on Rising US STD Rates


Krisberg, Kim, The Nation's Health


IN JANUARY, PHILADELPHIA public health workers began offering free, weekly syphilis testing at drop-in centers where women who are homeless can get food, clothing and a hot shower.

The work is in response to a recent spike in local syphilis cases among women. APHA member Cherie Walker-A, program manager in the Philadelphia Department of Public Health's STD Control Program, said health workers had been preparing for the possibility, as syphilis upticks often accompany addiction epidemics such as the current opioid crisis.

In fact, she said partnering with local drop-in centers is the same strategy health workers used in the 1990s to contain a syphilis uptick during the crack cocaine epidemic.

"It's never-ending," Walker-Baban said of STD prevention and control. "We may not see a disease for a while, but when it shows its head, we have to go full force at it so it doesn't get out of control. And that's regardless of what funding we have."

Unfortunately, syphilis is just one of the sexually transmitted diseases making a comeback across the country. According to the Centers for Disease Control and Prevention, STD rates have experienced a "steep and sustained" increase in the past few years.

Between 2013 and 2017, U.S. cases of gonorrhea increased 67 percent. Cases of primary and secondary syphilis--a disease that had reached an all-time low in 2000--increased 76 percent, with the bulk of cases among gay, bisexual and other men who have sex with men.

Syphilis more than doubled among women, with CDC researchers finding an association between heterosexual syphilis transmission and use of methamphetamine, injection drugs and heroin.

Cases of congenital syphilis--syphilis passed from woman to baby, which can result in miscarriage, infant death and lifelong health problems --are up from 326 cases in 2013 to more than 900 in 2017, CDC reported. Chlamydia is still the country's most common STD, with 1.7 million diagnosed cases in 2017.

Despite the rising rates, federal funding for STD prevention has failed to keep up. In a December report from the National Academy of Public Administration, "The Impact of Sexually Transmitted Diseases on the United States: Still Hidden, Getting Worse, Can Be Controlled," authors said that even though funding for CDC's Division of STD Prevention has been level for the last few years at about $157 million, failing to adjust for inflation means the division's purchasing power has gone down 40 percent since 2003.

According to Matthew Prior, MPH, director of communications at the National Coalition of STD Directors, an increase of at least $70 million is needed to jump-start a response to rising STDs and ready the public health workforce for STD challenges, such as emerging antibiotic-resistant gonorrhea.

He also noted that rising STD rates could threaten progress on HIV, which continues to decline in the U.S. thanks to preventive and medical advances such as preexposure prophylaxis. A study published this year found that 10 percent of all new HIV cases among men who have sex with men in the U.S. are attributable to gonorrhea and chlamydia infections.

"We're very optimistic that the field will eventually get the resources it needs to address the problem," Prior told The Nation's Health. "Our concern is that by the time we receive it, it might be too late."

In addition to funding problems, advocates and public health workers point to a number of likely contributors to the STD rise, including the shuttering of public health STD clinics, a lack of comprehensive sex education, not enough primary care providers equipped to address sexual health and persistent social stigmas around STDs. Health workers also caution that some of the rising statistics may reflect the success of better screening protocols and greater access to STD testing via the Affordable Care Act.

"There's no one thing that's going to change this," Zandt Bryan, infectious disease field services coordinator at the Washington State Department of Health, told The Nation's Health. …

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