STD rates started to spike in the US during the pandemic. Now, they continue to rise.

In 2021, the total number syphilis of cases hit its highest since 1948.
Safe sex habits are the best way to prevent spread. Pexels

Preliminary 2021 Sexually Transmitted Disease (STD) Surveillance Data from the Centers for Disease Control and Prevention (CDC) shows sharply rising STD rates in the United States, with syphilis rates seeing a 26 percent increase. The increase follows an alarming trend, as infection rates for some STDS have been rising for years. In 2021, the rate of syphilis cases reached its highest level in 20 years and the total number of cases hit its highest since 1948 (when Harry Truman was president). HIV cases also increased by 16 percent last year.

“It is imperative that we … work to rebuild, innovate, and expand (STD) prevention in the US,” said Leandro Mena, director of the CDC’s Division of STD Prevention, in a speech at a medical conference on sexually transmitted diseases yesterday.

Now, health officials are developing some new approaches to the problem. According to Mena, one option is home-test kits for some STDs that will make it easier for people to learn they are infected and to take steps to prevent spreading it to others.

[Related: A guide to preventing, spotting, and managing STIs.]

Infectious disease expert Mike Saag also explained a core part of any effort must work to increase the use of condoms.“It’s pretty simple. More sexually transmitted infections occur when people are having more unprotected sex,” Saag told the Associated Press. Rates of syphilis are highest in men who have sex with men, and among Black, and Latino, and Native American populations. The rate for women is lower than it is for men, however officials noted that it has been rising more dramatically (up by about 50 percent in 2021).

The news comes amid the continuing COVID-19 pandemic and an unprecedented monkeypox outbreak. Monkeypox is not technically an STD, but most cases have been linked to sexual activity, which has prompted some debate around whether to describe the illness as an STD. In an interview with Popular Science in July, Anne Rimoin, an epidemiologist at the University of California Los Angeles and a longtime monkeypox researcher, said that trying to categorize monkeypox as a sexual or non-sexual disease is an oversimplification. “Sexual contact is a very effective way for the virus to spread,” she said, but that doesn’t make it an STI.

In this greater context of STD spread, “Monkeypox is inundating these programs and it is interrupting our ability to diagnose and treat other STIs,” according to David Harvey, the executive director of the National Coalition of STD Directors said in policy outlook report released last week. “It’s shining a bright light on the fact that safety net clinics who provide essential services are in desperate need of federal support.” Harvey also called the current situation, “out of control.”

Syphilis is a bacterial disease that surfaces as genital sores and can ultimately lead to severe symptoms and death if left untreated. New infections of the disease dropped in the US in the 1940s, thanks to the availability of antibiotics. Infection rates hit their lowest levels in 1998 (fewer than 7,000 new cases), which prompted the CDC to launch a plan to eliminate syphilis in the US. Cases began to rise by 2002, largely among men who have sex with men. In late 2013, the CDC ended the elimination campaign due to limited funding and cases that surpassed 17,000.

[Related: Insurance coverage for at-home tests could help stop the rise in STIs.]

Troublingly, there is also a rise in congenital syphilis. This form of the disease occurs infected moms pass it on to babies, potentially leading to death of the child or health problems like deafness and blindness. Ten years ago, annual congenital syphilis cases numbered only about 300, but they surged to nearly 2,700 last year. According to Mena, 211 of these cases last year led to stillbirths or infant deaths.

Experts point to several causes for the increases in syphilis and other STDs. Inadequate funding has hobbled testing and prevention efforts for years. The spread also spread may have gotten worse (especially during the COVID-19 pandemic) due to delayed diagnosis and treatment. Other causes according to the CDC include increases drug and alcohol use contributing to risky sexual behavior and declining condom use. Saag also pointed to a surge in sexual activity after COVID-19 lockdowns. “People are feeling liberated,” he said.

Mena called for reducing the stigma surrounding STSs, broadening screening and treatment services, prevention methods, and supporting the development and accessibility of at-home testing. “I envision one day where getting tested (for STDs) can be as simple and as affordable as doing a home pregnancy test,” he told the Guardian.