By the Numbers: Why Are STI and STD Rates on the Rise?
Data published by the Centers for Disease Control and Prevention (CDC) indicates rates of sexually transmitted infections (STIs) are increasing despite medical advancements to combat them.
The reason for the rise in infection is more complex than you might think.
If the COVID-19 pandemic has taught us anything, it's that despite whatever advances we make in medical science, we may still be overcome by widespread disease on a grand and rapid scale. However, the same modern advancements allow us to detect and diagnose diseases much more quickly than in the past, meaning we can treat them sooner and more effectively.
But when you look at the numbers—specifically, CDC data on sexually transmitted diseases (STDs) such as chlamydia, gonorrhea and syphilis—detectable and treatable conditions remain on the rise, save for chlamydia cases, which have dropped 13 percent since 2019.
Confused? You might be, because there's a lot of conflicting data. Let's take a look.
How COVID-19 has affected STI rates
The most obvious reason STI rate trends went haywire, particularly between 2019 and 2022, was the COVID-19 pandemic.
"Though people were still having sex during the pandemic, we know that fewer people were getting tested due to COVID-19 safety restrictions," said Julia Bennett, senior director of digital education and learning strategy at the Planned Parenthood Federation of America. "Since it's common to have an STI without symptoms, it's possible that lack of regular testing led to an increased spread of STIs which went undiagnosed until restrictions were lifted."
The drop in STI testing during the pandemic reflects the dramatic shift in public health infrastructure through that time. A significant amount of attention was rightfully paid to combating the spread of COVID-19 and ensuring that proper safety measures were put in place.
While this may have contributed to the spread of STIs in general, there may be another reason that recent data reveals odd trends.
"Every time I look at data from 2019, 2020 and 2021, I have this real caution around understanding how good our mechanisms were to capture that data," said Yasaswi Kislovskiy, M.D., M.Sc., director of reproductive infectious disease at Allegheny Health Network in Pittsburgh and director of the Perinatal Hope Program. "It's actually a really complicated, multifactorial problem."
STI trends are complex
COVID-19 restrictions may have limited access to testing and altered how STIs were reported, but Kislovskiy pointed out that STI rates were already on the rise well before the pandemic.
Notably, a major component of preventing the spread of sexually transmitted diseases is being able to get tested and treated before there's a chance to spread the infection. However, the combination of limited access to quality healthcare, poor sexual health education and social inequality have created a problem.
Although the pandemic initially seemed to have made the general population more health-conscious, data has shown that drug and alcohol use increased during the pandemic. This means that despite public health concerns, more of the population was engaging in risky behaviors, including sexual ones.
"I view the drugs and alcohol as a marker for engaging in other risky behaviors," said John Goldman, M.D., a board-certified specialist in infectious disease and internal medicine in Pennsylvania. "Whether it's fast driving—car accidents have gone up. What we're really seeing is more drugs, more alcohol, more car accidents and more STIs. It's a reflection of what people do when they're under stress."
Goldman acknowledged STIs tend to correlate with socioeconomic status points. People without wealth or in marginalized groups often see higher rates of STI transference, mostly due to a lack of healthcare access.
Furthermore, both Goldman and Kislovskiy identified that STI rates tend to be higher in LGBTQIA+ communities. A not insignificant cause is that young people in those communities might not feel comfortable asking a parent to drive them to a clinic for testing, for example. The same principle applies to people new to sexual activity.
"Imagine being a college kid and your college shut down because of the pandemic," Kislovskiy said. "Living back at home and I think I might have an STD, but I have to ask my mom to take me to this sexual health clinic, which might be closed. It suddenly becomes really clear that this is hard stuff, actually. It's a highly stigmatized, a very personal part of someone's health journey."
The complication of the issue doesn't stop there, either.
Statistics don't quite paint the full picture, nor do they account for situations where a person doesn't have control over whether or not a condom is used, or even whether or not they consented to a sexual encounter.
Kislovskiy additionally pointed to the fact that we are dealing with multiple epidemics at the moment, including the ongoing opioid epidemic, which contributes heavily to the spread of STIs, through both drug paraphernalia and inhibited decision-making while using drugs.
Beyond that, while condoms may be widely available, they're not free. It's not uncommon for people to forgo purchasing condoms in favor of food or utility bills, for example. These situations are rarely as simple as statistics make them seem.
What can we do?
While the growing percentage of STIs out in the wild seems alarming, it's important to keep in mind the complex, multifaceted factors that contribute to those numbers.
It's important not to place blame on people who have STIs and may be unaware of their infection. There are many, many reasons a person might not have been able to get tested and even more reasons they might have contracted the infection in the first place. Judgment is not the answer. Empathy is.
Fortunately, most STDs and STIs are treatable. Getting tested as soon as you can enables your doctor to suggest viable treatment options. And, of course, using a condom can help stave off most (not all) infections in the first place.
"I would still strongly urge people to do the basics to prevent themselves," Goldman said. "Obviously, we don't encourage high-risk behavior, but I've been doing this long enough to know that my not encouraging high-risk behavior may not have much of an effect. But if you're going to engage in high-risk behavior, use a condom."
