Slim silver lining now available on STI rate

The United States' persistent sexually transmitted infection (STI) epidemic is showing signs of slowing in the number of cases of syphilis, gonorrhea and chlamydia, the newspaper said. Latest data From the Centers for Disease Control and Prevention (CDC).

Based on the CDC's new report, Sexually Transmitted Infection Surveillance 2023, more than 2.4 million cases of these three state-notifiable sexually transmitted diseases were reported in the United States in 2023; This represents a 1.8% decrease from 2022.

The 2023 report shows gonorrhea decreased by 7.2%, accounting for the majority of the decline.

The number of syphilis cases increased overall, but only by 1% compared to the double-digit increase the previous year, the report said. Primary and secondary syphilis decreased by 10% compared to all of 2022, and the number of infections among gay and bisexual men decreased by 13%.

The incidence of congenital syphilis increased by 3%. However, the 3% increase represents a significant decline compared to the 30% annual increase in recent years, the report said.

Chlamydia infection rates remained essentially stable, with an overall decline of less than 1.0%. Reported chlamydia infection rates increased by 1.3% in men and decreased by 1.7% in women.

Despite the declines, overall disparities remain, the report says, and disparities persist for gay and bisexual men, as well as American Indian and Alaska Native, black and African American, and Hispanic and Latino men. The prevalence of sexually transmitted diseases is also high among Americans.

CDC is cautiously optimistic

Bradley Stoner, MD, director of the CDC's Division of STD Prevention, said in an interview that the agency is “cautiously optimistic that the new data indicate a turning point for syphilis and gonorrhea.”

But a huge amount of work remains, particularly in addressing disparities in care, Stoner said.

New techniques for diagnosis and treatment, such as the increased use of doxycycline (Doxy PEP) Post-sexual STD prevention for high-risk populations with a history of sexually transmitted infections likely contributed to the overall decline, Stoner said. Other factors include improved communication and awareness of STI treatment options at the community level, such as in emergency departments, drug use facilities, and injecting use programs, she added.

Although the U.S. is not yet on track to reduce sexually transmitted infections, Stoner said, “After years of rising infections, we are at a tipping point in infectious diseases.” Medscape Medical News. “CDC is committed to maintaining this momentum and turning the situation around,” he said. Although the incidence of congenital syphilis is decreasing, it remains a significant problem with severe outcomes for mothers and infants, he noted.

Stoner stressed that the message to frontline health workers is to raise awareness, test widely and provide effective treatments.

Looking forward, Stoner said more research is needed to identify the settings where prevention tools can be most effectively utilized, such as urgent care and other programs. “I hope that implementation science research will give us some clues,” he said. Additionally, better tools for STI detection and treatment are always needed, and better diagnostics for syphilis in particular still require blood tests, but research into more efficient tests is ongoing. He said it was underway.

Shining a spotlight on inequality and syphilis

“I think these are very mixed results,” David J. Cennimo, MD, associate professor of medicine and pediatrics in the division of infectious diseases at Rutgers New Jersey Medical School in Newark, New Jersey, said in an interview. “We're happy to see that, in the first place, rates of sexually transmitted infections are decreasing,” he said. But a closer look shows that most of the improvement has come from a 7% decline in gonorrhea, while chlamydia and syphilis rates have remained relatively stable, he noted.

The decline may reflect the public getting the message about the need for testing and safer sex, Cennimo said. “Clinicians are also being educated about the need for screening,” he added. However, “we are still 90% ahead of our goal. [STI] This is the price from 20 years ago. ”

Clinicians also need to be aware of differences in sexually transmitted infection rates by race and other demographics, Cennimo said. Medscape Medical News. The current report “calls for sexually transmitted disease and other health services to be targeted to specific groups where needed and made widely available, especially in areas where resources are scarce,” he said. said.

“We are still disappointed by the high prevalence of syphilis, which also causes congenital syphilis,” Cennimo said. “Syphilis during pregnancy is extremely dangerous and any case of congenital syphilis is a failure of preventive care and screening. It is a potentially devastating disease,” he stressed.

“We have good treatments for sexually transmitted infections, but we need to continue to monitor for resistance,” Cennimo says. “More efforts are needed to reach high-risk populations and provide preventive care and testing,” he said.

This study was supported by the CDC. Mr. Stoner and Mr. Cennimo had no apparent financial conflict.