Earlier this week, the Centers for Disease Control and Prevention (CDC) released its annual update of sexually transmitted disease (STD) data for the United States. There are more than 19 million STD infections every year in this country. The 2009 data suggest a mixed bag of both progress and ongoing challenges to achieving sexual health in the nation when it comes to the three most commonly reported STDs: Chlamydia, Gonorrhea, and Syphilis.
In 2009, some modicum of good news can be reported for Gonorrhea as there were the fewest recorded cases than in any other year since the CDC began tracking the disease in 1941. The CDC reports 301,174 cases of Gonorrhea being reported in 2009, down 10 percent since 2008 and down 17 percent since 2006. Still, we should not be breaking out the champagne – 300,000 cases of any disease is too much, but as I have previously written , we are on the verge of having a Gonorrhea epidemic that resists existing treatments. With that frightening perspective, is there any comfort with the fact last year nearly 100 out of every 100,000 Americans had Gonorrhea?
However, with both syphilis and Chlamydia, reported cases again increased in 2009. Nearly 1.25 million cases of Chlamydia were reported in 2009 – an increase of 3 percent since last year and up 19 percent since 2006. The CDC credits increased testing for identifying a larger number of infections, but also indicate that screening remains too low as there are likely nearly 3 million actual new infections each year. So while increased testing may explain why reported cases of Chlamydia are increasing, it should also serve as a clarion call to ensure that screening and treatment are consistently expanded and that health care reform can help that process along significantly.
For syphilis, the nation continues to experience a disturbingly dramatic resurgence in the disease with rates steadily increasing since 2001. In 2009, 13,997 cases of primary and secondary syphilis were reported to the CDC, an increase of 5 percent over the previous year and up 39% since 2006. A glimmer of good news is that for the first time in five years, syphilis declined among all women by 7 percent.
Just below the layers of these numbers, however, lie some of the most profound health disparities of any diseases in this country. With all three reportable STDs, shockingly high patterns of health inequities persist, particularly among African-Americans. While blacks represent only 14 percent of the population, they experienced 71 percent of all Gonorrhea cases in 2009, 48 percent of all reported Chlamydia cases, and 52 percent of all primary and secondary syphilis cases. Health inequities in syphilis infection are also significant among gay men and other men who have sex with men (MSM), with nearly two-thirds of all syphilis cases in 2009 occurring in this population.
While sexually transmitted diseases (STDs) in and of themselves are not discriminatory, additional factors in society – including inadequate access to health care, poverty, stigma, discrimination, and homophobia – conspire to create unjust and shameful health inequities among communities of color and gay men. Further, the persistence of such high rates of STDs among African-Americans and gay men are getting worse, not better, and yet, the resources to combat the situation have only declined over the past decade.
For example, when adjusted for inflation, federal resources for STD prevention and treatment have declined by 17 percent since 2000 and state budget crises have seen state resources for these efforts dwindle. Yet, the CDC estimates that STDs cost the U.S health care system upwards of $16.4 billion a year.
This makes abundantly clear that our failure to invest in prevention up front means we pay exponentially on the back end. And while the lame duck Congress finishes its business this year – or punts their constitutionally mandated role of controlling the federal government’s purse to the next Congress – both Houses of Congress and the President have recognized the need for increased resources to combat STDs in this country. So whoever finishes the appropriations process for 2011, this recent data should serve as sufficient evidence for why additional resources are needed for state and local health departments and their partners to get the nation on the road to being sexually healthier.