On October 8, 2019, the Centers for Disease Control and Prevention (CDC) released the Sexually Transmitted Disease (STD) Surveillance Report, 2018. Devastatingly, rates of reportable STDs, syphilis, chlamydia, and gonorrhea, surged for the fifth year in a row. An especially alarming figure is that congenital syphilis, which occurs when a pregnant person with untreated syphilis passes it to the fetus, rose 40% in just one year (918 cases in 2017 to 1306 in 2018) with almost 100 congenital syphilis-related fatalities (22% increase).

From 2017-2018:

• Primary and secondary syphilis have increased 14% (with the most alarming increase among newborns)
• Gonorrhea increased 5% but 2018 showed the most cases reported in more than 20 years
• Chlamydia increased 3% but 2018 had the highest case count ever recorded by the CDC

STDs can have serious consequences for adults and babies if left untreated—this is especially true for syphilis which is simple to cure, including in utero, with the right treatment. Congenital syphilis increases are a widespread problem with 41 states and Washington DC reporting at least case of congenital syphilis in 2018. But there are portions of the country which are disproportionately burdened. Just one syphilis test during pregnancy is unlikely to be enough so it is essential that providers are performing multiple tests and discussing pregnancy intention with their non-pregnant patients who may be at risk of STDs, especially syphilis. Syphilis during pregnancy is easily cured but without early and regular prenatal care, cases of syphilis in pregnant people will not be detected.

Everyone should know that syphilis is not a disease of the past—it is still here, and it is thriving. With increasing prevalence, even women who traditionally would have been considered to have few risk behaviors may be exposed, and many may not know that they have syphilis. An additional concern is drug use—data shows that methamphetamines, heroin, and injection drug use have continued to increase among heterosexuals with syphilis.

NACCHO, representing the nation’s nearly 3,000 local governmental health departments, has worked closely with the CDC to support its members to tackle rising STD rates.

Engaging Local Health Departments to Address Rising STI Rates

Reversing these trends will require health departments, healthcare providers, and other stakeholders to work together to more effectively implement proven prevention strategies and develop new tools and approaches to address what isn’t working. For local health departments, this includes educating providers and the public about the increasing risk of syphilis, including congenital syphilis, and the need for early prenatal care. Local health departments across the country are actively expanding evidence-based strategies to increase identification of STDs; assuring appropriate clinical services for STD clients and their sexual partners; conducting health education and promotion; using surveillance data to inform programmatic efforts and focus on populations disproportionately impacted by STDs; and educating the public, providers, and key stakeholders on effective policy approaches. You can read about many of these approaches in the most recent issue of NACCHO Exchange, which focuses completely on local health department efforts to address STIs.

STD prevention and treatment are important to address in every jurisdiction. We recommend you sign up to receive NACCHO’s HIV, STI, and Viral Hepatitis Digest, which highlights the latest in the efforts to combat these increases, shares funding opportunities (from NACCHO and elsewhere), and includes “requests for information” that have been received by NACCHO to encourage peer learning and assistance between local health departments! Additionally, you can join NACCHO’s HIV, STI, and Viral Hepatitis Sentinel Network to inform our work on STIs—the network was formed to increase NACCHO’s understanding of LHD efforts, needs, challenges, and successes, and is comprised of more than 100 LHDs from over 40 states and Washington, DC, who complete brief surveys on HIV, STI, and viral hepatitis issues.