Brief State Strategies to Address Soaring Rates of STDs

Rates of sexually transmitted diseases continue to rise to historic levels, according to data recently released by the Centers for Disease Control and Prevention. While reported cases of STDs drastically decreased during the early months of the COVID-19 pandemic, reported cases of gonorrhea, primary and secondary syphilis and congenital syphilis had surpassed their 2019 totals by the end of 2020.

Reported cases of gonorrhea were up 10% from 2019 and up a staggering 45% from 2016. Cases of chlamydia, the most commonly reported STD in the United States, dropped from more than 1.8 million in 2019 to 1.6 million in 2020. However, according to researchers, chlamydial infections are usually asymptomatic and identified through screening. Therefore, the decline in reported chlamydia cases is likely due to decreased STD screening and undiagnosed infections. Despite the decline, total cases of chlamydia remain near their record highs.

Primary and secondary syphilis cases were up 7% in 2020 over 2019 and up 50% from 2016. More disconcertingly, cases of congenital syphilis, which occurs when syphilis infection is passed from a mother to a baby during pregnancy, rose 15% in 2019 and 235% since 2016. Congenital syphilis can cause miscarriage, stillbirth or infant death. Infants born with the infection can experience lifelong physical and neurologic problems. In 2020, congenital syphilis-related deaths rose 14.6% from 2019 and 210.4% since 2016.

In 2019, 36,801 people received an HIV diagnosis in the United States. From 2016 to 2019, rates of hepatitis A infection increased by an unprecedented 1,325% due in large part to outbreaks in 31 states among people who use drugs and people experiencing homelessness. Rates of new hepatitis B and C infections are rising as well.

Treating STDs costs the US $16 billion in direct medical costs, a figure which does not include the $28 billion the country spends treating HIV. Reduced screening, limited resources and lapses in health insurance are all possible explanations for the surge of some STDs. Stigma, lack of medical care, increased drug use and a reduction in funding available to state STD programs were other possible contributors.

While STDs are increasing across many groups, 2020 STD data show some groups are affected more than others. Racial and ethnic minority groups, gay and bisexual men and youth continue to experience higher rates of STDs.

While disconcerting, the good news is that all STDs are preventable, and many states have taken action to reduce future cases.

State Action

Many people with these infections are unaware of their status. For instance, an estimated 15% of people with HIV do not know they have it and 40% of new infections are transmitted by people unaware of their status. Routine opt-out screening at least once per year for disproportionately affected populations can lead to early detection and greatly reduce risk of transmission.  

Several states enacted legislation in recent years to expand access to screening services. West Virginia’s statutes stipulate health care providers should recommend routine HIV testing and patients from disproportionately impacted communities should be encouraged to undergo HIV testing at least annually. Connecticut requires private insurers to cover screening for HIV, chlamydia, gonorrhea, HPV, hepatitis B and syphilis. Kentucky requires providers to test pregnant women for hepatitis C. California requires adult patients receiving primary care services in specified settings be offered a screening test for hepatitis B and hepatitis C.

In 2015, Texas passed SB 1128 requiring providers to offer syphilis testing in the first and third trimester of pregnancy. In 2019, the state passed SB 748 further expanding testing requirements to include syphilis testing at delivery and creating the Newborn Screening Preservation Account to help cover the costs of expanded testing.

States can also explore their laws regulating expedited partner therapy as a prevention tactic. Expedited partner therapy (EPT) is the clinical practice of treating the sex partners of patients diagnosed with STDs by providing prescriptions or medications for the partner without an examination. EPT can curtail further spread of infections.

Illinois allows health care professionals who make a clinical diagnosis of trichomoniasis (another common STD that can make it easier to get HIV) to prescribe and dispense drugs to the patient’s partner. West Virginia allows the state’s department of health to regulate rules related to expedited partner therapy and prohibits disciplinary action against providers who prescribe medications under these rules. California allows pharmacists to provide prescriptions to partners of people diagnosed with an STD without the individual’s name and removes liability from the pharmacist.

Increasing access to prevention medications can also reduce new infections. PrEP (pre-exposure prophylaxis) can reduce the risk of acquiring HIV by about 99% when taken as prescribed. PEP (post-exposure prophylaxis) can reduce the risk of acquiring HIV by 80% or more if taken within 72 hours of exposure.

Utah and Oregon enacted legislation allowing pharmacists to prescribe these medications in 2021. Maine recently enacted legislation authorizing pharmacists to prescribe and dispense HIV prevention drugs, requiring health plans to cover at least one prevention drug and preventing pre-authorization for these drugs. Georgia created a three-year pilot program in 2019 to provide PrEP financial assistance. New Mexico appropriated $107,000 in 2019 to improve awareness of PrEP and its benefits among health care professionals.

Federal Action

The federal government supports state efforts to prevent and mitigate infectious diseases, including STDs. The Department of Health and Human Services launched the Ending the HIV Epidemic (EHE) initiative in 2019. This plan aims to diagnose new HIV cases quickly and connect individuals to treatment. To achieve maximum impact, the CDC is focusing resources on communities most affected by HIV—more than 50% of new HIV diagnoses occurred in only 50 localities.

As part of STD Awareness Week and its ongoing effort to educate Americans about STDs, the CDC provides a number of resources for states, including fact sheets, updated STD surveillance reports and state tables. The CDC also coordinates efforts and resources to prevent STDs through the STI National Strategic Plan, Viral Hepatitis National Strategic Plan and National HIV/AIDS Strategy.

This project is supported by the Centers for Disease Control (CDC) and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $100,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.