Rates of sexually transmitted diseases (STDs) dropped early in 2020 before surging towards the end of the year, with rates of gonorrhea and syphilis rising higher than 2019 levels, according to CDC data.

STD rates remained high in the US in 2020

In total, there were 2.4 million STD cases reported in 2020, a slight drop from the 2.6 million cases reported in 2019. However, certain types of STDs saw notable rises.

According to CDC, rates of gonorrhea rose 10%, syphilis rose 7%, and congenital syphilis rose 15% at the end of 2020 compared with 2019. Overall, congenital syphilis rates are up 235% since 2016, while gonorrhea rates are up 45% and syphilis cases are up 52%.

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Meanwhile, rates of chlamydia saw a 13% drop in 2020 compared with 2019. However, CDC noted that drop was likely a result of decreased STD screenings and underdiagnoses rather than a drop in infections.

CDC found that 61% of all chlamydia cases occurred among individuals ages 15-24 and men who have sex with men (MSM) comprised 53% of all syphilis cases in 2020.

CDC also reported state-by-state level data for rates of chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis.

CDC data shows 'crumbling public health infrastructure'

Jonathan Mermin, director of CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said the Covid-19 pandemic made STD control even harder due to a "crumbling public health infrastructure."

"There were moments in 2020 when it felt like the world was standing still, but STDs weren't," he said. "The unrelenting momentum of the STD epidemic continued even as STD prevention services were disrupted."

Mermin noted there are "multi-sector solutions" for addressing the rise of STDs in the United States, adding that more accessible STD testing in community-based organizations beyond clinics is needed. Mermin also said "new scientific discoveries" are needed in the STD field, including vaccines against gonorrhea, chlamydia, and syphilis.

Patients also need "treatments that are more easily taken than the ones we have," Mermin said. "There is much to be done to rebuild, innovate, and expand STI prevention," he added.

Leandro Mena, director of CDC's Division of STD Prevention, said the rise in congenital syphilis could be due to an increase in risky behaviors, like injection drug use or sex with partners who inject drugs. He added that unstable housing and a lack of health insurance could also be factors, noting there's a need to address "prevention gaps for women who may not have health insurance."

Mena added that young people, MSM, and members of minority groups "bear the brunt of this epidemic."

"Lack of access to regular medical care, discrimination, and stigma continue to stand in the way of health care," Mena said.

A lack of public funding is also a significant problem, Mena said. "We have had more than a decade of decreasing public health funding that's caused a dropoff in STD screening, prevention, education, and other health services," he said.

Despite rising STD rates, many independent sexual health organizations and state departments included in the federal Title X family planning program are receiving less funding now than they have in previous years, Politico reports.

"The significant gap between resources available and what communities need has translated directly into challenging decisions with consequences that reverberate across our highly qualified Title X community," said Jessica Swafford Marcella, HHS deputy assistant secretary for population affairs

CDC's report "affirms once again that America isn't taking the STD crisis seriously," said David Harvey, executive director of the National Coalition of STD Directors. "We can only fight this out-of-control epidemic with new funding and the kind of urgency that reflects the enormity of this crisis." (Choi, The Hill, 4/12; Walker, MedPage Today, 4/12; Ollstein, Politico, 4/12; Shepherd, Washington Post, 4/12)