Gonorrhea and syphilis are on the rise in the U.S., mostly in men who have sex with men, a trend the government said is linked to inadequate testing among people stymied by homophobia and limited access to health care.
The rate of new gonorrhea cases rose 4 percent in 2012 from the year before, while syphilis jumped 11 percent, the U.S. Centers for Disease Control and Prevention said today in a report. Rates for chlamydia, the most common of the bacterial sexually transmitted diseases, gained less than 1 percent.
While all three diseases are curable with antibiotics, many people don’t get tested as recommended, said Gail Bolan, the director of the CDC’s STD prevention division. That’s especially the case for syphilis, where the rise is entirely attributable to men, particularly those who are gay or bisexual.
“We know that having access to high-quality health care is important to controlling and reducing STDs,” Bolan said in a telephone interview. “Some of our more-vulnerable populations don’t have access. There are a number of men who come in to our clinic for confidential services because they’re too embarrassed to see their primary care doctors.”
The CDC rate for gonorrhea was 107.5 cases out of 100,000 in 2012, while syphilis was 5 cases per 100,000 people. Sexually transmitted diseases, including these infections, cost the U.S. health-care system about $16 billion every year, according to the report.
Gay and bisexual men may not have access to high-quality care, because homophobia and stigma around STDs may prevent men from being tested, Bolan said. This is particularly true of poor people in the South, said George W. Rutherford, a professor of epidemiology at the University of California at San Francisco.
“With most of these populations, having a sexually transmitted disease from having sex with another man is highly stigmatized,” he said. “They’d rather not get tested for HIV, syphilis, or whatever. They don’t want it to show up on their records.”
That’s problematic because bacterial diseases such as syphilis and gonorrhea make it easier for people to acquire serious viral infections, such as HIV, Rutherford said. What’s more, patients who are screened and treated lower the spread of disease, since their future sexual partners aren’t infected.
Syphilis was at an all-time low in the U.S. in 1999 and 2000, Bolan said. Though the CDC surveyed individuals about risk factors, such as unprotected sex or a higher number of partners, there hasn’t been enough difference in behavior to explain the increase, she said. Probably stigma is playing a role.
The 2010 Patient Protection and Affordable Care Act, which largely took effect this year, expanded U.S. health-insurance coverage mandates to include STD tests for most adults.
Cases of syphilis present at birth dropped 10 percent over the year, the study found. The stable chlamydia levels were probably due to screening, which has become more common, Rutherford said,
People ages 15 to 24 account for more than half of the annual cases of gonorrhea and chlamydia, the report showed. Though young men and young women are affected, undiagnosed STDs cause an estimated 24,000 women to become infertile yearly. That’s because many of these diseases don’t cause symptoms, Bolan said.
The CDC recommends annual chlamydia screening for sexually active women 25 years old or younger, as well as for older women with new or multiple sex partners. It also recommends yearly gonorrhea screening for sexually active women with new or multiple sex partners, and those who live in communities where the disease is more common. All sexually active men who have sex with men should be screened at least once a year for syphilis, chlamydia, gonorrhea and HIV, the report said.
The report didn’t address HIV, which fell by a third globally in 2012 from 2001, according to a report from the United Nations. Everyone age 15 to 65 should be screened at least once for HIV, according to a CDC recommendation made in 2006 and adopted by the U.S. Preventive Services Task Force in November.
A November study from U.S. health officials found a 20 percent rise in unprotected sex among gay men, with sexual risk highest for those who haven’t been tested for HIV. An analysis of data by the CDC from 20 major U.S. cities found that the number of men who reported having unprotected anal sex in the past year rose in 2011 from 2005. Men who didn’t know they were HIV positive were more than twice as likely to have sex with someone who wasn’t infected, compared with those who knew their HIV status, the report found.