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Despite shutdowns and stay-at-home orders during the pandemic, reported cases of sexually transmitted diseases (STDs) in the United States, including congenital syphilis, increased in 2020.
While reported cases of STDs initially decreased during the early months of the pandemic, most resurged by the end of the year, according to a new report from the Centers for Disease Control and Prevention (CDC).
Ultimately, reported cases of gonorrhea, syphilis and congenital syphilis surpassed 2019 levels, while chlamydia cases declined 13% from 2019 numbers. In total, 2.4 million cases of chlamydia, gonorrhea and syphilis were reported in 2020 compared to 2.5 million in 2019.
“While there were moments in 2020 when it felt like the world was standing still, STDs were not,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention. “At the end of 2020, primary and secondary (P&S) syphilis cases increased 7%, gonorrhea cases increased 10% and syphilis cases among newborns, or congenital syphilis, experienced the largest increase at 15%.”
Early data indicate P&S syphilis and congenital syphilis cases continued to increase in 2021 as well.
According to Dr. Mermin, reported cases of congenital syphilis in the United States increased 235% between 2016 and 2020, a trend he called “worrisome.”
“The consequences of congenital syphilis are the most severe,” Dr. Mermin said. “They include lifelong physical and mental health problems, miscarriage or stillbirth. Unfortunately, we already know some STDs continued to increase in 2021 as well.”
In 2020, 1.6 million cases of chlamydia were reported, down 1.6% from 2016. Gonorrhea cases (677,769) increased 45% from 2016 levels, while syphilis cases (133,945) also increased, up 52% from 2016 numbers.
Dr. Mermin said he believes the decline in cases of chlamydia, which often is asymptomatic, may be a reflection of reduced STD screening and under-diagnosing of the disease rather than a reduction in new infections.
The data also show significant disparities in rates of reported STDs. In 2020, more than half (53%) of reported cases of STDs were among adolescents and young adults ages 15 to 24 years. Disparities continued to persist in rates of reported STDs among some racial minority or Hispanic groups when compared with rates among non-Hispanic White people.
In 2020, 32% of all cases of chlamydia, gonorrhea and P&S syphilis were among non-Hispanic Black people, while they made up approximately 12% of the U.S. population.
The disparities are unlikely explained by differences in sexual behavior, health officials said, and rather reflect differential access to quality sexual health care.
Health officials warn the overall STD numbers may be underreported as frequency of in-person health care services likely declined in early 2020, which likely resulted in less-frequent STD screening. Public health staff also likely were diverted from STD work to help respond to the COVID-19 pandemic.
“Social and economic factors, such as poverty and health insurance status, create barriers, increase health risks and often result in worse health outcomes for some people,” Leandro Mena, M.D., M.P.H., director of the CDC’s Division of STD Prevention, said in a press release. “If we are to make lasting progress against STDs in this country, we have to understand the systems that create inequities and work with partners to change them. No one can be left behind.”