What to know about sexually transmitted infections
With rates of some STIs on the rise, it’s never been more important to understand the risks, symptoms and treatments.
While the pandemic delayed many routine screenings, rates of some common sexually transmitted infections didn’t slow. Rather, rates of syphilis and congenital syphilis continued to surge, as did gonorrhea cases, according to a recent report from the United States Centers for Disease Control and Prevention of 2020 data.
Chlamydia infections declined though that may have been due to pandemic-related decreases in screening, rather than an actual drop in cases, the CDC notes.
Overall, rising cases of many STIs—including congenital syphilis—highlight the need for people to be aware of the risks, prevention strategies, and treatment options, says Okeoma Mmeje, M.D., M.P.H., an obstetrician-gynecologist at University of Michigan Health Von Voigtlander Women’s Hospital who has expertise in reproductive infectious diseases.
Who is at risk for STIs?
More than 50% of new STIs in the U.S. are in people aged 15 to 24. Generally, if you’re in this age group and sexually active, it’s recommended that you be screened at least once a year whether that’s at a student health center, a pediatrician or a gynecologist. The CDC also recommends that everyone between the ages of 13 and 64 be screened for HIV at least once.
In Michigan, anyone over the age of 13 can access reproductive services without parental consent, which can help make accessing services easier for young people.
“Testing is important because we know that untreated or recurrent STIs can be associated with reproductive harm, especially in those who have chronic pelvic pain, pelvic inflammatory disease or damage to their fallopian tubes, which increases their risk for ectopic pregnancy or infertility in the future,” says Mmeje.
People should be particularly aware of rising syphilis rates among heterosexual women. In recent years, syphilis hasn’t affected women as much as men. But a change in incidence means women need to know about the risk, including the worrying increase in congenital syphilis.
Congenital syphilis is still relatively rare—there were 2,148 cases in 2020, which amounts to 57.3 cases per 100,000 live births in the U.S. But that’s a staggering increase of 254% over 2016 numbers. And it can be deadly to newborns. Most people can be screened for STIs during pregnancy, so it’s thought the rise in cases is due to a lack of access to prenatal care.
“If someone misses appointments or has no prenatal care at all, that's where we see these incidents of people falling through the cracks,” Mmeje says.
Preventing and treating STIs
Mmeje wants people to feel empowered and not judged when it comes to STIs. It’s important to have conversations about risks with sexual partners to understand your risk. Barrier methods, like male or female condoms, can help prevent STIs.
If you know you’re at a higher risk for HIV, there are medications you can take to help prevent infection. Risk factors for HIV include multiple sexual partners and intravenous drug use. Other STIs, including chlamydia, gonorrhea, and trichomoniasis, can be associated with an increased risk of HIV infection.
If you do contract an STI, most can be easily treated. In most states, your partner can get medication too without a visit to a health care provider. It’s called expedited partner therapy. A physician can prescribe medication to a person’s sexual partner without doing a separate clinical evaluation.
Mmeje says that clinicians would prefer that sexual partners of a person diagnosed with an STI come in for their own evaluation. But expedited partner therapy can help in cases when it’s not possible for the sexual partner to come in and be seen.
COVID-19 and STI testing
At the beginning of the COVID-19 pandemic, public health resources were redirected to pandemic-related efforts. As a result, STI clinics were shut down and a decrease in sexual health screening and testing followed, according to a study from the National Coalition of STD Directors. People receiving treatment at student health centers may have been particularly impacted.
While this caused many people—particularly those in economically and/or socially marginalized populations—to lose access to these critical health care services, the pandemic forced innovation too.
At-home tests for STIs are more available now than ever before.
“Almost overnight, there were all these platforms available for ordering STI tests online that can be done at home,” Mmeje says.
These home-based tests can be expensive and aren’t covered by insurance. But the privacy and convenience can’t be beat, especially for young people or college students who may not regularly visit a primary care physician or OB-GYN, or for individuals with sexual partners who do not want to seek care in a traditional clinical setting.
Trichomoniasis in women
Most people know about syphilis, gonorrhea, and chlamydia, but trichomoniasis—known as “trich”—isn’t as well known among the general population. But it’s extremely common: there were an estimated 2.6 million cases of it in 2018, according to the CDC. That works out to infections in about 2.1% of women between the ages of 14 and 59.
Trich is a parasitic infection. About 70% of people with it don’t have symptoms. But for those who do, the signs include itching, burning and irritation, discharge from the penis or vaginal area, and discomfort while urinating.
In pregnant people, trich can be associated with early birth or a low birth weight.
Like other common STIs, it’s easily treatable after diagnosis.
Overall, Mmeje wants to reduce stigma around STIs to help more people access STI screening and treatment services.
“I want people to understand and know that an STI is not the end of the world,” says Mmeje. “You can be treated to prevent recurrent infection and complications.”
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