After sexually transmitted diseases fell during the early months of pandemic lockdowns and social distancing, the U.S. saw a resurgence of some of the most common infections through the end of 2020, according to a report.While STD diagnoses fell slightly overall to 2.4 million reported cases in 2020, gonorrhea, syphilis and congenital syphilis all surged later in the year to exceed 2019 totals, the Centers for Disease Control and Prevention said in the report. Chlamydia remained the most common STD for the year, although cases declined overall, likely because of under-diagnosis.
The World Health Organization declared the Covid-19 outbreak a pandemic in March 2020, and dozens of countries, including the U.S., locked down large segments of their populations to restrict spread and preserve hospital capacity. Even those strict measures, along with widespread concern about the health implications of personal contact, were insufficient to keep STDs to keep from spreading, the data suggest.
“There were moments in 2020 when it felt like the world was standing still, but STDs weren’t,” said Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “The unrelenting momentum of the STD epidemic continued even as STD prevention services were disrupted.”
Possible reasons for the low numbers of cases in the beginning of 2020 include decreased health-care visits, diversion of public-health resources to fighting the pandemic, lapses in insurance coverage due to unemployment and gaps in national data collection because of increased use of telehealth services. By the end of the year, gonorrhea cases were up 10% compared to 2019, and syphilis cases had risen 7%, the report said.
The year also saw more than 2,000 reported cases of syphilis in newborns, which occurs when a mother passes the infection to a fetus. It marked the highest number in nearly three decades, and adds to a dramatic increase seen in the last five years, the report said. Congenital syphilis can cause serious complications, including stillbirth, and can continue to impact a child later in life.
The pandemic “put enormous pressure on an already strained public-health infrastructure,” Mermin said.
STDs were most common among adolescents and young adults, with the highest rates of chlamydia among young people between the ages of 15 and 24. Black people, along with men who have sex with other men, were overrepresented among reported cases, the CDC said, as one in three reported cases of chlamydia, gonorrhea, and syphilis affected non-Hispanic Black people
Those trends point to health inequities, according to the report: About 12% of Black Americans did not have health insurance in 2019, according to a February brief from the Department of Health and Human Services. The health-care marketplace and Medicaid expansion helped shrink that number from 20% in 2011, but uninsured rates were highest in states such as Florida and Georgia, which haven’t expanded Medicaid coverage and have proportionately larger Black populations. LGBTQ people are also more likely to be uninsured than their non-LGBTQ counterparts, and are at greater risk of being excluded in sex education discussions, which are largely aimed at heterosexual people. Sex education can help prevent the spread of STDs, and only six states and the District of Columbia mandate that it be LGBTQ-inclusive.
“The COVID-19 pandemic increased awareness of a reality we’ve long known about STDs,” Leandro Mena, director of the CDC’s Division of STD Prevention, said in a statement. “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.”
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