The STD epidemic is slowing as the number of new cases of syphilis and gonorrhea in the US declines

NEW YORK — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, federal data released Tuesday showed.

The numbers represented good news about sexually transmitted diseases, of which there were some alarming increases in recent years as a result of declining condom usefail sex educationand reduced testing and treatment when the COVID-19 pandemic hit.

Last year, the number of cases of the most contagious stages of syphilis fell by 10% the year before– the first substantial decline in more than twenty years. Gonorrhea cases fell by 7%, marking a second straight year of decline and bringing numbers below 2019 levels.

“I’m encouraged, and it’s been a long time since I felt this way” about the country’s epidemic of sexually transmitted infections, said Dr. Jonathan Mermin of the CDC. “Something is working.”

Last year, more than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported: 1.6 million cases of chlamydia, 600,000 of gonorrhea and more than 209,000 of syphilis.

Syphilis is of particular concern. For centuries, it was a common but feared infection that could deform the body and lead to death. The number of new cases in the US declined starting in the 1940s, when infection-fighting antibiotics became widely available, and then the trend declined for half a century. However, in 2002, cases began to rise again, with men who had sex with other men disproportionately affected.

The new report shows that cases of syphilis in the early, most contagious stages have fallen by 13% among gay and bisexual men. It was the first decline since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the number of cases of unknown or later-stage syphilis – reflecting people who were infected years ago.

Cases of syphilis in newbornspassed on by infected mothers also increased. There were almost 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some STD trends to improve? Several experts say one contributor is the increasing use of an antibiotic as a ‘morning-after pill’. Studies have shown that taking doxycycline within 72 hours of unprotected sex reduces the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC began recommending doxycycline as a morning-after pill specifically for gay and bisexual men and transgender women who had recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a few years.

Some experts believe that the 2022 MPox outbreak – which mainly affected gay and bisexual men – may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested if strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, conducting contact tracing and connecting people to treatment. Congress provided $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that receive funding for STD prevention from the CDC.

Last year saw “the most activity on that funding” in the U.S., said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress terminated the funds early as part of last year’s debt ceiling deal, which cut $400 million. Some people have already lost their jobs, a spokeswoman for Harvey’s organization said.

Still, Harvey said he had reasons for optimism, including the increasing use of doxycycline and the push for at-home STD testing kits.

There are also reasons to think that the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” America’s HIV epidemic by 2030. (Federal health officials later clarified that the real goal was a massive reduction in the number of new infections — fewer than 3,000 per year.)

According to CDC estimates, there were nearly 32,000 new HIV infections in 2022. But a boost in it public health financing for HIV could also help reduce other sexually transmitted infections, experts said.

“As the government puts resources in, invests money, we see a decline in the number of STDs,” Klausner said.

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