After years of consistent rises, rates of (sexually transmitted infections) STI Rates in the U.S. may be leveling off, according to new data from the Centers for Disease Control and Prevention (CDC). The latest report reveals a decline in gonorrhea cases across most age groups in 2023, while new diagnoses of syphilis and chlamydia have held relatively steady. This trend has brought cautious optimism to experts who believe the long upward trend in STIs might finally be slowing.
The decline in Gonorrhea Cases and Stabilization in STI Rates in the U.S.
The CDC data indicates that gonorrhea cases dropped in nearly all age groups in 2023 compared to 2022, marking the second consecutive year of decline. The rate of gonorrhea diagnoses per 100,000 people fell by 9.2% from 2021 to 2022, followed by an additional decrease of 7.7% last year. Meanwhile, the rates of syphilis and chlamydia held steady in 2023, a promising change after a rapid increase in cases over the last few years.
While these changes suggest a hopeful trend, more than 2.4 million new STI cases were still diagnosed in the U.S. last year—almost a million more than 20 years ago. Alarmingly, nearly 4,000 babies were diagnosed with congenital syphilis, with 279 of them stillborn or dying shortly after birth.
Potential Factors Behind the Trend
Experts believe that various factors may have contributed to the stabilization of STI rates. Increased funding to public health departments during the COVID-19 pandemic, changes in sexual behavior among some populations due to the pox outbreak in 2022, and the recent availability of the antibiotic doxycycline as a preventative measure may all have played a role in reducing STI rates.
Dr. Jonathan Mermin, Director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention at the CDC, noted that this combination of public health initiatives and behavioral shifts could be key in driving down STI rates.
A Persistent Rise in Syphilis, but a Slowdown in 2023
Although syphilis cases have surged in recent years, nearly doubling in some regions, the 2023 data showed a less dramatic increase. While syphilis cases overall rose by only 1%, congenital syphilis saw a modest 3% increase compared to the 32% jump between 2020 and 2021. Congenital syphilis remains a serious concern as it can lead to miscarriage, stillbirth, and long-term disabilities such as blindness, deafness, or developmental delays in infants.
According to the CDC, timely testing and treatment with a single shot of penicillin during pregnancy can prevent such outcomes in most cases. Dr. Ina Park, an STI expert at the University of California, San Francisco, stressed that with proper care, congenital syphilis should be entirely preventable in modern healthcare settings.
Success Among Gay and Bisexual Men, But Regional Disparities Remain
Primary and secondary syphilis—the stages during which the infection is most contagious—dropped by 10% last year, with cases among gay and bisexual men decreasing by 13%, marking the first decrease in over 15 years. However, STI rates vary by region and demographic group. Nearly half of new STI cases in 2023 occurred among adolescents and young adults aged 15 to 24. Native American, Alaska Native and Black populations also experienced disproportionately high rates of infection, and the South saw a higher prevalence of cases compared to other regions.
Southern states, where sex education often focuses on abstinence or is omitted from school curricula, have had difficulty reducing STI rates, noted Dr. Thomas Dobbs, Dean of the University of Mississippi’s John D. Bower School of Population Health. Syphilis rates per 100,000 people dropped by less than 5% in the South, compared to reductions of over 15% in the West and nearly 18% in the Northeast.
Efforts to Expand STI Prevention and Treatment
In response to the STI crisis, local and state health departments have increased efforts to expand STI testing in clinics, emergency rooms, correctional facilities, and other community settings. Some health departments are working to reduce the stigma associated with STIs by addressing them openly and providing accessible testing and treatment options.
The Biden administration recently established a task force to combat syphilis, and the Food and Drug Administration approved the first at-home test for syphilis, allowing people to screen for the infection in the privacy of their own homes. Additionally, the Indian Health Service has recommended universal syphilis screening for individuals aged 13 to 64.
Dr. Park remarked that the coordinated efforts among health professionals and agencies to address syphilis are a promising development in the field. She expressed optimism that with continued dedication, further declines in STI rates are possible.
This united approach, coupled with new tools and resources, has given experts hope that the recent progress is only the beginning of a broader decline in STI rates in the U.S.
