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According to the experts, we’re in the midst of a real public health crisis: the increase in cases of sexually transmitted diseases (STDs) being diagnosed in the United States.
Preliminary data released by the Centers for Disease Control and Prevention (CDC) on Tuesday, August 28, on the occasion of the National STD Prevention Conference in Washington, show that during the year 2017 “nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States,” that is to say, an increase of more than 200,000 compared to 2016: from 2,094,682 to 2,294,821, to be precise. This is also a new record high, and the fourth consecutive year of increasing numbers.
“We’re sliding backward”
“We’re sliding backward,” said one of the participants at the Washington conference, Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, and TB Prevention (NCHHSTP).
The new statistics confirm that the most widespread STD is (or continues to be) chlamydia. Indeed, in 2017, more than 1.7 million cases of this sexually transmitted bacterial infection were diagnosed in the United States, of which nearly half (45 percent) were among young women aged 15-24 (771,340 cases).
The spread of gonorrhea is also a cause for concern. The total number of infections caused by the bacteria Neisseria gonorrhoeae rose from 468,514 in 2016 to 555,608 last year. During the period from 2013 to 2017, there was a jump of 67 pecent: from 333,004 to 555,608 cases, according to data from the CDC. In the same period, from 2013 to 2017, the number of gonorrhea infections among men nearly doubled, from 169,130 to 322,169.
Even clearer is the increase in cases of syphilis, an infectious disease that was thought to have been left in the past. The number of primary and secondary syphilis cases—the most infectious stages of the disease—diagnosed in the USA grew in 2017 by 76% as compared to 2013, from 17,375 to 30,644. In nearly 70 percent of the primary and secondary syphilis cases last year in which the gender of the sex partner is known, the infected individuals were men who have sex with men, the federal agency reveals.
Congenital syphilis
Precisely when dealing with syphilis—a disease that has afflicted famous people including Franz Schubert, Arthur Schopenhauer, and Charles Baudelaire—it’s important to mention the real and serious risk of the bacterium (Treponema pallidum) passing from an infected mother to her fetus or newborn child.
“Shockingly, in America today, we have 1,000 and it’s an undercount, 1,000 babies born with congenital syphilis. We know around 40% of them will be a stillbirth,” said Dr. David Harvey, executive director of the National Coalition of STDs Directors, during the conference in Washington. It’s downright “shocking” to note that even today there are children born in America with congenital syphilis, Harvey continued, whereas the transmission of HIV from mother to child has practically been eradicated.
In the 2014-2015 period, cases of congenital syphilis increased by 6 percent in the United States, reports CNN (March 1, 2017). The trend was then confirmed in 2016 when a 4 percent increase was recorded.
Just in California, the number of cases tripled in the period from 2011 to 2015. Nearly half were recorded in Fresno and Kern counties. In the latter of these two counties, there were 28 cases in 2015, compared to just one in 2011. Equally dramatic is the increase in Fresno county, where in 2015, 40 cases were identified, compared to 2 four years earlier. “It’s just spreading very, very quickly,” explained neonatologist Gurvir Khurana, who works in four Central Valley hospitals, to CNN. “It’s been an absolute explosion.”
Antibiotic resistance
Alexander Fleming, the scientist from Scotland who discovered penicillin—the first effective antibiotic in the fight against bacterial infections—had foreseen and warned against the risk of pathogens becoming resistant to antibiotics. “If you use penicillin, use enough,” he said explicitly in his acceptance speech for the Nobel Prize for Medicine (1945).
The phenomenon of the growing resistance of bacteria to antibiotics is gravely complicating the battle against various diseases, including pneumonia—last year, Chinese scientists discovered a resistant strain, which is spreading very quickly—and particularly gonorrhea.
“Over the years, gonorrhea has become resistant to nearly every class of antibiotic we’ve used to treat it,” explained Gail Bolan, the director of the CDC’s Division of STD Prevention, at the Washington conference. Ceftriaxone is “the only remaining highly effective antibiotic to treat gonorrhea in the United States now,” she continued.
While only five ceftriaxone-resistant cases have been recorded worldwide, there has been an increase of cases of resistance to the other antibiotic used to help treat gonorrhea, azithromycin. In laboratory tests, resistance to this antibiotic of the macrolide family is growing: from 1 percent in 2013 to more than 4 percent in 2017. Experts calculate that drug-resistant superbugs (super-germs resistant to drugs) cause approximately 700,000 deaths every year.
How to proceed
Research into new antibiotics or new molecules capable of combating pathogens, such as those that cause STDs, is therefore one of the great challenges of the future. “In the past 10-20 years, the number of new antibiotics available and the development of new antibiotics has slowed notably,” said Edward Hook, president of the scientific commission of the National STD Prevention Conference and professor at the University of Alabama School of Medicine.
In the fight against superbugs, a promising antibacterial enzyme has been created by researchers at the Catholic University of Leuven (KU Leuven, in Belgium), called Artilysin. As compared to antibiotics, “Artilysins have the advantage that they only attack germs and leave the natural bacterial flora untouched,” the university announced. The first publicly available treatments using these enzymes are produced by the German company Lysando AG.
Given the growing resistance to antibiotics, it is important to focus especially on the prevention of STDs, and that includes a need for education. According to David Harvey, one of the primary causes of the increase of STDs in the USA is “an extreme lack of awareness and education about STDs and sexual health.” In addition, Harvey emphasizes, medical professionals need to insist on screening, because patients often don’t know that they should ask for screening and treatment.
The situation is serious. The increase of cases of STDs isn’t limited to the United States; it is appearing in many countries around the world, for example in France, where the diagnoses of chlamydia and gonococcus (the pathogen that causes gonorrhea) have at least tripled from 2012 to 2016. While in 2012 there were 76,918 and 15,067 diagnoses of chlamydia and gonorrhea, respectively, in 2016 the numbers rose to 267,097 and 49,628.
STDs are also advancing in the United Kingdom. As CNN reported on June 6, 2018, in 2017 there were 7,137 cases of syphilis in England, the largest number since 1949. It’s an increase of 20 percent compared to 2016, and 148 percent compared to 2008. Cases of gonorrhea have also increased notably, by 22 percent. Last year there were 46,676 cases.
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