STDs: A Growing Problem With Dwindling Resources

Dr. Will Wong

New statistics released by the National Coalition of STD Directors and the Centers for Disease Control show the public health burden of STDs in the U.S. is worsening at the same time the resources needed to fight them continues to shrink.

This week, the National Coalition of STD Directors (NCSD)
and the Centers for Disease Control and Prevention (CDC) have both released new
information about the sad state of affairs in our country when it comes to
sexually transmitted diseases (STDs).

Let’s begin with the newly published CDC 2008 Sexually
Transmitted Diseases Surveillance Report since it underscores the scope of the
STD epidemic in this country.  Each
year, CDC collects and releases data on the three different STDs that are
reportable to health officials: 
chlamydia, gonorrhea, and syphilis.  For 2008, the news on this trifecta of diseases that undermines
sexual and reproductive health is not good.

Chlamydia and gonorrhea are two of the most commonly
reported diseases and together, added up to more than 1.5 million cases in
2008.  These diseases are both preventable
and curable with appropriate treatment, but unfortunately, often go undiagnosed
resulting in serious health consequences. 
According to the CDC, an estimated 10-20% of undiagnosed infections in
women will result in long term consequences for reproductive health such as
ectopic pregnancies, chronic pelvic pain, pelvic inflammatory disease, and
infertility.  Each year, an
estimated 24,000 women in the United States will become infertile due to STDs
left untreated.

The situation with syphilis is even more troubling.  It was not so long ago that syphilis
was on the verge of being eliminated from the United States.  Yes…eliminated.  But in 2008, our country saw an 18 percent
increase in cases of syphilis from 2007 totaling more than 13,500 cases. 

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Keep in mind that these are just the cases reported and
gathered through health department STD programs.  Since STDs commonly have no symptoms whatsoever, the
majority of cases go undiagnosed and unreported.  The CDC actually estimates that more than 19 million new
infections occur in the U.S. each year. 
What is presented in the disease statistics is only the “tip of the iceberg”
of the silent epidemic of STDs in this nation.  Behind the topline numbers, however, one finds additionally
disturbing evidence of how our efforts to combat these illnesses are falling
disastrously short.  For example,
racial disparities in how these diseases are affecting African-Americans are
shocking and unacceptable. 
Gonorrhea rates are 20 times higher among African-Americans than they
are among whites.  African-Americans
represent only 12 percent of the population, yet they made up for 71 percent of
reported gonorrhea cases, 48 percent of chlamydia cases, and 49 percent of syphilis cases in
2008 according to the CDC report. 
This racial disparity has further widened in some parts of the country
as people continue to lose their health insurance along with their jobs and their
access to medical care in the current economic recession. 

Youth also continue to be disproportionately affected,
particularly adolescent girls.  Half
of the estimated 19 million new STD infections each year occur among youth 15
to 24 years old.  In 2008, however,
nearly a third of the new chlamydia and gonorrhea cases occurred among girls
ages 15-19 years old followed by 20-24 year old girls in close second.

Finally on the CDC data, the increase in syphilis cases is
particularly worrisome because the epidemic continues to expand among men who
have sex with men (MSM).  Since
syphilis can facilitate the transmission of HIV, the control of the HIV
epidemic in this country is being undermined by the rising rate of syphilis.  With the CDC also indicating that HIV
is on the rise among MSM, we have a profound recipe for a public health
disaster if we cannot get a handle on the current situation.

So, for those of us on the frontline combating STDs – like I
am in Chicago – the news from the CDC is sobering, but not a surprise:  we see this every day in our clinics and
programs across our city.  But the
CDC data presents only half the picture, because what I and other colleagues
have also been witnessing across the country is a cut to the resources we need
to tackle STDs, including HIV.  In
particular, budget cuts by state and local jurisdictions, and flat or declining
federal resources to tackle STDs, were everywhere apparent, but we needed to determine
the actual impact.

So earlier this year NCSD set out to conduct a study on how
the budget cuts were affecting the operation of programs that are designed to
prevent, diagnose, and treat STDs. 
Our survey of states, large U.S. cities, and the territories is as
equally sobering as the scale of the STD epidemic itself.

Our research found:

  69 percent of STD programs experienced funding
cuts from 2008 to 2009;

  39 clinics supported by state and local
STD programs closed due to lack of funding over the past year;

  20 percent of the frontline STD program
workforce – known as Disease Intervention Specialists – have disappeared over
the past decade, and;

  69 percent of STD programs supported by state
and local dollars have experienced salary freezes and 29% have experiences

In other words, the burden of STDs is becoming worse in this
country at the same time that the resources we need to fight these illnesses continue
to shrink.  None of this bodes well
for the future health of our nation and our communities.

NCSD is working to ensure that STDs are not lost in the
shuffle.  Of course, the current
debate over healthcare reform provides an opportunity to address these issues,
but taking STDs seriously will require additional targeted resources for
prevention, diagnosis and treatment. 
What we know for certain is that without more resources, the situation
will grow still worse and as a nation, that is an outcome we simply cannot

To access a fact sheet on the NCSD study, go to

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