ARE STIs ACTUALLY ON THE RISE?

Justin Lehmiller,  a sex educator and researcher at
Ball State University, a Faculty Affiliate of The Kinsey
Institute, and author of the blog Sex and Psychology writes:

Last month, the CDC released its 2016 STD
Surveillance Report accompanied by a press
release claiming that sexually transmitted
infections (STIs, also known as STDs, or
sexually transmitted diseases) in the United States are
at a “record high.” This bold claim earned national
attention and generated tons of media headlines about
the dangers of sex. But is it true? Are STIs in the US
more common than ever before?

I fact-checked this statement and discovered that, at
best, it’s misleading. At worst, it’s yet another
politically motivated scare tactic designed to
discourage people from having sex.

Before I go on, let me first clarify that STIs are indeed
a major public health concern and we would do well to
take action, beginning by improving our approach to
sex education. Perhaps we should teach all kids what
they need to know about sex in order to protect
themselves, as opposed to telling them that they’ll get
pregnant and/or die if they decide to do it.

Returning to the “record high” claim, it’s technically
true that the CDC recorded more combined cases of
the three major bacterial STIs—syphilis, gonorrhea
and chlamydiain 2016 than in any previous year
dating back to the early 1980s (only data on syphilis
and gonorrhea were available before that). So, at least
on the surface, the numbers would appear to support
the claim. However, when you start digging deeper
into the data, things quickly get murky.

For one thing, claiming that these three STIs are more
common than ever obscures the fact that rates of two
of them, syphilis and gonorrhea, are actually much
closer to their record lows that they are to their record
highs. In fact, the rate of syphilis today is just six
percent of the rate in 1943 when this disease was at
its peak. Likewise, the rate of gonorrhea today is just
one-third (32 percent) of its peak in 1978. You can
review the data for yourself.

It is certainly true that rates of syphilis and gonorrhea
have increased recently, and that’s something that
should concern us, indeed. Both of these infections
are now at their highest levels since the mid-90s.
However, it’s important to keep things in perspective.
The reality is that these two STIs are still far less
prevalent than they used to be.

By contrast, rates of chlamydia are higher than
they’ve ever been. And if you look at the data (see
here), you’ll see that chlamydia rates have risen
dramatically each year since the CDC started tracking
chlamydia diagnoses in 1984. Why have rates of
chlamydia been on such a steady rise for the last 30-
plus years? Unfortunately, we can’t say for sure.

It might be that this infection is spreading more and
more (and maybe it is, given that infected men and
women often show no symptoms, making it very easy
to pass on without knowing it); however, it’s also the
case that doctors today are testing for chlamydia far
more often, with routine testing now recommended
for anyone deemed to be high risk, regardless of
whether they’re showing symptoms. At the same time,
our detection tools have gotten a lot better. The DNA
test for chlamydia that doctors perform these days is
a vast improvement on the older methods. What all of
this means is that we don’t actually know with
certainty how many chlamydia cases there used to be,
so we can’t really say whether there are more
chlamydia infections today than ever.

Also, when syphilis and gonorrhea were at their high
points, we didn’t have any reliable data at all on
chlamydia (though we certainly know it was around,
given that it was discovered way back in 1907). This
makes it impossible to make valid comparisons of STI
rates across years because we just haven’t always
had the same amount and quality of data that we do
today.

All of this is simply to say that, as a scientist, I’d be
very hesitant to throw around a claim that STIs in
general are higher than ever before—especially in an
era when we have more access than ever to condoms
and STI treatments than we did in the past. Again, this
isn’t to say that STIs aren’t a problem—they are. And
regardless of whether they’re technically at their
highest level or not, we need to get serious about
tackling them in light of the fact that some of these
infections, like gonorrhea, are starting to develop
resistance to antibiotics and some groups, including
men who have sex with men, are being
disproportionately impacted by several STIs. However,
taking action doesn’t mean we need to make claims
about STIs that go beyond the bounds of the data.

Science has shown us time and again that scare
tactics just don’t work when it comes to sex. In fact,
we have a mountain of data looking at the outcomes
of abstinence-only sex education, and that research
shows that an approach based in fear is
counterproductive. If anything, scare tactics actually
increase risky sexual behavior, and that ultimately
costs us far more in the end.