Sexually Transmitted Disease Surveillance, 2021

Dear Partners in Prevention,

Today, during STI Awareness Week, CDC released Sexually Transmitted Disease (STD) Surveillance, 2021. The annual report shows infections continued to forge ahead, compromising the nation’s health. In fact, in 2021, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported.

The report indicates that in the United States in 2021:

• 1.6 million chlamydial infections were reported. This 4.1 percent increase from 2020 signals a return to pre-pandemic levels.
• More than 700,000 gonorrhea cases were reported, reflecting a 28 percent increase since 2017.
• Reported cases of syphilis (all stages) have increased 74 percent since 2017, totaling more than 176,000 cases in 2021.
• Congenital syphilis continues to surge, increasing 203 percent in the past five years. In 2021, 38 jurisdictions, including 37 states and the District of Columbia, reported an increase in congenital syphilis cases.

The report also highlights concerning trends among racial and ethnic minority groups and gay, bisexual, and other men who have sex with men, emphasizing a need for enhanced care for those most affected by these infections.

STIs are common but some groups are more affected than others

Racial/ethnic and sexual minority groups remain disproportionately affected by STIs. Data show Black or African American people accounted for nearly a third of chlamydia, gonorrhea, and syphilis cases, yet make up just 12 percent of the U.S. population. Gay and bisexual men were severely impacted by gonorrhea and syphilis in 2021. According to recent data from the STD Surveillance Network (SSuN), nearly one-third of all reported cases of gonorrhea were among gay and bisexual men. They also accounted for almost half of all male primary and secondary (P&S) syphilis cases. Congenital syphilis rates increased for most racial and ethnic groups, but the highest rate was among infants born to American Indian and Alaska Native people in 2021.

While tried-and-true prevention strategies are key, social inequities often leads to health inequities and, ultimately, manifest as health disparities. We must work collaboratively to address social, cultural, and economic conditions to make it easier for people to stay healthy.

The nation’s prevention efforts struggle to keep pace with the growing syphilis epidemic

Since historic lows in 2000-2001, the resurgence of syphilis in the U.S. remains a significant source of concern. Cases of P&S syphilis—the most infectious stages of the disease— have increased a staggering 781 percent since 2001. Congenital syphilis, the most tragic outcome of the overall syphilis epidemic, has increased 464 percent since 2001. In 2021 alone, there were 220 congenital syphilis-related stillbirths and infant deaths and over 2,800 cases reported.

Although the syphilis epidemic is impacting all states across the country, there are some geographic areas that are disproportionately affected. For example, in 2021, California, Texas, Arizona, Florida, and Louisiana, represented 58 percent of all reported cases of congenital syphilis. Furthermore, the broader syphilis epidemic was concentrated within states, as just 100 counties accounted for 60 percent of all reported P&S syphilis cases in 2021. While this report is useful for drawing attention to the national epidemic, this geographical clustering highlights the importance of jurisdictions concurrently looking at their data to ensure their messages are tailored to the populations and areas most affected locally.

Syphilis may be thriving, but the infection is completely preventable and treatable. Sexually active people, healthcare providers, and CDC all have a role to play in reducing U.S. syphilis rates. Timely screening, diagnosis, and treatment can save lives, but if left untreated, the infection can cause serious health problems and increase the risk of getting an HIV infection.

Reversing the STI epidemic is possible with a holistic approach

We have experienced unprecedented public health challenges in the past several years. The COVID-19 pandemic exposed shortcomings within the public health infrastructure. And, although this 2021 data predates the 2022 mpox outbreak, we can view this report in the context of what we learned through mpox. Each of these public health emergencies monopolized STD program resources and threatened the health of those already disproportionately affected by STIs. At times, it’s been difficult to even see a path forward, much less navigate it. But we can pick up the pieces in our quest to reverse STI trends by moving forward with a new approach that employs holistic, coordinated care to address concurrent epidemics and health disparities.

A critical first step in using this approach includes connecting people to the STI testing and treatment services they need. In recent years, we’ve seen the field quickly pivot to offer innovative solutions for meeting people where they are, including pharmacy and retail health clinic partnerships and STD express clinic visits. And, in recent months, we’ve seen historic progress toward new STI prevention innovations. We can and must continue to build on this momentum. While CDC is bringing its resources to bear through initiatives like the new Sexually Transmitted Infections Impact Research Consortium (STIIRC) and ongoing efforts to build and strengthen the Disease Intervention Specialists Workforce, the agency can’t do it alone.

Through collaboration and a whole-of-nation, whole-person approach, I am hopeful that we can improve our nation’s health and well-being.

Best regards,

Leandro Mena, MD, MPH, FIDSA
Director, Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
US Centers for Disease Control and Prevention