STDs on the Rise — and Often Go Untreated, Despite Being Curable

Gonorrhea, syphilis and chlamydia: screening and prevention

STDs on the Rise — and Often Go Untreated, Despite Being Curable | Chlamydia

Sexually transmitted diseases (STDs) are not a new problem, but they are taking on new proportions in recent days.

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In 2017 alone, rates have risen at an alarming rate: gonorrhea (up 67 percent), syphilis (up 76 percent) and chlamydia (up from 1.6M to 1.7M), together representing about 2.3 million cases in the U.S., according to the Centers for Disease Control (CDC).

The dramatic rise in STDs is a disturbing trend of “steep, sustained increases” over the last four years, the CDC reports. Experts say it’s a critical time for STD prevention, particularly in light of skyrocketing infection rates and the threat of antibiotic resistance.

According to Ob/Gyn Infectious Disease specialist Oluwatosin Goje, MD, “It’s absolutely critical for at-risk patients to be screened so that they can be treated promptly for sexually transmitted infections (STIs).”

Who should get tested for STDs?

Dr. Goje says screening is especially important for both at-risk populations and women ages 15-24, who represent a whopping 45 percent of the 1.7 million cases of chlamydia.

She also advises STI screening for patients:

  • Reporting new or multiple sex partners.
  • With symptoms of STIs.
  • Who have concerns about urethritis, cervicitis, vaginitis, pelvic inflammatory disease, and endometritis.
  • Who have experienced rape and sexual assault.

How do doctors test for STDs?

To test for gonorrhea or chlamydia, doctors use a nucleic acid test (NAT). These are painless tests involving swab samples.

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“Usually, urine can be tested for gonorrhea and chlamydia if swabs can not be collected in female patients.”

To test for chlamydia, doctors need a swab sample collected from the cervix or vagina.

“We can do the swab tests in the office or, in special circumstances, patients can self-collect them, which expedites screening,” Dr. Goje says.

Syphilis screening usually involves a blood test. It detects the infection and helps doctors determine whether it is in a primary or secondary stage, which affects treatment.

What are the concerns about antibiotic-resistant gonorrhea?

In recent years, antibiotic resistance has become more of a problem in treating gonorrhea. Dr. Goje says  that steps to combat this involved blending the use of two antibiotics.

“Since 2015, we began adding oral azithromycin to delay the development of resistance to ceftriaxone. Emerging resistance to ceftriaxone seems to have stopped ever since we implemented this dual-therapy approach.”

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On the other hand, a new problem is emerging with azithromycin resistance, increasing from 1 to 4 percent from 2013 to 2017, according to the CDC.

“Eventually, we may have to turn, yet again, to alternative medications for treating gonorrhea,” she says.

What is the role of counseling in STI treatment?

For all patients who test positive for STIs, Dr. Goje suggests offering immediate treatment, intensive counseling, and partner tracking and treatment based on local and state government rules.

“Counseling is an important tool that often goes underused. As part of the treatment, it can help patients understand how important it is to consistently and properly use condoms during all sexual activities,” she says.

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