How Scared Should I Be of the Rise in STDs?

Time for “How Scared Should I Be?” the column that quantifies the scariness of everything under the sun, and teaches you how to allocate that most precious of natural resources: your fear.

A report last week from the Centers for Disease Control (CDC) showed that 2015 saw more STD diagnoses than any year in recorded history. That includes 1.5 million cases of chlamydia, 400,000 cases of gonorrhea, and 24,000 cases of syphilis. Syphilis in particular has been on a meteoric rise, increasing 66.7 percent since 2011. The diseases disproportionally affect people under 25 and people in the Western United States, and particularly men with male partners—as you can see in the chart below—but the increases are present across the board.

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The numbers are shocking, but how should Americans deal with this new information other than by being horrified?

What we’re seeing might not necessarily be a rise, according to Dr. Richard Santucci, specialist-in-chief of urology at Detroit Medical Center. It’s “an almost astonishingly complex situation,” he told me. Rates appear to be soaring, but more widespread screenings might just be revealing that STDs were always more common than we thought. “If you screened everyone in the US, you would get a spike in cases since you now would be picking up all the cases you were missing,” Santucci said. But he cautioned against suggesting that infections aren’t increasing, since “some STDs do seem to be rising.”

Screenings themselves have certainly improved, according to CDC epidemiologist Elizabeth Torrone. “For chlamydia, you used to have a swab, and it was a pretty uncomfortable swab because it went up inside the penis—not something most men want to have done. Now we can diagnose chlamydia by just peeing in a cup,” she told me. Such tests earned acceptance from the medical community around 2005. “We’ve really made a lot of advances in how easy it is to get checked for STDs, to try and break down some of those barriers.”

But the situation is bleak either way. We’re either seeing a sharp increase in STDs, or finally understanding how widespread these infections are. “These numbers really drive home the message that there are STDs in our communities, and we need to start talking about it,” Torrone told me.

But talking about it might not do much. Jonathan Mermin, the director of the CDC’s STD-fighting effort told NPR last week that “more than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.”

If better infrastructure were in place to treated infected people, there wouldn’t be much for sufferers of highly treatable chlamydia and syphilis to worry about. But as the CDC report frequently notes, antibiotic resistance is making gonorrhea harder and harder to cure. “Right now, there’s only one class of antibiotics that is recommended for the treatment of gonorrhea, and we are constantly monitoring any changes in susceptibility to that because we know it will likely develop resistance,” Torrone told me.

And not to get all tenth grade health class on you, but if these infections go untreated there are consequences. Syphilis is more than just sores on your genitals. “You can get neurologic involvement with syphilis. We’ve actually had a number of cases of vision problems with syphilis—some people even went blind from syphilis infections,” Torrone said. Untreated gonorrhea can cause infertility in women. Chlamydia can be passed on to a baby, leading to “deformities or even stillbirth,” Torrone warned.

According to Torrone, if there’s one thing people should take away from this report, it’s not that they should be scared. “People need to get screened, and they need to get treated, but they also need to make sure they’re talking to their partners about how to prevent STDs, so they don’t have any of these consequences,” she offered.

Patients also need to get over the stigma surrounding STDs. A CDC-led study this past June found that nearly half of patients seeking STD treatments were actively avoiding telling their primary doctors about them. Patient surveys revealed that 40 percent of patients had insurance, but weren’t using it for their STD treatments. According to Dr. William S. Pearson who wrote that study, “Individuals receiving STD-related healthcare services will typically want to keep receipt of these services private.”

Torrone envisions a future in which patients just level with their doctors about their own risky behaviors, and aren’t shamed by their doctors about it. When that happens, she said, patients might start sounding like this:

“Hey, I saw this story on the news that STDs are going up. Do I need to get checked for STDs? Here’s who I have sex with, and what type of sex I have.”