A recent report from the Centers for Disease Control and Prevention found a small decline in sexually transmitted infections (STIs) across the United States in 2023 compared to 2022. Community health workers say the latest numbers are signs that expanded strategies like vaccines, culturally-relevant outreach, and routine screening are working to slow the rates of STIs—which have steadily increased by 90 percent since 2004.
While all sexually active people are at risk for STIs, Black, Indigenous, Latine, LGBTQ+, and other historically underserved communities can be impacted by higher STI rates than others due to systemic barriers to accessing information and care.
To better understand what’s at stake for these communities and for the CBOs who serve them, Public Good News spoke with two health care providers from the National Coalition for Sexual Health.
Dr. Ana Cepin, is an obstetrician-gynecologist, associate professor, and director of the Community Women’s Health program at Columbia University, Irving Medical Center. She also runs a family planning practice that provides sexual and reproductive health care, especially for those who may not have insurance in Washington Heights, New York City.
Dr. Jorge Ramallo is an internal medicine and pediatrics physician and medical director of the Inova Pride clinic, which focuses on LGBTQ+ patients in Falls Church, Virginia.
They shared their insights about what you and your community should know about the state of STIs.
Here’s what they said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
PGN: In 2023, more than 2.4 million cases of STIs were reported in the U.S. What’s important for health workers to know about the CDC’s latest numbers?
Dr. Ana Cepin: We are fortunate in this country that there is monitoring of STIs, and so we are able to see the rates on an annual basis. What was interesting about this latest report is that despite there being still a very significant number of new cases, the epidemic is slowing.
For example, gonorrhea cases have continued to drop, chlamydia rates are pretty stable. This is all good news that things are getting better.
Syphilis continues to rise, but not as exponentially as it was before. I want to highlight syphilis, because of how dangerous it can be for everyone, but in pregnancy, it can have very dire consequences.
In terms of my community, we do see higher rates of STIs. We are a Title X-funded practice, so we have to also track our rates closely, and we have seen increases in the past year, for example.
But again, there’s not exponential growth. So, these nationwide trends are very reassuring, but still a lot of work remains to be done.
Dr. Jorge Ramallo: We’ve been way more diligent in trying to spread the news about the epidemic of syphilis that’s been [affecting] our communities, especially the LGBTQ+ community.
We’ve seen such a rapid increase over the past few years, that [it] has been really concerning. And, obviously, that also permeates into the general population, which in turn, has led to an increase in congenital syphilis, which is the really scary piece that no baby should go through.
So, because we knew that the syphilis epidemic was blowing up years prior, there have been a lot of efforts taken, both at a national and local level, to try to be proactive in addressing this. And the question that’s being answered by this report is, are they actually helping?
And the answer is yes, they’re actually working.
PGN: What strategies are working to slow down STI rates?
J.R.: We can think about it in a few different ways. At the health system level, just making sure that we’re ringing the alarm, providing more awareness and education for the health care workforce to make sure they’re including and thinking about this in their differential diagnosis when they’re evaluating patients with symptoms.
If you don’t have your antennas ready to go thinking about things like, OK, this patient’s coming into the emergency room with a serious rash, should we be thinking about syphilis?
Should we be testing people we encounter in different health care scenarios more frequently, such as the emergency room, urgent care, or even primary care clinics?
The second thing is, educating the public about things like, what are some of the symptoms of syphilis? What are some of the things that you should be looking out for, especially if you consider yourself to be a person that might be at risk of acquiring an STI based on your sexual practices?
We try to do this with messaging that is sex-positive, and making sure that people are not feeling ashamed, othered, or ostracized, especially for the LGBTQ+ community.
So, not only learning about what are some of the potential symptoms, but also what are some of the potential things you can do to help yourself prevent STIs.
Some of the strategies we discuss typically include maybe reducing your sexual network to a few trusted people that you know, that you trust. Having conversations like, ‘Hey, I got tested. Did you get tested?’
[We make] sure that they are on PrEP to prevent HIV. And now we have this new tool for STI prevention called DoxyPEP.
It’s for men who have sex with men and other members of the LGBTQ+ community. You can actually take a medication to help you decrease your risk of syphilis by 86 percent, chlamydia by 72 percent, and gonorrhea by 66 percent, if you take it properly.
So, [we make] sure they’re also aware of that and they have it available for use, just in case they need it.
I think adoption of innovative tools to help people help themselves and prevent things is one of the key reasons why we’re seeing a slowing down of the syphilis epidemic, because even though it increased by 1 percent, it’s certainly not the rapid, massive increases we’ve seen in years prior, so that’s actually been very reassuring.
A.C.: We’re talking about gonorrhea, chlamydia and syphilis, but there are other STIs that can be prevented with vaccinations. Certainly, getting things like the HPV vaccine is really important.
PGN: What strategies or solutions need more attention?
A.C.: I’ll take it back to the COVID-19 vaccine. Initially, there was all this talk about vaccine hesitancy in the Latino community and that it was leading to lower rates of vaccination. But, actually, people wanted to be vaccinated.
I think people are very interested in their health and want to do the right thing, but accessing health care is very difficult. It can be because of a language barrier. It can be because of an insurance barrier, payment barrier, and just appointment availability.
So, I don’t think that it’s that people don’t necessarily want to go to the doctor. They just can’t get there in an easy way.
So, for community health workers, I think helping people navigate our complex health care system is a really important role that they can play.
J.R.: It was very encouraging to see that the rates within the LGBTQ+ population are dropping, and we think it’s because of the concerted efforts that we’ve made.
But we are seeing that this STI epidemic is affecting American Indian, Alaska Native people, definitely Black communities, and Hispanic, Latino communities as well.
So, as we’re thinking about solutions, we have to really think about who is at the table when we’re making decisions about programming. Are we including those voices?
Like, the community health workers who would be really great sources of information for us to be like, ‘OK, where do we need to go? What do we need to do to change what’s happening on the ground?’
That’s really critical for us to be successful moving forward.