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Are STIs Really at a ‘Record High’?

By Justin Lehmiller
Are STIs Really at a 'Record High'?: rudall30

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 Americans 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. Comprehensive sex ed works—just ask our friends in the Netherlands.

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.

The misleading claim that STIs are at a ‘record high’ is really just a page from the same playbook that’s used in abstinence-only classes.

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 here.

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.

So why all the focus on “record high” rates of STIs? Could this be because the CDC, which is overseen by the US Department of Health and Human Services, is fundamentally a political body? It currently operates under a very sex-negative administration and, until recently, was headed by disgraced former Congressman Tom Price (whose wife, a current member of Congress, recently suggested that we try to curb the spread of HIV by quarantining infected individuals). This administration has sought to cut funding for comprehensive sex education, while spending hundreds of millions of dollars on abstinence-only programs. The misleading claim that STIs are at a “record high” is really just a page from the same playbook that’s used in abstinence-only classes, which involves twisting and distorting data in ways that scare the bejesus out of people with the hope that they’ll be too afraid to have sex.

The irony here is that at the same time the US government is blasting STI scare tactics to the entire country, they’re simultaneously proposing massive cuts to HIV and STI research and prevention programs. If they think they can save money on STI prevention by scaring people away from sex with trumped-up claims about the prevalence of STIs, well, think again.

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.

Justin Lehmiller, PhD is a sex educator and researcher at Ball State University, a Faculty Affiliate of The Kinsey Institute, and author of the blog Sex and Psychology. Follow him on Twitter @JustinLehmiller.