How are STIs transmitted? When should someone be tested? A national survey from the Ohio State University Wexner Medical Center finds many in the U.S. struggle when answering those questions.

The Centers for Disease Control and Prevention released their annual surveillance report on STIs earlier this year and the numbers are sobering: 1.6 million cases of chlamydia and nearly 650,000 cases of gonorrhea. The report also documented more than 207,000 cases of syphilis, an 80% increase since 2018; in the same interval rates of congenital syphilis (when the infection is passed to a fetus during pregnancy) jumped a staggering 183%.

There’s no simple answer to explain these numbers, but lack of awareness about how STIs are transmitted (and prevented) surely contributes. The Ohio State researchers surveyed 1,005 adults in the U.S. and found:

• 34% thought STIs can only be transmitted through sexual intercourse. The reality is that other types of behaviors – including kissing, childbirth, and sharing needles – can also transmit STIs.
  
  
• 20% believed STI testing is only necessary when a person is experiencing signs or symptoms. With many STIs, symptoms can be mild or absent altogether and can also mimic those of other common conditions (many people who’ve contacted ASHA over the years following an STI diagnosis, for example, say they thought they were experiencing symptoms from a yeast infection or an allergic reaction).

To explore these topics, ASHA spoke with Abigail Norris Turner, PhD, an infectious diseases epidemiologist and professor with the Ohio State University College of Public Health. Dr. Turner says the sharp uptick in syphilis infections is driven by many factors, including people’s perception of their risk: “Some people are surprised to learn that syphilis continues to circulate today – they associate it with a bygone era.”

She says current guidelines call for syphilis testing of all pregnant people at the first prenatal visit, but it wasn’t always that way: “For decades, screening guidelines varied by state. Providers used their clinical judgement to determine who needed a syphilis test during pregnancy. That led to missed opportunities for testing and thus also missed opportunities to avert congenital syphilis cases.”

Dr. Turner says stigma plays a role, too. “Most people don’t want to talk about their STI risk, and many are not open to messages encouraging them to get tested for STIs, even when they are symptomatic. If they do get a test and it comes back positive, it can be very hard to tell recent partners. Some people choose not to let their past partners know of their potential infection because of the stigma of having, and possibly transmitting, an STI. Stigma contributes to ongoing cycles of transmission and are part of the increased STI rates we see today.”

Shrinking budgets make it even more challenging to combat the current surge in STIs. “Reduced funding makes it harder for public health programs to get their messages of testing and treatment out to the community. Those messages were especially hard to deliver during COVID. Post-pandemic, people have largely returned to their pre-pandemic sexual lives, but the underlying prevalence of many STIs is higher now than in 2020. It’s critical that public health programs have the resources they need to continue testing and treating these infections.”