Rates of Most Sexually Transmitted Infections are Rising
Sexually transmitted infections (STIs) are passed from one person to another through sexual activity. STIs are typically treatable, but there may not be any symptoms or only mild symptoms resulting from an infection; thus, prevention and screening for infection are important public health interventions. According to the National Centers for Disease Control and Prevention, roughly half of STIs occur among young people ages 15-24 years old. These infections can lead to long-term health consequences, such as infertility and an increased likelihood of acquiring HIV (human immunodeficiency virus). Beyond the impact on an individual’s health, STIs are also an economic drain on the U.S. healthcare system, costing billions annually.[1] This indicator tracks the prevalence of three common STIs: chlamydia, gonorrhea, and syphilis (including congenital syphilis).[2]
TREND
Sexually transmitted infections are on the rise in San Bernardino County. While the county’s rate of chlamydia dropped 23% from 631.9 per 100,000 residents in 2019 to 484.9 per 100,000 residents in 2020, this is likely due to the COVID-19 pandemic and decreased screenings resulting in undiagnosed infections.[3] Without including the 2020 pandemic year, chlamydia has increased 18% since 2011, when the rate was 531.2 per 100,000 residents, to 631.9 per 100,000 residents in 2019.
Gonorrhea incidence in San Bernardino County increased 189%, rising to 197.1 reported cases per 100,000 people in 2020, up from 68.3 per 100,000 in 2011. Syphilis occurs at a much lower rate but is also increasing among San Bernardino County residents. Primary and secondary stage syphilis (the most infectious stages of the disease) increased more than 500% between 2011 and 2020, with a rate of 17.5 cases per 100,000 residents reported in 2020. Unlike chlamydia, which may not show symptoms, COVID-19 did not have the same level of suppressed diagnoses of gonorrhea and primary and secondary stage syphilis because symptoms can be visible and/or painful, which leads to people seeking care.3
CASE RATE OF CHLAMYDIA DECREASED, LIKELY DUE TO COVID
Incidence of Chlamydia per 100,000 Residents in San Bernardino County, California, and the United States, 2011-2020
CASE RATE OF GONORRHEA TRENDING UP, WITH SIGNS OF LEVELING IN MOST RECENT DATA
Incidence of Gonorrhea per 100,000 Residents in San Bernardino County, California, and the United States, 2011-2020
CASE RATE OF SYPHILIS INCREASING IN RECENT YEARS
Incidence of Syphilis per 100,000 Residents in San Bernardino County, California, and the United States, 2011-2020
GEOGRAPHIC COMPARISON
San Bernardino County’s STI rates are higher than the state and nation for chlamydia, in between the state and nation for syphilis, and lower than the state and nation for gonorrhea. Specifically, the San Bernardino County chlamydia rate of 485 per 100,000 is higher than both the California and United States chlamydia rates of 452 and 481 cases per 100,000 residents, respectively. In comparison, San Bernardino County’s rate of primary and secondary syphilis (17.5 per 100,000 people) was lower than California’s (19.5 per 100,000 people) yet higher than the U.S. rate (12.7 per 100,000 people). San Bernardino County’s gonorrhea rate of 197 per 100,000 is lower than both the California rate of 199 per 100,000 and the U.S. rate of 207 per 100,000.
Common STIs and Complications, if Untreated
Chlamydia, a bacterial infection, is the most commonly reported STI in the United States. Untreated chlamydia infection in women can result in pelvic inflammatory disease, which is a major cause of infertility, ectopic pregnancy, and chronic pelvic pain. Untreated chlamydia in men can cause urethral infection or swollen testicles.
Gonorrhea is the second most common STI in the U.S. and is also a bacterial infection. As with chlamydia, it can cause pelvic inflammatory disease. It can also be passed from a pregnant mother to her child and can lead to blindness and pneumonia in the child.
Syphilis is a genital ulcerative disease (also a bacterial infection). If left untreated, syphilis can cause mental illness, blindness, and death. Congenital syphilis is when the infection is passed from a pregnant mother to the unborn baby, and can lead to a low birth weight, premature birth, or stillbirth. Infants infected with congenital syphilis may develop serious health problems such as cataracts, deafness, and seizures, and can die.
According to the Centers for Disease Control and Prevention, individuals who are infected with STIs are two- to five-times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. Each of these STIs, if left untreated, can facilitate the transmission of HIV infection. Almost half of all new STI cases each year are in people between the ages of 15 and 24 years.
[1] Centers for Disease Control and Prevention, Data & Statistics (cdc.gov/std/stats)
[2] Syphilis is divided into stages including primary, secondary, latent, and tertiary. This indicator tracks the incidence of primary and secondary syphilis – which are the most infectious stages of the disease – as well as congenital syphilis, which is syphilis in an infant that has been passed from mother to child. Latent and tertiary syphilis are not tracked in this indicator.
[3] Impacts of COVID-19 on STDs, https://www.cdc.gov/std/statistics/2020/impact.htm