STD rates continue to spike, and Philadelphia sexual health experts are especially concerned

In the last four to five months, Judy Politzer, a nurse practitioner who works at a community health center in South Philadelphia, began noticing an increase in sexually transmitted diseases among patients, especially those over age 50.

“I started noticing that I had to call a lot more people about their test results and have them come in and get treated with their partners,” said Politzer, who treated a syphilis infection for the first time in years during the pandemic. “I usually only have to call two people, and I was calling four or five. It just seemed like a noticeable increase.”

Many of her patients in this age group don’t use condoms as widely as younger people, Politzer said, and are shocked by positive test results, often for chlamydia or trichomoniasis.

“The fact that people are wearing masks but not protecting themselves during sex is amazing to me,” Politzer said. “It’s exposing themselves so intimately.”

Politzer’s experience reflects what has been happening across the country — STD rates have continued to climb, sparking concerns among public health experts.

According to new data published by the Centers for Disease Control and Prevention, STD cases reached an all-time high for the sixth consecutive year in 2019, the latest year available. The data showed 2.5 million reported cases of chlamydia, gonorrhea, and syphilis, a nearly 30% increase since 2015.

Syphilis among newborns, or congenital syphilis, nearly quadrupled between 2015 and 2019. Newborns contract syphilis from their mothers during fetal development or birth, but the infection can be treated with antibiotics if caught early.

Preliminary data suggest that this trend continued in 2020, and was exacerbated by pandemic interruptions to regular STD testing and other sexual health services, as well as staffing shortages at community health centers. Last fall, hospitals and health centers had to conserve STD testing kits because COVID-19 tests disrupted the supply chain, even as people continued to engage in risky sexual behavior.

This is particularly worrying in Philadelphia, where STD rates far exceed the national average. The rate of chlamydia in Philadelphia was nearly 1,285 cases per 100,000 residents in 2019, more than double the national rate of 553 cases per 100,000 people. The city recorded a similar trend in gonorrhea case rates.

While rates of gonorrhea and chlamydia have remained steady from the first three months of 2020 to the first three months of 2021, there has been a 25% increase in syphilis cases over the past year and a half, said Lenore Asbel, the medical director of the Philadelphia Department of Public Health’s STD clinic.

“This is a scary thing to me,” Asbel said. “And we’ve seen a 28% increase in latent syphilis. It’s concerning that it’s happened sort of early because if I was looking at the whole year, I would think that there was a lot of active testing going on. But instead, this may be underrepresentative of what’s going on.”

The city has also seen a significant increase in congenital syphilis cases — Asbel said that at this time last year, there was one reported case. This year, there are already four.

“While men still make up the vast majority of syphilis cases, a few years ago with the increase of injection drug and opioid use, we did see an increase in women,” she said.

» READ MORE: Fatal overdoses soared among Black Philadelphians during the pandemic

And although chlamydia rates fell 7.2% in the first three months of this year, Asbel cautiously noted this could be due to the drop in testing availability, especially since the disease is often asymptomatic.

“This could mean that we’re doing a good job of seeing symptomatic patients, but not necessarily screening people who are asymptomatic,” Asbel said. “I’m hoping that in the next several months, as more people are vaccinated [against COVID-19], we can test more asymptomatic people and people with minor symptoms.”

Throughout the pandemic, Elaina Tully has continued to treat patients with STD infections. But Tully, the medical director of the Y-HEP Adolescent and Young Adult Health Center in Center City, said the interruptions to testing and walk-in services and limitations of social distancing at medical offices have made it harder for patients to get access to sexual health care, even as STD rates continue to increase.

“Young people have had other priorities besides routine STI testing,” Tully said. “They’re focused on online school and their mental health. They’re trying to make money and get vaccinated. It’s not surprising that I’ve seen several patients only start to reengage in care over the last few months.”

Tully is hopeful that as more people are vaccinated against COVID-19, they will be more comfortable coming back into the clinic, where they can get tested for STDs.

In conversations with patients, Tully focuses on creating opportunities for open discussion because fear-based counseling has “traditionally made people shy away from conversations about sex with providers,” she said.

“It might seem counterintuitive to not come at it with scary and frightening statistics about rising rates of STIs in the country,” Tully said. “But we want to encourage people to be open and honest about the ways they are engaging in sex so we can really understand how to move them towards safer sex practices in a way that isn’t alienating.”

It’s too early to say what effect the pandemic will have on STD rates overall, Asbel said. Although the city is working to prioritize people who are at highest risk for syphilis and other STDs, it’s been hard to get a full picture of what’s going on without the ability to offer walk-in services.

“We may have missed cases and that may lead to an increase in the future,” Asbel said. “I don’t think we’re alone in that.”