Sexually transmitted diseases — particularly gonorrhea and syphilis — have climbed sharply in Georgia to their highest level in at least a decade, according to government data.
Public health officials point to myriad possible reasons, including declining condom use, as they try to address the problem.
The 106,180 reported cases of chlamydia, gonorrhea and syphilis combined in 2021 marked a 17% increase from the year earlier and 60% from 10 years before, according to preliminary data from the Georgia Department of Public Health. Rates are also the highest in at least a decade after adjusting for population growth.
The nation is headed in the same general direction with STDs, but not nearly at the pace in Georgia.
The state — and much of the Southeast — already had some of the highest rates in the country in 2020. Georgia had the sixth-highest rate of chlamydia, the 16th highest of gonorrhea and the ninth highest of syphilis.
The U.S. Centers for Disease Control and Prevention has reported preliminary national figures for 2021, but hasn’t released updated state data that would show how Georgia ranked.
Delma Gomez Adisa, director of the health care center in Midtown for AID Atlanta, said she started noticing big increases in STD cases by the middle of last year.
To handle the surge, AID Atlanta’s office for STD testing and treatment farmed out patients to other parts of the health services nonprofit for assistance.
Officials and health care workers in Georgia and elsewhere say one of the most basic reasons for the rise is likely that fewer people may be using condoms.
They suspect some have let down their guards because of better antiviral drugs to combat HIV and improved contraceptives with fewer side effects.
“We have to not lose focus of condom use,” Gomez Adisa said.
Among other issues she cites disparities in care and insurance coverage.
“Folks who are disproportionately affected generally tend to be patients who have limited access to health care,” she said.
Alexander Millman, the state DPH’s medical director, suggested in an email that advances in STD surveillance have led to more cases to be counted that might have been missed in the past.
But he cited several other factors, such as growing engagement in condom-less sex, less frequent testing and difficulty notifying members of online sex networks about potential exposures. He also pointed to stigmas and lack of awareness related to testing and treatment, and federal funding levels that for a number of years didn’t help keep state public health staffing on pace with the increase in STD cases.
A new supplemental federal funding will boost public health staffing in Georgia, but the dollars aren’t permanent.
The ripple effects from COVID-19 added new wrinkles. As health care providers turned their attention to the pandemic, some put fewer resources into STD screenings and some people held off on seeking regular medical checks.
At the same time, people likely changed their sexual behaviors during the pandemic or when COVID worries eased, according to those in health care. In Georgia, the total number of reported STD cases declined in 2020 compared with 2019, but then more than rebounded in 2021.
Leandro Mena, director of CDC’s Division of STD Prevention, said in emailed statements that social and economic conditions make it more difficult for some populations to stay healthy.
But increases in infections can also be attributed to reduced STD services at state and local levels, growth in substance abuse which has been linked to risky sexual behavior, and decreased condom use, particularly among young people and gay and bisexual men.
The COVID pandemic and the monkeypox outbreak also added to the strain on public health staff, according to Mena.
Preliminary 2021 figures for the U.S. also show that some racial and ethnic minority groups, gay and bisexual men, and youth are still disproportionately impacted by higher STD rates, Mena said.
The nation needs updated ways to prevent and control infections, he said. “It’s time for innovation.”
One hope: the development of self tests “that are as accessible and affordable as home pregnancy tests,” he said.
In the meantime, Millman of the state DPH said Georgians should “have positive sexual health conversations with their medical providers and their partners,” get tested for STDs and complete treatment if they test positive.
Public health districts in Georgia have at least one STD clinic in every county. Testing and treatment are provided on a sliding fee scale.
And the state is launching an educational campaign aimed at health care providers, reminding them that Georgia law requires they offer to test pregnant women for syphilis and HIV in the first and third trimesters. One hope is that early testing, treatment and retesting will cut down on congenital syphilis in newborns, which has increased sharply in recent years.
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