Sexually transmitted infections (STIs) impose billions of dollars in medical costs in the U.S., but STI prevention and control is chronically underfunded, stigmatized, and siloed from efforts to promote overall health and well-being, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report calls for modernizing national STI surveillance and monitoring systems, bolstering the STI workforce, developing and scaling up structural and behavioral interventions, and accelerating the development of vaccines, diagnostics, and therapeutics. Taking these strategic actions would also better position the U.S. to respond to COVID-19, HIV/AIDS, and future infectious disease outbreaks, the report says.
The prevention and control of STIs requires a more holistic approach that promotes sexual health and expands access to comprehensive prevention and treatment services — rather than focusing on individual behaviors or blaming people who acquire STIs, says Sexually Transmitted Infections: Adopting a Sexual Health Paradigm.
Despite the economic burden and alarming increase of STI rates over the last 20 years, the Centers for Disease Control and Prevention’s STI funding has remained flat. Although HIV is an ongoing and highly significant concern, the mandate of the committee that wrote the report was to focus its recommendations on STIs other than HIV, due to increasing rates of chlamydia, gonorrhea, and syphilis. However, the report discusses the interplay between HIV and other STIs, and ways HIV and STI services can collaborate or integrate their prevention, care, and research efforts.
One in five people in the United States will have an STI in a given year. Many cases can be asymptomatic, and therefore go undiagnosed and unreported. Left untreated, STIs can lead to chronic pelvic pain, infertility, miscarriage or newborn death, increased risk of HIV infection, genital and oral cancers, and neurological and rheumatological consequences. The COVID-19 pandemic has also set back efforts to control STIs, the report notes. People are delaying routine STI screenings and may have undiagnosed and more advanced cases. Furthermore, STI clinic staff and resources have been diverted to the COVID-19 response.
The report emphasizes the need for easier access points for STI care. Specifically, the U.S. Department of Health and Human Services (HHS) and state governments should ensure that STI prevention and treatment is available through multiple venues, such as comprehensive sexual health clinics, pharmacies, urgent care settings, and telehealth visits. These settings should also address concerns about confidentiality, particularly among adolescents and young adults on their parents’ health insurance plans.