CDC 2022 STI Surveillance Report: Key Findings

introduction[00:00] Introduction

Hello everyone. My name is Meena Ramchandani. I'm an infectious disease physician at the University of Washington in Seattle. This podcast is dedicated to an STD [sexually transmitted disease] literature review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs.

In this episode, we're going to review the CDC's 2022 STI Surveillance Report. The CDC indicates that, all together, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in the U.S. and it underscores that STIs must be a public health priority. The trends for STI surveillance should be interpreted with the understanding that there were disruptions in STI-related prevention and care activities that were related to the COVID-19 pandemic response. If you're interested in learning more, I encourage you to review this report in detail but this will be a brief overview of some of the key findings.

syphilis-congenital-syphilis[01:01] Syphilis and Congenital Syphilis

Now, the most alarming concerns about this report center around the syphilis and congenital syphilis epidemics, which are worsening in the U.S. 

1. There were over 200,000 cases of syphilis in 2022, and this represented almost an 80% increase over the last five years. This is the greatest number of syphilis cases reported since 1950. 
2. The rates of primary and secondary syphilis increased in most racial/Hispanic/Latinx ethnicity groups, with the greatest increases were seen among American Indian and Alaska Native persons. 
3. Men who have sex with men continue to be disproportionately impacted by syphilis, but there is an expanding heterosexual syphilis epidemic in the U.S. And as one example, the rates of primary and secondary syphilis increased by 19% from 2021 to 2022 among women. 
4. With this expanding heterosexual-exposed epidemic, congenital syphilis has also increased. There was a 183% increase in congenital syphilis over the last five years. This has resulted in greater than 3,700 cases of congenital syphilis in 2022. In 2022, there were 282 congenital syphilis-related stillbirths and infant deaths.

Now, congenital syphilis is a devastating disease resulting in great morbidity and mortality but it is fully preventable. With routine syphilis testing per the [CDC 2021] STI Treatment Guidelines and appropriate and timely treatment, congenital syphilis can be averted. The increasing syphilis rates is a national concern and a public health priority.

chlamydia[02:40] Chlamydia

Now, turning to chlamydia infections. There were 1.6 million cases of chlamydia in the U.S., and the rate of reported chlamydia in 2022 was similar to the rate in 2021. 

1. The rates from 2021 to 2022 decreased among women by 1.2% and actually increased among men by 1.8%. 
2. While rates decreased in women, it was most pronounced among women who were ages 20-24 years.
3. The rates of chlamydia remained highest among adolescents and young adults. Almost 60% of chlamydia cases were among persons who were ages 15-24 years. 

The report notes that case rates for chlamydia are heavily influenced by screening coverage since infections are usually asymptomatic. Now, during the COVID-19 pandemic, there was decreased access to sexual health care, which might have contributed to reductions in chlamydia screening coverage and thereby decreased reporting.

gonorrhea[03:37] Gonorrhea

Let's turn to talking about gonorrhea. There were almost 650,000 cases of gonorrhea that were reported in 2022, and the rates of gonorrhea increased through 2021, but from 2021 to 2022, the rates actually decreased by 9%.

1. Rates of gonorrhea have been higher among men compared to women.
2. Taking a look at the sentinel surveillance system (the STD Surveillance Network) results indicate that almost 40% of gonorrhea cases occurred in MSM (or men who have sex with men), although the proportion did vary across jurisdictions.
3. Based on gonococcal isolates that were collected through the Gonococcal Isolate Surveillance Project, almost half of all infections were estimated to be resistant or have elevated minimum inhibitory concentrations to at least one antibiotic.
4. Almost all circulating gonorrhea strains in the U.S. remain susceptible to ceftriaxone. Less than 0.1% of isolates displayed elevated ceftriaxone minimum inhibitory concentrations.

So, continued surveillance of this organism, treatment practices, and cure is a top public health priority to help address the emerging threat of antimicrobial-resistant gonorrhea.

disparities[04:52] Disparities

You can't talk about STIs without talking about disparity. Disparities in STIs do exist and need to be mentioned. 

1. In 2022, almost 50% of bacterial STIs were among adolescents and young adults ages 15-24 years. 
2. MSM are disproportionally impacted by STIs in the U.S., especially gonorrhea and syphilis, and coinfection with HIV is common.
3. Some racial or ethnic groups are also disproportionally impacted by STIs, and in 2022, around 30% of bacterial STIs were among Black or African American persons.

So, what does this tell us? It means that more resources are needed to address STIs in these populations and to ensure access to sexual health care. This achieves the goal of minimizing the health impact of STIs, both on individuals as well as the community. 

summary[05:43] Summary

To conclude, I'd like to summarize some key points from this session:

1. Syphilis is rising nationally and 2022 saw the highest number of syphilis cases since 1950.
2. Congenital syphilis continues to increase with over 3,500 cases in 2022, resulting in 282 syphilis-related stillbirths and infant deaths. 
3. The rates of chlamydia remained similar to 2021, but this might be due to decreased screening and reporting that were related to the COVID-19 pandemic response. 
4. Rates of gonorrhea are higher among men compared to women, and almost 40% of cases occurred in MSM.
5. Gonorrhea antimicrobial resistance remains a public health concern and a top public health priority.
6. Disparities in STIs exist, and improved access to quality sexual health care for all groups will help to alleviate these disparities.

credits[06:37] Credits

This podcast is brought to you by the National STD Curriculum, the University of Washington STD Prevention Training Center, and is funded by the Centers for Disease Control and Prevention. 

Transcripts and references for this podcast series can be found on our website, the National STD Curriculum, at www.std.uw.edu. Thank you for listening, and have a wonderful day.