What's driving the rise in STIs NPR's Ayesha Rascoe speaks with infectious disease expert Michael Saag about the rising rates of sexually transmitted infections.

What's driving the rise in STIs

What's driving the rise in STIs

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NPR's Ayesha Rascoe speaks with infectious disease expert Michael Saag about the rising rates of sexually transmitted infections.


Sexually transmitted infections are up. That's according to preliminary data for 2021 from the Centers for Disease Control and Prevention. Some STIs have been on the rise for years, but last year saw a bump in case numbers for three major ones - gonorrhea, chlamydia and syphilis. Syphilis saw the biggest spike at 26% over the year before. We're joined now by Dr. Michael Saag, an infectious disease expert at the University of Alabama at Birmingham. Welcome.

MICHAEL SAAG: It's good to be with you.

RASCOE: So you do outpatient work in a clinic at the University of Alabama, and you specialize in STI treatment. Are you seeing a rise in infections among your patients that reflects what the CDC is showing?

SAAG: Absolutely. And we've been noticing this for the last 5 to 7 years, for sure. It's been the three diseases that you mentioned - the three infections, chlamydia, syphilis, gonorrhea. And then, of course, most recently we've seen monkeypox, which is not precisely a sexually transmitted infection because it can also be transmitted by other means, but it's predominantly transmitted through sexual activity.

RASCOE: What is your sense of the factors that are driving this rise?

SAAG: Well, on one level, it's really pretty simple. That is that sexually transmitted infections happen from person to person. And if a infection is present in one of the partners and they have an intimate sexual relationship, then the entity oftentimes is transmitted through that sexual activity. But there also is resistance to going in and getting tested and treated, owing to stigma or access to care, and a problem with messaging from public health officials to indicate that this is going on in our communities.

RASCOE: What do you think are the most important things that need to happen to try to reverse this trend? Is this a matter where you need more funding for prevention or maybe even more testing - at-home testing? You know, does that need to be pushed by the government?

SAAG: I think at the bottom-line core of this is awareness. There's not much new under the sun, unfortunately, in terms of ways to prevent this - it's basically abstinence, which is not an acceptable option - we are, as adults, sexually active beings - condom use, which we know works, especially when they're used properly. But over the decades that those have been promoted, going back to World War II and soldiers up till now, we're not really having a lot of great uptake with condom use. So it really boils down to restricting, if possible, the number of different sexual partners that we can have.

With regard to funding, yes, we do need more funding on multiple levels. The first, I would say, is a public health campaign to raise the awareness so that people can modify their behavior to minimize risk in terms of, in my opinion, reduction of numbers of different sexual partners and, hopefully, the reduction of recreational drug use during sex. That's something that would help. The other thing is we need more dollars for research. Is there a way to develop a gonorrhea vaccine, a syphilis vaccine, a chlamydia vaccine? And that will help us by giving added tools to our ability to treat. And then, as you mentioned, testing, tracking infections and something we use in public health - case contact tracing.

RASCOE: You know, you mentioned something earlier about, you know, maybe trying to limit sexual partners. How do you deal with the stigma and the shame that people feel around STIs or even, you know, just sex more broadly? Because that can be a barrier to seeking information about prevention or treatment. How do you talk to patients about this stuff without making them feel judged or ashamed about having sex?

SAAG: Well, that's a good point. Most STIs do carry with it a good bit of stigma. So right off the bat, they may not want to come to a clinic with their symptoms. They suffer with it for a while longer. And that means that they continue to have sex during that time period. Then they're, by definition, transmitting those infections to others, making the epidemic worse. Fortunately, all the health care workers who work in sexually transmitted infection clinics and treat a lot of STIs are extremely well trained and well versed in how to talk to patients and make the patient feel as comfortable as possible during their visit - acknowledging that sex is a normal part of adult life. They just happened to pick up an infection through their activities. Once they understand that, then we emphasize the importance of treatment, compliment them on coming in, and then encourage them to share their sexual contacts so we can stop the spread of infection in the community.

RASCOE: Michael Saag is a doctor and professor of medicine at the University of Alabama at Birmingham. Thank you so much for joining us.

SAAG: Oh, it's great to be with you.

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