Map of life expectancy at birth from Global Education Project.

Wednesday, August 29, 2018

The Clap

Back when I was working for a community based public health agency, we thought we were close to conquering the common sexually transmitted infections -- syphilis, gonorrhea, and chlamydia. We spent a lot of effort on HIV prevention because it's incurable, but the incidence (that means the number of new cases per given time period) was declining, and the other STIs were becoming pretty rare. The public health response to these diseases basically has two components: convince people to use condoms whenever they have risky sex, and detect new cases quickly and treat them.

Well there's bad news, and it isn't getting much attention: the incidence of STIs has exploded in recent years. We've lost all the ground we had gained and then some:

Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017, according to preliminary data released today by the Centers for Disease Control and Prevention (CDC) at the National STD Prevention Conference in Washington, D.C. This surpassed the previous record set in 2016 by more than 200,000 cases and marked the fourth consecutive year of sharp increases in these sexually transmitted diseases (STDs).
The CDC analysis of STD cases reported for 2013 and preliminary data for 2017 shows steep, sustained increases:
  • Gonorrhea diagnoses increased 67 percent overall (from 333,004 to 555,608 cases according to preliminary 2017 data) and nearly doubled among men (from 169,130 to 322,169). Increases in diagnoses among women — and the speed with which they are increasing — are also concerning, with cases going up for the third year in a row (from 197,499 to 232,587).
  • Primary and secondary syphilis diagnoses increased 76 percent (from 17,375 to 30,644 cases). Gay, bisexual and other men who have sex with men (MSM) made up almost 70 percent of primary and secondary syphilis cases where the gender of the sex partner is known in 2017. Primary and secondary syphilis are the most infectious stages of the disease.
  • Chlamydia remained the most common condition reported to CDC. More than 1.7 million cases were diagnosed in 2017, with 45 percent among 15- to 24-year-old females.
So why is this happening? Some reasons are fairly apparent, others more speculative. There has been an increase in risk behavior by gay men, probably because HIV is now less scary since there is effective treatment, and also because of Pre-Exposure Prophylaxis (PrEP), that is antiretrovirals given to HIV negative people to prevent infection. Many of my colleagues are big advocates for PrEP but it does appear it makes some users more willing to have condomless sex which puts them at risk for other STIs. Since some men who have sex with men also have sex with women, that means these infections are going to become more common in both sexes.

Many suspect that hook-up apps are also encouraging more casual sex. This is my own speculation, but the opioid epidemic may also result in more women engaging in risky transactional sex. But as Julia Belluz at Vox notes, STD clinics have seen substantial budget cuts in recent years meaning reduced services. With fewer people diagnosed and treated, the infections continue to spread.

Yeah yeah, people shouldn't do all this nasty stuff. But just spouting moral disapprobation isn't going to accomplish anything. And the best opportunity to engage with people about safer sex is when you diagnose and treat them. That's your teachable moment. If we aren't willing to pay for it, we're going to continue to be less healthy.


Don Quixote said...

Isn't that what the current regime wants--for us to be less healthy?

Also, I assume "all that nasty stuff" means drugs, hookups, etc., and not sex itself.

What could be more essential and natural? Sort of necessary for propagation as well, though the wisdom of that is in doubt, at least in certain countries like Saudi Arabia, Syria, and the United States of America.

Don Quixote said...

"all this nasty stuff," that is :-)

Anonymous said...

People feel they deserve sex without consequences.

This is an expectation that started in the sixties with birth control and was further fueled by the SCOTUS Roe v Wade decision. And now that marriage and faithfulness with your partner is passe, we're in full free fall with STDs. No big surprise.

As the culture changes, so do the disease stats. This problem cannot be solved without a cultural paradigm shift about sex.

The heartbreak about all of this is almost all of these cases were preventable.

No one has more control over your life and your health than you do.

Don Quixote said...

I wonder how GBB can be a Christian? Isn't homosexuality prohibited?

Don Quixote said...

And while we're on the subject ... I guess, according to the cowardly "Anonymous"'s (GBB's?)post, above, there is not a more recklessly degenerate person than ...

Donald J. Trump!

[Speaking of Shitler, remember when he referred to his having the clap as his "own personal Vietnam?"

That's like a person with a minor ear infection comparing themselves to Helen Keller.]

Also, according to our resident idiot, no one before the 1960s expected sex without consequences! Wow! And Roe v. Wade--which has nothing to do with sex--fomented promiscuity! Wow!

How can some people be so completely full of shit? And nothing slows them down. "Anonymous" probably identifies himself as a "Christian"--that is, in many cases, a person who practices the OPPOSITE of what s/he preaches, but tries to convert everyone else to Christianity! In his own way, "Anonymous" probably haunts this site in an effort to "save" the pagans who read and comment on this blog.

Oh, well ... perhaps in the process, we'll save him. But I doubt it.

Cervantes said...

Yep, these STIs have been around for thousands of years. Many famous people died of them, including Pope Julius II.

Mark said...

The idea that sex should have "consequences" usually means that other people who have sex, especially more sex than me, should be punished. That's one reason the self-styled christians are so opposed to abortion, and even birth control. They believe that women who have sex should be punished by having to bear a child. It's okay for men, of course (wink wink nod nod), but not for women. It's also OK for wealthy people to have sex, even outside marriage, but not for poor people, and especially not for people with darker skin, or gay people. What they do is terrible! Unimaginable! They should all be punished! Severely! We should not eliminate or lessen the possibility of the "consequences" for people who do what people have done since people have existed. Sex is fine for me, but not for you.

Anonymous said...


No one said sex "should" have consequences. What I'm saying is birth control and Roe certainly reduced the perceived risk of consequences and people adjusted their behavior and expectations.

HIV also changed perceived risk when it was a death sentence, especially in the homosexual community.

This is a fairly easy concept. People change their behaviors as their perception of risk changes.

You seem to read a lot into it such as "darker skin", "Christians" etc. and no one said jack-shit about any of that.

Mark said...

Anonymous, your poor, disingenuous fool, we understand what you mean, even when you don't feel bold enough to say it. But it's OK. You haven't let the Trump revolution convince you that such sentiments are perfectly acceptable to express in public, and so must still be hidden by dog whistles. Good for you.

Anonymous said...

OK, maybe it's not that easy a concept for everybody, after all...

Anonymous said...

From Cervantes' post:

There has been an increase in risk behavior by gay men, probably because HIV is now less scary since there is effective treatment, and also because of Pre-Exposure Prophylaxis (PrEP), that is antiretrovirals given to HIV negative people to prevent infection. Many of my colleagues are big advocates for PrEP but it does appear it makes some users more willing to have condomless sex which puts them at risk for other STIs.

Hmmmm... perceived changes in risk changes behavior...

Perhaps Mark can glean the same dog whistles in Cervantes' post. It's clear he's not bold enough to to say what he really means and must hide his true feeling in "dog whistles".

what a goober

Don Quixote said...

Good to see "Anonymous" showing some emotion! But the intellect lags.

Don Quixote said...

You know, it occurs to me that "Anonymous"--all personal comments aside--has made absolutely invalid points.

Cervantes has talked about how, after he left the medical program where he assisted the Latino population in Boston to fund health care, the rate of STIs was much lower than it had been in the past. The marked rise is in the last four years. For "Anonymous" to blame this on mores of the 1960s is ... PREPOSTEROUS and ILLOGICAL! Because transmission rates were down in the 80s, 90, and 2000s ... which were all a long time after the "60s" ...

So that ain't the reason. The reasons, however, are clear in Cervantes's post.