Gonorrhea and syphillis get sporadic attention from the press–and now is one of those times because rates of STIs in the US are increasing. In recognition of STD Awareness month, William Smith of the National Coalition of STD Directors provides an overview of these and other contemporary STD/STI and sexual health trends. As noted below by Smith, gonorrhea rates are particularly acute in the African-American population, while syphillis is making a come-back among MSM (men who have sex with men). Smith warns that “we are on the verge of a highly untreatable gonorrhea epidemic:”

Gonorrhea is a bacterial infection and bacteria have a funny way of developing resistance to treatments – their own built-in evolutionary survival mode. This is what has happened with gonorrhea, the second most commonly reported notifiable disease in the United States with more than 336,000 cases reported in 2008.

It is also among one of the most racially- and age-disparate diseases. For example, according to the CDC, though blacks make up only 12 percent of the U.S. population, more than 70 percent of reported cases of gonorrhea in 2008 were among blacks. It also affects young people disproportionately, with the majority of new cases being consistently reported among 15 to 24 year olds. In early 2007, after much reporting of resistance to the class of antibiotics known as quinolones, the CDC stopped recommending them for use in treating gonorrhea. We now have just a single class of antibiotics left to treat gonorrhea but resistance is also developing with this class and the pipeline of new drugs is nearly empty. Future treatment might require multiple drug combinations or multiple doses over a longer period of time and even then, we are not sure what the future holds.

Gonorrhea leads to all sorts of adverse sexual health outcomes including infertility and likely exacerbates susceptibility to HIV. Something called Disseminated Gonococcal Infection that can cause crippling arthritis could become commonplace, and toxic blood and outright organ failure are likely prospects for infected persons if we do not get ahead of this situation with new treatments. I hate to sound alarmist, but the prospects of this situation are frightening.

Over the past several years, Advocates for Youth have also voiced alarm over gonorrhea rates in the US, especially in comparison to the Netherlands and other European countries. The following graph from Advocates for Youth illustrates a cross-national comparison of teens in both countries (but no distinctions by race, sex, class, etc):

"Gonorrhea is the second most commonly reported infectious disease in the United States, and U.S. adolescent rate is almost 33 times greater than the reported teen rates the Netherlands." (Source: Advocates for Youth).


In addition to the escalating rates of gonorrhea, syphillis is back in business in the US. William Smith of the National Coalition of STD Directors also warns that “we are about to grasp defeat from the jaws of victory in the battle against syphillis”:

Once on the verge of a major public health success story, the nation’s efforts to combat syphilis – still optimistically termed as an effort to eliminate it – have virtually collapsed. In 2008, we had the highest number of reported syphilis cases since 1995 at 13,500 (these are primary and secondary syphilis cases which is when the disease is most infectious). There were another 431 cases of congenital syphilis in 2008 – cases where mother to child transmission occurs. In Chicago last year, one colleague told me that two babies died of congenital syphilis. Yes – in the 21stcentury United States of America, children die of syphilis. Where is the outcry? And the disease is now increasingly shifting to men who have sex with men, where syphilis infection in a sexual network can have devastating results both on its own and in increasing susceptibility to HIV infection. NCSD has called for a renewed discussion on our nation’s approach to syphilis control and sexual health and we will be convening a meeting later this year to help pave a new way forward.

The graph below from Advocates for Youth also shows a gap in syphillis rates between the US and the Netherlands:

"Among teens, syphilis rates in the United States are more than twice those in the Netherlands." (Source: Advocates for Youth)


The reasons for these and other sexual health distinctions between the US and the Netherlands are a complex, involving a mixture of social, institutional, and cultural factors. And, race and class relations–and their intersection look very different in the US and the Netherlands. Regardless, much work is needed in the US to offset these and other negative sexual health trends, and raising the visibility of these trends is at least one step toward this goal.

Bibliography and Related links:

Adolescent Sexual Health in Europe and the U.S.: Why the Difference? Advocates for Youth.

William Smith. (4/15/2010). “What I didn’t know about sexual health: Reflections from a new perch. Rh Reality Check.

GYT (Get Yourself Tested)

National Coalition of STD Directors