The pandemic’s stress on the nation’s health system has amplified challenges in rising rates of sexually transmitted infections, which have been overlooked because of a lack of funding and personnel in the past year.

The new challenges in preventing the spread of STIs come as contact tracers were shifted to work on COVID-19 prevention. STI clinics also rely on local funding, which was cut in many places during the economic downturn. Meanwhile, testing supplies remain in shortage.

Experts say additional policies to expand education, combat supply shortages and provide direct funding are needed, especially as states continue to ease COVID-19 restrictions that could lead to even more cases of sexually transmitted infections.

The rates of new cases of common sexually transmitted diseases or infections climbed to more than 2.4 million in 2018, up from 1.8 million in 2013, according to Centers for Disease Control and Prevention data. One in five Americans had a sexually transmitted infection, according to CDC data released in late January.

From 2014–2018, reported cases of STIs increased dramatically, according to CDC data released in December. Primary and secondary syphilis cases rose 71 percent, congenital syphilis climbed 185 percent, gonorrhea jumped 63 percent and chlamydia increased 19 percent.

Democrats have argued that a push in recent years toward abstinence-only education and “sexual risk avoidance” policies contributed to a lack of knowledge, especially among young people. CDC data show that over 45 percent of all new STIs in 2018 were among people 15 to 24 years old. The pivot to online learning posed a new challenge for ensuring youth access to sexual health resources.

Public health advocates worry about spikes now and in years to come due to the pandemic. They are looking to Congress and the Biden administration to push for policies and funding to reverse this trend.

Disruptions to health care delivery, the shuttering of STI clinics, the lack of contact tracing and nationwide testing supply shortages all concern advocates.

“People are not stopping having sex. There is evidence emerging from local communities that we will see an explosion of new STI and HIV rates once we recover from COVID and people start testing again,” said David Harvey, executive director of the National Coalition of STD Directors.

CDC surveillance efforts were disrupted by the pandemic, but Harvey predicts national data will eventually show increases mirroring trends from state and local reporting.

“We are very worried about what this means for the public health system and for the American public’s health,” said Harvey.

Pandemic challenges

One challenge during the pandemic is that many individuals are delaying care, including prevention and screening services.

The World Health Organization recommends that adolescents receive human papillomavirus, or HPV, vaccines, before they are likely to have been exposed to that virus. The vaccines prevent some of the strains of HPV most closely associated with cervical cancer. 

There is no data specific to HPV vaccine usage during the pandemic, but more broadly, experts saw drops in vaccination rates during the past year.

“We may pay for that at a later stage,” said Harvey, who estimates the overall disruption and recovery period will last two to three years.

Data published in January in the Journal of the American Sexually Transmitted Diseases Association showed a significant decrease in visits related to STIs and treatment during the pandemic.

As states lifted some restrictions, rates of preventive care began to increase. But many experts caution it may take time to fill the backlog as clinics continue to follow safety precautions and limit personnel and patients.

Raegan McDonald-Mosley, CEO of Power to Decide, a nonprofit that focuses on reducing unplanned pregnancies among young people, said her own OB-GYN practice in Maryland was not allowed to have patients come in last spring for noncritical services including cancer screenings and HPV vaccines.

“When the regulations changed and people were allowed to come in for routine health services again, there was such a demand for it that we couldn’t get patients in fast enough,” she said. “I definitely think that this year has caused people to delay accessing noncritical services [and] preventive services, including cervical cancer screenings and HPV vaccines, and it may take quite some time, frankly, to sort of circle back and be able to address the full backlog of those services.”

Diana Thu-Thao Rhodes, vice president of policy, partnerships and organizing at Advocates for Youth, a nonprofit focused on sexual health education for young people, noted how teenagers are limited in access to care during the pandemic. For instance, college students who are no longer living on campus may not have access to a student health center.

Rhodes wants a data-based approach reinstated in federally funded youth programs. She said the Trump administration and some states focused on “abstinence-only-until-marriage” programs.

A January review in the Journal of Adolescent Health of 30 years of data on school programs “offers strong support for comprehensive sex education” rather than abstinence-only programs, wrote the authors, Eva S. Goldfarb and Lisa D. Lieberman of Montclair State University.

Brett Giroir, a former Trump administration assistant secretary for health, said HHS sought to include STI prevention in programs like the Personal Responsibility Education Program that gives states grants and the Title X family planning program.

“We really tried to, in the programs we had, really expand that as a core component,” he said in an interview. HHS released a multiyear strategic plan for STI reduction in December, which Giroir called “very nonpartisan, very science-based.”

The nonpartisan National Conference of State Legislatures found that only 28 states require sex education and HIV education in schools.

Policy requests

The pandemic’s effects are also driving providers and sexual health education advocates to push for resources and policies that could prevent the spread of STIs and expand treatment. 

The recent COVID-19 relief law provides nearly $7.7 billion for public health workforce development grants. The language says the funds would be applicable to disease intervention specialists, workers who find and counsel individuals diagnosed with STIs and contact trace others who may be affected.

The National Coalition of STD Directors asked CDC to use $1.3 billion of that pool to hire 10,000 specialists who could restore STI contact tracing efforts.

A January survey of STD directors found that 87 percent of their programs are involved in leading or assisting COVID-19 contact tracing efforts in their jurisdictions. Thirty-seven percent of workers are fully focused on COVID-19.

Harvey said the STD directors group is also seeking federal funding in future appropriations bills to directly support STI clinics, which rely on state and local funding.

“We know the true economic impact of COVID is yet to hit state and local government, which is why we predict that this network of providers is really going to be decimated in the recovery period,” he said.

Harvey also suggested utilizing the Defense Production Act to ramp up manufacturing of supplies to be used in COVID-19 and STI testing.

“It’s the same testing swabs and testing kits that are used for STDs that are used for COVID, so all of the supply chain has been disrupted because the resources are going to COVID testing. There’s a massive shortage of STD testing swabs,” he said.

Rhodes said advocates hope the upcoming White House budget will serve as a signal for Congress and will not include funding for abstinence-only programs but will include more funds for comprehensive sexual education.

“There’s urgent work to be done when it comes to access to care, as well as access to comprehensive sex ed, especially given … the COVID-19 crisis and virtual learning,” she said.

Lauren Clason contributed to this report.