Sexually transmitted infections (STIs) have been increasing in NYC in recent years. Data released for New York City show citywide rises in syphilis, chlamydia, and gonorrhea cases, with a notable 36% increase in syphilis cases among women.
Rates of infection have been more stable nationwide, with CDC data showing between 2.4 and 2.5 million STI cases per year for the last six years, although cases of syphilis have reached 70-year highs nationally.
In the face of these trends, both government and nonprofit organizations have worked to combat these infections with some success. A recently released report from the NYC Department of Health and Mental Hygiene (DOHMH) showed a substantial 22% decline in year-over-year syphilis cases, although chlamydia and gonorrhea cases continued to climb.
To understand how the current STI landscape developed, the AmNews spoke with Marlene LaLota, MPH, regional director for the AIDS Healthcare Foundation (AHF), a nonprofit organization that provides healthcare and testing to people who have STIs. In looking at trends, LaLota said the impacts of the COVID-19 pandemic are still a factor.
“COVID messed us up in so many more ways than just COVID. And in New York, because we were hit so hard, the health department and pretty much every other healthcare infrastructure turned their attention to COVID,” she said.
As a result of this focus shift, fewer people got tested for STIs during the pandemic. More recently, according to Chantal Gomez, deputy press secretary for the DOHMH, “As regular healthcare visits, and STI screening during many of those visits, started to return to levels seen prior to the COVID-19 pandemic, numbers of syphilis cases detected via routine screening rebounded somewhat.”
Regular testing is critical for people who suspect they have STIs because of the long-term effects these conditions can have on health. As LaLota explained, “if you have syphilis and you’re not diagnosed pretty early in the disease, it has very severe consequences. Syphilis is very dangerous; people die from it. Chlamydia [and] gonorrhea can cause infertility in young women.” These health consequences can be avoided, since syphilis, chlamydia, and gonorrhea can be cured with medication. Even STIs that are not curable, such as genital herpes or HIV, can be treated and managed.
Controlling STI spread requires constant testing and treatment. As STI testing fell off in the early days of the pandemic, it created the conditions where STIs could flourish. Not getting tested meant not getting treated, and not getting treated meant spreading STIs to more and more partners.
As Gomez said, “STI case rates have been increasing for well over a decade, and the higher the prevalence of STIs among sexual networks … the higher the probability of exposure to and acquisition of STIs for members of those networks.”
Solutions exist but funding sparse
Over the past two years, the NYC government has taken steps to address the climbing STI rates, such as strengthening reporting guidelines and providing additional funding for rapid STI testing throughout the city. However, despite the support and the city’s Sexual Health Clinics, the government alone is unable to meet the needs of its large population. According to LaLota, in recent years, “some of [the Sexual Health Clinics] have closed, and some of them that are operating stop seeing people at about 2:30 [p.m.] or so. They get pretty full.”
To combat the demand for sexual health services, AHF opened a new Healthcare Center and Wellness Clinic last year in Hell’s Kitchen that is open until 8:00 p.m. Tuesday–Friday, and until 6:00 p.m. on Saturdays. “When you walk in there at 6 to 7:00 at night, it’s standing-room only, and we have a pretty large waiting area,” LaLota said. That shows “it has been incredibly needed in the community.”
Last year also saw a new way to get tested for syphilis with FDA approval of an at-home syphilis test: NOWDiagnostics’ First To Know Syphilis Test. Gomez said these at-home tests “are especially useful as a screening test for people without previous syphilis diagnoses.” However, she clarified that “laboratory testing by a healthcare provider must follow to confirm diagnosis … so that the patient can receive appropriate treatment.”
LaLota emphasized the importance of in-person testing at medical facilities, compared to at-home tests: “I feel like it is better for people to come in, to get the counselling, to have the discussion … There’s nothing like having that news in person from a healthcare professional, and then being treated right away.”
The most recent data shows that efforts to combat STIs in NYC have met with some success, with cases of primary and secondary syphilis — the earliest stage of the disease — decreasing by 21.7% among men and 29.7% among women in 2023 in NYC, although cases of latent and late-stage syphilis continued to increase in women. Chlamydia and gonorrhea rates increased for the third year in a row, indicating that there is much more to be done in addressing the overall STI surge. A similar slowing of trends has been seen nationally, per a CDC report released late last year.
It is important to recognize that these data are only through the end of 2023, and the impact of interventions in late 2023 or 2024 will not be seen until future years.
Key to the ongoing fight against STIs is funding. Reflecting on both her work at AHF and the Florida State Health Department, LaLota said that “STIs are and always have been a big issue and a big challenge. The funding is not there for STIs.” Funding STI education, testing, and treatment correlates strongly with new cases; according to LaLota, “if you look at, if you overlay graphs of funding for STIs and STI incidence, it overlaps.”
Control of STIs also relies on individuals making informed decisions based upon their health status. W. Imara Canady, AHF’s national director for communications, said that when a person suspects that they might have an STI, they need to act upon it. “Sometimes, particularly our younger population, [people think] that ‘if I don’t deal with it, it will go away,’ and that’s not the reality,” Canady said. “It’s actually ‘if I do deal with it, then I’m empowered to make healthy decisions moving forward’.”
The most important aspect of sexual health is STI testing. According to DOHMH, “routine STI testing …will ensure timely diagnosis and effective treatment.” As part of her job at AHF, LaLota handles calls about suspected STIs on a daily basis: “Anybody that told me ‘it’s burning, it’s itching, it’s dripping, it’s green’ — please go get checked out!”
Despite years of work to overcome stigma related to sexual health, some stigma about STIs and STI testing remains. Clinics like those operated by NYC government or AHF take steps to make visitors comfortable and supported as they seek to understand their STI status. LaLota described AHF’s perspective as “You’re not a bad person, you’re not a dirty person, you’re not a slutty person. You’re just a person that got a disease — an infection that is incredibly prevalent.”
STI testing is not just a concern for anyone who is dating multiple people, but also those in committed relationships. “There is nothing sexier than a couple that says they love each other to go get tested together,” said Canady. “The first, most empowering thing that any individual can do for themselves and their partners is to know their status and get tested.”
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