This week, leaders from across the country engaged in the ongoing battle to combat the spread of sexually transmitted diseases (STDs) are gathering in San Antonio to assess the current state of affairs and plot out a path for moving forward.  Unfortunately, we gather in the midst of ever-decreasing resources to do this work at the same time that we are seeing more and more disease.

For example, a short time ago, a strategy was created to “eliminate” syphilis in the U.S.  Now, we see burgeoning cases of syphilis in many parts of the country – particularly in the South and among gay men.  In 2008, there was an 18 percent increase in reported cases of syphilis and among women, a whopping 36 percent increase, compared to cases reported in 2007.  Worse still, it seems increasingly likely that increased syphilis infections – and other STDs such as gonorrhea – are exacerbating the HIV epidemic which itself remains a national health emergency.  Leaders in San Antonio will be using part of their time to lay out the basic principles and actions for a renewed effort on syphilis and it could not come soon enough.

There have also been increased efforts across the country to prioritize screening and treatment for Chlamydia, which with 1.2 million reported cases a year, is the most commonly reported STD in America.  While Chlamydia is easily diagnosed and treated, too many cases go undetected and Chlamydia is one of the primary culprits behind the estimated 24,000 women who become infertile in the U.S. each year as a result of untreated STDs.  In fact, the CDC estimates that the majority of infections each year go undiagnosed.

Then there is gonorrhea.  The good news – if one can call it that – is that reported cases of gonorrhea have stabilized over the past decade – about 350,000 cases a year. However, CDC believes there are probably twice as many actual infections each year.  The frightening thing about gonorrhea, however, is that we are in the process of losing the last line of defense against the disease.  Already, cases of untreatable gonorrhea, resistant to the existing treatment, have surfaced outside the United States, but in a global society, it is but a matter of time before it hits our shores.  We need to invest in the research pipeline now if we hope to avoid a major public health disaster.

With so much disease on our hands, it is equally unsettling that for the most part, federal investment in STD prevention has essentially been stagnant over the past decade.  For the coming fiscal year, Congress could approve the largest increase in federal investment in domestic STD prevention in more than a decade.  NCSD continues to press the case on Capitol Hill, but this being an election year, the Congressional appropriations process is in a predictable state of disarray.  And at the state level, NCSD’s own research demonstrates a continued decline in STD specific resources that are worrisome at best, and a harbinger of a major STD public health crisis at worst.

Further still, some appalling revelations on STDs made major news last week when the U.S. Government admitted to a conducting a ‘study” in Guatemala in the 1940’s where people were intentionally exposed to syphilis and gonorrhea and many may have never received treatment.  The U.S. Government is doing the right thing by profoundly apologizing for the unethical nature of the study and trying to shine a light – once and for all – on any other such studies that may have occurred.  However, the Guatemala study, coupled with the now infamous Tuskegee syphilis travesty where African-Americans U.S. citizens were left untreated, underscores that the history of U.S efforts to combat STDs is complicated and has in many instances, instilled fear and distrust of the medical establishment.  STDs disproportionately affect communities of color at astonishing rates, and we need to redouble efforts that are aimed at demonstrating to vulnerable communities that the times of the Tuskegee and Guatemala STD experiences are part of a dark past and are anathema to present practice.

So, as our nation’s STD leaders come together this week, we have significant challenges on our hands.  But most importantly, we need to educate the American public that this “silent epidemic” – as STDs are frequently called – is real, in our midst, and we need to prioritize them as part of the national focus on prevention. 

The politics of healthcare reform, and an ignominious display by certain members of Congress about STD spending during the stimulus package debate, served to jettison a much needed national reinvestment in STDs. Sexual health advocates must not be deterred and NCSD and its many members gathering in San Antonio this week will be more vigilant than ever in giving voice to the not-so “silent epidemic” affecting 19 million Americans every year.