For the first time in over two decades, sexually transmitted infections (STIs) in the United States are showing signs of slowing down.
New data released Tuesday by the Centers for Disease Control and Prevention (CDC) highlights significant declines in syphilis and gonorrhea cases in 2023, providing a rare moment of optimism in the ongoing battle against rising STI rates.
According to CDC data, syphilis cases in their most infectious stages fell by 10%, marking the first substantial decrease since the early 2000s. Gonorrhea cases also saw a 7% drop for the second consecutive year, returning to levels last seen before the COVID-19 pandemic disrupted testing and treatment access. Chlamydia cases, while still high, remained below pre-pandemic levels. These trends come as a welcome shift for a public health sector that has been working tirelessly to stem the surge in STI rates.
“I’m encouraged, and it’s been a long time since I felt that way… I do feel we’ve reached an inflection point with the STI epidemic,” said Dr. Jonathan Mermin, CDC Director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
The declines in cases are linked to several factors, including the increased use of the antibiotic doxycycline as a preventive treatment. Dubbed “Doxy PEP” for its post-exposure preventive qualities, this antibiotic has proven effective in reducing cases of syphilis, gonorrhea, and chlamydia when taken shortly after unprotected sex. The CDC formally recommended doxycycline as a post-exposure treatment earlier this year, specifically for gay, bisexual men, and transgender women at higher risk of STI exposure. Additionally, community-based efforts, federal funding, and behavioral changes following the 2022 mpox outbreak have likely contributed to these positive trends.
The decline was particularly notable among gay and bisexual men, a demographic that has experienced high rates of syphilis for years. In 2023, cases of primary and secondary syphilis among this group dropped 13%, a first-time decrease since data began being tracked in the mid-2000s.
Despite these successes, the CDC data also underscores the persistent challenges. Nearly 4,000 cases of congenital syphilis—transmitted from infected mothers to infants—were reported in 2023, leading to 279 infant deaths. This is an ongoing concern, as timely prenatal testing and treatment could prevent most cases. Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California, emphasized that these deaths point to a gap in prenatal care:
“This means pregnant women are not being tested often enough.”
Racial and regional disparities remain another hurdle. Native American, Alaska Native, and Black Americans, as well as residents of Southern states, were disproportionately affected by STIs in 2023. These groups face limited access to testing and preventive resources, and some Southern states restrict sex education to abstinence-only programs, according to Dr. Thomas Dobbs, dean of the University of Mississippi’s John D. Bower School of Population Health. Such educational policies, he argued, hinder young people from making informed health decisions.
Funding remains a major concern. Federal funds bolstered public health resources for STI testing and treatment during the COVID-19 pandemic. However, a debt ceiling agreement in 2023 ended this support early, eliminating approximately $400 million for STI prevention programs. This funding reduction has already led to layoffs among public health workers, which may limit future progress, particularly in areas of the country where resources were already stretched thin.
Still, experts are optimistic. The Biden administration’s creation of a task force to address syphilis and the approval of at-home syphilis tests by the FDA are positive steps toward reducing stigma and making STI testing more accessible.
“There is absolutely no reason a baby should be dying of syphilis in 2024… We are starting to see some successes,” said Dr. Ina Park, an STI expert at the University of California, San Francisco.
With the Associated Press, Bloomberg, and the New York Times.
