Why STDs like gonorrhea and syphilis are on the rise

According to the California Department of Health, more than 300,000 cases of chlamydia, gonorrhea, or syphilis were reported in the state in 2017 alone. Overall, the transmission rate of these three STIs has spiked by a staggering 45 percent over the past five years.

But the rise of STIs isn’t just a concern in the Golden State. Figures from the Centers for Disease Control and Prevention (CDC) show that STIs are rising everywhere. From 2015 to 2016 alone, gonorrhea rates in men increased by 22 percent nationwide, while syphilisrates increased by 14.7 percent.

The biggest problem? Many men might not even know they're infected with these STIs. About half of men don't exhibit any symptoms of chlamydia, while many men with gonorrhea are similarly asymptomatic. The early signs of syphilis - small, painless sores around the mouth, genitals, or rectum - also tend to be subtle, and can easily be explained away as an ingrown hair.

The massive spike in STI rates is particularly concerning, given that just a decade ago, STI rates were on the decline. But “progress has since unraveled," the CDC wrote in a 2016 report.

So what's to blame for this unraveling? The answer is more complicated than you might think.

It's not dating apps

Over the past few years, many media outlets have published alarmist stories linking Tinder and Grindr to the rise in STIs. As recently as May 15, the Los Angeles Times reported that some health experts partially attribute the spike to people having “more sexual partners linked to dating apps.”

But Matthew Prior of the National Coalition of STD Directors says we shouldn't be so quick to point the finger at Tinder and Grindr. Most experts "don’t think it’s a primary reason that STDs are spreading,” he told MensHealth.com.

Instead, Prior and other public health experts attribute the nationwide spike in STIs to a confluence of different factors.

Men who have unprotected anal sex with other men are increasingly not using condoms.

While STI rates have risen across the board, cases of syphilis in particular are on the rise among men who have sex with other men (MSMs, according to CDC lingo), who accounted for 80.6% of the new syphilis diagnoses between 2000 and 2016. That's in part because MSMs are more likely to have receptive anal sex, which ups their risk of contracting STIs: the anus is narrow, doesn't offer natural lubrication, and the skin tears easily, which means that STIs can easily enter the bloodstream.

Dr. Hunter Handsfield, Professor Emeritus of Medicine at the University of Washington Center for AIDS and STD, believes an additional reason why men who have sex with men may have gotten more lax about using condoms is because of PrEP, a daily medication taken to prevent HIV infection.

“Because HIV is now less of a worry, there’s less condom use,” Handsfield tells MensHealth.com. "That’s the biggest single change.”

STIs are on the rise among young people, who may not exhibit symptoms.

According to the California data, half of chlamydia cases and a third of gonorrhea cases were among people under 25, indicating that young people in particular are at heightened risk. That's in part because they simply don't know that many of the most common STIs are asymptomatic, Heidi Bauer, the chief of the California Department of Public Health, told BuzzFeed News.

"I hear it all the time - they think, Well, if I have something, I will know it and I will just go in and get it treated. But the reality is the vast majority of these infections don’t cause any symptoms at all," she said. "So people just pass them around without realizing it."

Thanks to federal budget cuts, there's just no funding for STI prevention and treatment.

Over the past decade, federal budget cuts have led to the closure of STI clinics across the country, making it harder for people to get tested and treated. In a 2016 report, for example, the CDC reported that more than 20 health department STI clinics had been shuttered in 2012 alone.

Prior also says there are now fewer Disease Intervention Specialists throughout the United States, who typically reach out to people infected with gonorrhea and syphilis to ensure they’re getting proper treatment and help them contact their sexual partners for testing.

“Those are really important access points for people to get STI care,” Prior explains.

Doctors just don't feel comfortable talking about sex.

Doctors may be tasked with knowing everything about our bodies, but some would rather avoid awkward sex talk, according to Prior.

“There’s a certain amount of stigma around STIs,” he explains. “Talking about sexual health and sexuality is not comfortable, even among healthcare providers. It’s easier to not talk about that.”

It's not just that doctors are avoid talking to their patients about sex - they're avoiding testing their patients for STIs altogether. Even worse, some don’t know how to properly treat patients with STIs in the first place: Prior says that that about one in five gonorrhea cases aren’t being handled adequately, with doctors prescribing one antibiotic instead of the two recommended by the CDC.

Given how much training doctors receive, it might be surprising to hear that they're ill-equipped to treat STIs. But most physicians only receive about three to 10 hours of sexual health training during four years of medical school, says Prior.

“There’s a real need to educate providers nationally about what’s going on, and unfortunately the primary care provider network is ill-prepared to handle the STI epidemic,” Prior asserts.

How to protect yourself

Thankfully, gonorrhea, chlamydia, and syphilis are all easily treatable with a course of antibiotics. The problem is that most guys aren't getting tested regularly, thereby putting their own health and that of their partners at risk.

If you are sexually active, you should be getting tested at least once a year, regardless of whether you are monogamous. And of course, if you or your partner haven't been tested in a while, you should be wearing a condom every time you have sex.