While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.
We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services. Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.
While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity. Annual chlamydia screening of sexually active young women is now a quality metric for Medicaid, and is recommended for sexually active young women between the ages of 15 and 26 years by the Centers for Disease Control and Prevention (CDC).
The U.S. Department of Health and Human Services recently released the first national STI strategic plan with the vision of making the U.S. a place “where STIs are prevented and where every person has high-quality STI prevention, care, and treatment while living free from stigma and discrimination.”
Unfortunately, these efforts have been dangerously constrained by the COVID-19 pandemic. While adolescents and young adults have been largely spared from the worst health outcomes of COVID-19, they now face new health risks from rising STI rates and a severely hampered public health system. Engagement in routine preventative health care has declined since the pandemic began, translating to fewer opportunities for STI prevention, education and screening. Meanwhile, with remote learning and caregivers’ irregular work schedules, teens may experience more emotional isolation while having less adult supervision — a combination that could increase sexual risk behavior.
Public health resources that previously supported STI treatment and prevention have now shifted to manage the growing pandemic. Contact tracing, which has been a cornerstone of STI prevention efforts, is losing ground as public health officials reallocate resources to meet contact tracing needs for COVID-19. Public health clinics and community testing sites, as well as primary care settings, have been forced to shut down, severely reduce hours, or limit their ability to provide services and outreach to populations most in need, including the most vulnerable adolescents and young adults.
Further compounding these access issues, there is now a national supply shortage of STI test kits and lab supplies due to the common supplies, reagents, and testing platforms that are used for both STI and COVID-19 testing. The shortage has led the CDC to recommend strict conservation strategies, which force clinicians to provide substandard screening and treatment.
We implore policymakers to take swift action to address these barriers to STI testing. Funding and resources must be made available to ensure we have sufficient supplies, a consistent manufacturing pipeline, and the workforce needed to perform routine STI testing, laboratory capacity to run the tests, and public health infrastructure for managing positive results, including contact tracing and prevention services. As health disparities have widened during the COVID-19 pandemic, additional funding for these areas is crucial — addressing one epidemic should not be contingent on sacrificing another. The health of our nation’s young people depends on it now and for years to come.
Nadia Dowshen is the director of Adolescent HIV Services at Children’s Hospital of Philadelphia (CHOP) and a faculty member of PolicyLab at CHOP. Sarah Wood is the assistant director of Adolescent HIV Services at CHOP and a faculty member of PolicyLab. Cynthia Mollen is chief of Emergency Medicine at CHOP and a faculty member of PolicyLab. Kenisha Campbell is the director of Adolescent Medicine Outpatient Clinical Services at CHOP.