Objective Status

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About the Workgroup

Approach and Rationale

STIs are very common. Millions of new infections happen every year in the United States.1 STIs are passed from one person to another through sexual activity including vaginal, oral, and anal sex.

Biological factors that affect the spread and complications of STIs include:

  • Asymptomatic nature of STIs. The majority of STIs either don’t have any symptoms or signs — or they cause symptoms so mild that they aren’t noticeable. Therefore, many people who have STIs don’t know they need medical care.
  • Gender disparities. Women have more frequent and more serious STI complications than men.2 Among the most serious STI complications are pelvic inflammatory disease, ectopic pregnancy (pregnancy outside of the uterus), infertility, and chronic pelvic pain.
  • Age disparities. Young people ages 15 to 24 years account for half of all new cases of STIs — yet they represent only 25 percent of the sexually active population.3 Adolescent girls may be at higher risk for infection because of increased cervical ectopy (erosion).

Understanding Sexually Transmitted Infections

The spread of STIs is directly affected by social, economic, and behavioral factors. These factors may cause serious obstacles to STI prevention due to their influence on social and sexual networks, access to and provision of care, willingness to seek care, and social norms regarding sex and sexuality. In addition, historical experience with segregation and discrimination can intensify the influence of these factors for some populations.

Social, economic, and behavioral factors that affect the spread of STIs include:

  • Racial and ethnic disparities. Certain racial/ethnic groups (mainly African American, Hispanic, and American Indian/Alaska Native populations) have high rates of STIs, compared with rates for whites1In the United States, race/ethnicity is linked to other determinants of health status, like poverty, limited access to health care, fewer attempts to get medical treatment, and living in communities with high rates of STIs.  
  • Poverty and marginalization. STIs disproportionately affect disadvantaged people and people in social networks where high-risk sexual behavior is common — and where access to care or health-seeking behavior is compromised.
  • Access to health care. Access to high-quality health care is essential for early detection, treatment, and behavior-change counseling for STIs. Groups with the highest rates of STIs are often the same groups with the most limited access to or use of health services.
  • Substance abuse. Many studies document the association of substance abuse with STIs. The introduction of new illicit substances into communities can drastically change sexual behaviors in high-risk sexual networks, leading to the epidemic spread of STIs.
  • Stigma and secrecy. Perhaps the most important social factors contributing to the spread of STIs in the United States are the stigma associated with STIs and general discomfort with talking about sex. These social factors separate the United States from industrialized countries with low rates of STIs.
  • Sexual networks. Sexual networks refer to groups of people who can be considered “linked” by sexual partners. A person may have only 1 sex partner — but if that partner is a member of a risky sexual network, then the person is at higher risk for STIs than a similar individual from a lower-risk network.

Emerging Issues in Sexually Transmitted Infections

There are several emerging issues in STI prevention:

  • Each U.S. state needs to address system-level barriers to timely treatment of partners of people with STIs, including the implementation of expedited partner therapy for treating chlamydia and gonorrhea. 
  • Enhanced data collection on demographic and behavioral variables, like the sex of an infected person’s sex partner(s), is essential to understanding the epidemiology of STIs and to guiding prevention efforts.
  • Innovative communication strategies are critical for addressing issues of disparities, facilitating HPV vaccine uptake, and normalizing perceptions of sexual health and STI prevention, particularly as they help reduce health disparities.
  • It is necessary to coordinate STI prevention efforts with the health care delivery.

Citations

1.

Centers for Disease Control and Prevention. (2019) Sexually Transmitted Disease Surveillance 2018. Retrieved from https://www.cdc.gov/std/stats18/toc.htm

2.

National Institute of Allergy and Infectious Diseases (2015). Sexually Transmitted Diseases. Retrieved from https://www.niaid.nih.gov/diseases-conditions/sexually-transmitted-diseases

3.

Centers for Disease Control and Prevention (2017). Adolescents and Young Adults. Retrieved from https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm