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Twenty-five years ago, the Institute of Medicine (IOM) published a report on confronting sexually transmitted diseases (STDs) as the “hidden epidemic of tremendous health and economic consequence in the United States, and that the scope, impact, and consequences of STDs are under recognized by the public and in healthcare.”1

Today, the United States is in the midst of a major sexually transmitted diseases (STDs) epidemic and public health crisis. Over the past decade, current recorded rates of STDs are at an all-time high2 with alarming increases in rates of sexually transmitted infections (STIs) of chlamydia, gonorrhea, and syphilis.

A Pressing Public Health Challenge

STDs are preventable—and infections are treatable. Many Americans largely underestimate the risk of STIs and for myriad reasons may not proactively seek care. Without diagnosis, testing, and treatment, the long-term health consequences of STDs are significant. The social stigma associated with STDs continues to complicate STD diagnosis, prevention, and treatment efforts, while access to care and social equity often factor in to approaches to reach groups at higher risk for contracting STDs.2

Today, the STD epidemic still remains a critical public health challenge3 that disproportionately affects certain racial, ethnic, geographic, and socioeconomic groups. Such disparities in STD rates are complex to understand but may be rooted in a number of social factors such as poverty, unemployment, inadequate access to health care, lack of education, discrimination, social inequality, and cultural influences.4 While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, approximately 20 million new STI infections occur in the United States each year, with half of them occurring in adolescents and young adults ages 15–24.5

What We Know About Sexually Transmitted Infections and Diseases

STIs refer to a pathogen e.g., virus, bacteria, fungus, or parasite, that usually passes from one person to another through sexual contact, whereas the term STD refers to a recognizable disease state that has developed from an STI infection.6

More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact. Eight of these pathogens are linked to the greatest incidence of sexually transmitted disease. Of these, 4 are currently curable: chlamydia, gonorrhea, syphilis and trichomoniasis. The other 4 are viral infections which are incurable: hepatitis B, herpes simplex virus (HSV or herpes), HIV and human papillomavirus (HPV).7

Reported Cases

In 2019, U.S. health departments reported that cases of chlamydia, gonorrhea, and syphilis have increased for the sixth consecutive year – reaching a new, all-time high.8

  • 1.8 million cases of chlamydia, an increase of nearly 20 percent since 2015.
  • 616,392 cases of gonorrhea, an increase of more than 50 percent since 2015; and
  • 129,813 cases of syphilis (all stages), an increase of more than 70 percent since 2015.

STDs During COVID-19

Reported cases of STDs in the US decreased during the early months of the COVID-19 pandemic, but most had resurged by the end of 2020, with 2.4 million cases of STDs reported.Ultimately, reported cases of gonorrhea, syphilis, and congenital syphilis surpassed 2019 levels, while chlamydia declined.9

In 2020,

  • 1,579,885 cases of chlamydia were reported to the CDC, making it the most common notifiable sexually transmitted infection in the United States for this year.9
  • 677,769 cases of gonorrhea were reported to the CDC, making it the second most common notifiable sexually transmitted infection in the United States for this year.9
  • Between 2019–2020, reported gonorrhea rates increased among both males and females in most racial/Hispanic ethnicity groups, with the greatest increases observed among non-Hispanic Black/African American persons and non-Hispanic persons of multiple races.9

Social Determinants of Health: Know What Affects Health

Social Determinants of Health (SDOH) are social and economic conditions such as poverty, stigma, housing, food insecurity, discrimination, racism, medical mistrust, violence/trauma, access to care, and education, that are considered the underlying, contributing factors of health inequities. Addressing these SDOH is a primary approach to help (a) achieve health equity, so everyone has the opportunity to attain their full health potential, and (b) prevent the disadvantages due to social position or other socially determined circumstance”.10

What is Health Equity

Health equity is achieved when everyone has an equal chance to be healthy regardless of their background race, ethnicity, income, gender, religion, sexual identity, and disability. Research shows that there are higher rates of STDs among some racial or ethnic minority groups compared to whites. It is important to understand that these higher rates are not caused by ethnicity or heritage, but by social conditions that are more likely to affect minority groups. Factors such as poverty, large gaps between the rich and the poor, fewer jobs, and low education levels can make it more difficult for people to stay sexually healthy.11

Health Inequities and Disparities

Social inequity often leads to health inequity and, ultimately, manifests as health disparities.12 It is important to recognize the negative impact that health disparities and inequities has that adversely impacts certain racial, ethnic, geographic, and socioeconomic groups access to receive quality healthcare, including STI testing, prevention, and treatment.13

Testing Solutions to Ensure Healthcare Equity

Numerous factors contribute to the persistent STI public health burden, but of particular importance is delay in treatment resulting from lengthy diagnostic protocols.14 Point-of-care (POC) tests offer many advantages regarding early diagnosis, detection, chronic disease screening, and infectious disease management as an important strategy to address the STIs in the United States. While access to care and confidentiality are major barriers to STI care, POC tests allow the clinician to provide patients with immediate and confidential test results, diagnosis, and treatment during the same appointment.15

Tests for Chlamydia and Ghonorrhea

The goal of screening sexually active adolescents and adults (including pregnant women), who are asymptomatic for chlamydia or gonorrhea, is to catch and treat infections that may present without symptoms, to prevent additional transmission and complications.16

A Clear Need for Rapid Chlamydia and Ghonorrhea Tests

Nucleic acid amplification tests (NAATs) are considered the gold standard for screening chlamydia and gonorrhea infections because their sensitivity and specificity are high for detecting these infections.17

Most NAATs for chlamydia and gonorrhea must be performed in a central lab, requiring patients to return to their health care provider for treatment should the results be positive.

By providing diagnostic tests that can be performed at the point of care, delivering test results within minutes, could help ensure more patients with chlamydia and gonorrhea are tested and receive treatment, potentially interrupting the transmission cycle.

Bridging the Technology Gap

At Talis, we are pioneering science and technology to diagnose infectious disease rapidly, accurately, and directly at the point of care. Fueled by excellence and clinical rigor, we’re developing a robust menu of tests to advance health equity and outcomes.

One System, Multiple Applications

With access to lab-quality molecular diagnostics at the point of need, clinicians get timely results for actionable decision making. In the future, our portfolio of point-of-care diagnostic tests will include solutions for multiple infectious disease states in a variety of settings.

Learn more about our Talis One COVID-19 Instrument

Meet the Talis One

References

  1. Institute of Medicine Committee on Prevention and Control of Sexually Transmitted Diseases. The Hidden Epidemic: Confronting Sexually Transmitted Diseases, Summary. National Academies Press; 1997. eds. Washington, DC:   https://www.ncbi.nlm.nih.gov/books/NBK232935/. Eng. TR, Butler WT.
  2. National Academy of Public Administration; The STD Epidemic in America: The Frontline Struggle. November 19, 2019. http://www.ncsddc.org/wp-content/uploads/2019/11/NCSD-Phase-II-Final-Report.pdf
  3. Sexually Transmitted Diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases
  4. Division of Epidemiology and Disease Prevention- Sexually Transmitted Diseases (STDs). https://www.ihs.gov/Epi/std/overview/.
  5. Sexually Transmitted Infections Among US Women and Men: Prevalence and Incidence Estimates, 2018. Sexually Transmitted Diseases: April 2021 – Volume 48 – Issue 4 – p 208-214. https://pubmed.ncbi.nlm.nih.gov/33492089/. Kreisel KM, Spicknall IH, Gargano JW, Lewis FMT, Lewis RM, Markowitz LE, Roberts H, Johnson AS, Song R, St Cyr SB, Weston EJ, Torrone EA, Weinstock HS.
  6. Centers for Disease Control and Prevention (CDC) – Sexually Transmitted Diseases (STDs) – STI Treatment Guidelines, 2021. https://www.cdc.gov/std/treatment-guidelines/intro.htm.
  7. World Health Organization (WHO) – Sexually transmitted infections (STIs). https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis).
  8. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance 2019. https://www.cdc.gov/std/statistics/2019/infographic-html.htm.
  9. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance 2020. https://www.cdc.gov/std/statistics/2020/overview.htm#Disparities. https://www.cdc.gov/std/statistics/2020/overview.htm
  10. Centers for Disease Control and Prevention (CDC). NCHHSTP Social Determinants of Health. https://www.cdc.gov/nchhstp/socialdeterminants/faq.html#what-is-health-equity.
  11. Centers for Disease Control and Prevention (CDC). Health Equity. https://www.cdc.gov/healthequity/index.html.
  12. Sexually Transmitted Disease Surveillance, 2019. https://www.cdc.gov/std/statistics/2019/foreword.htm.
  13. U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020 [Internet]. Section IV: Advisory Committee findings and recommendations [cited 2010 January 6]HealthyPeople.Gov. Foundation Health Measures – Foundation Health Measures Archive – Disparities. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities.
  14. “Point of care diagnostics for sexually transmitted infections: perspectives and advances.” Expert review of anti-infective therapy vol. 12,6 (2014): 657-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065592/. Gaydos, Charlotte, and Justin Hardick.
  15. “What’s the Point? How Point-of-Care STI Tests Can Impact Infected Patients.” Point of care vol. 9,1 (2010): 36-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853950/. Huppert, Jill et al.
  16. United States Preventative Task Force (USPSTF) Chlamydia and Gonorrhea: Screening. September 14, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening.
  17. Centers for Disease Control and Prevention (CDC). CDC. Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae — 2014. MMWR 2014;63(No. RR-2). Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae — 2014. https://www.cdc.gov/std/laboratory/2014labrec/default.htm.
     

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