Sexually transmitted infections (STIs) are on the rise in the U.S., including an 80% increase in syphilis over a five-year period, according to the Centers for Disease Control and Prevention. A new national survey by The Ohio State University Wexner Medical Center finds many Americans have misconceptions on how STIs are spread and who should be treated. 

Treponema_pallidum_Bacteria_(Syphilis) (1)

Source: NIAID

Colorized electron micrograph of Treponema pallidum, the bacteria that cause syphilis.

The national poll of 1,005 people found over a third of Americans (34%) falsely believe STIs can only be transmitted through sexual intercourse. In reality, there are many ways STIs can spread such as by kissing or sharing needles and even during childbirth. The survey also found that one in five Americans (20%) believe they only need to be tested for STIs if they’re experiencing symptoms. 

“We’re likely still experiencing some of the effects of the COVID-19 pandemic when STI prevention services were completely shut down. A lot of STIs were undiagnosed and under-reported then, allowing these infections to spread within the population. The CDC’s latest surveillance data from 2022 showed an alarming increase in cases of syphilis and congenital syphilis,” said Jose A. Bazan, DO, a professor of clinical internal medicine with the Division of Infectious Diseases at Ohio State.

Congenital syphilis

Congenital syphilis occurs when people pass syphilis to their babies during pregnancy, sometimes resulting in stillbirths or other life-threatening conditions. U.S. cases of congenital syphilis increased 180% from 2018-2022, according to the CDC. 

“It’s important that pregnant individuals get screened for syphilis as this is a very preventable infection that can easily be treated with antibiotics. Unfortunately, the rising number of cases tells us we’re not reaching vulnerable populations in time,” Bazan said.

The most effective way to prevent an STI is to use a condom and discuss STI testing with a doctor or sexual partner, said Stacey Biffle-Quimba, a family nurse practitioner who is program manager for sexual health and women’s health at Columbus Public Health in Ohio. 

“Part of having a safe and healthy relationship with your partner is being able to have those conversations and say, ‘When was the last time that you were tested? What’s your status?’ Preventing transmission to a partner is very important because that partner may have other partners and that’s where it can turn into an epidemic. It’s important that people be tested, especially if they’ve never been screened, have new sexual partners or have high risk sexual partners,” she said. 

Vaccinations and antibiotics

Vaccinations for HPV and hepatitis A/B are also effective, as well as the HIV medications for pre-exposure and post-exposure prophylaxis (PrEP and PEP). This month the CDC finalized new guidelines for using the antibiotic pill doxycycline for post-exposure prophylaxis (doxy PEP) in certain groups at risk for STIs. 

“Doxy PEP is a new intervention taken within 72 hours after a sexual encounter with the hope that it can prevent them from acquiring an STI such as chlamydia, gonorrhea or syphilis,” Bazan said.

For some people, infections like HPV, chlamydia, gonorrhea and HIV can develop without significant symptoms and may go undetected for long periods of time, resulting in serious health problems such as cancers of the anogenital tract, fertility issues, chronic pain and a compromised immune system.

Sexual health conversations

“Doctors need to normalize talking about sexual health with their patients. We should feel just as comfortable talking about sexual health topics as we do about blood pressure, cholesterol and diabetes,” Bazan said. 

The CDC recommends individuals and healthcare providers take three simple actions to help prevent the transmission of STIs: talk, test and treat. Several at-home testing kits are available for different STIs, including HIV, chlamydia, gonorrhea and syphilis. 

“While these tests are convenient and private, it’s important to discuss the results with a doctor to determine if a repeat STI test or treatment is needed,” Bazan said. “Having these conversations in a safe and non-judgmental way is a critical tool in helping us fight the epidemic of STIs.”

This study was conducted on behalf of The Ohio State University Wexner Medical Center by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from April 5-7, 2024 among a sample of 1,005 respondents.

The survey was conducted via web (n=975) and telephone (n=30) and administered in English. The margin of error for total respondents is +/- 3.4 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.