Colorado syphilis, gonorrhea rates shot up during first year of pandemic as STDs returned to 1990s levels nationally - The Denver Post

Rates of sexually transmitted infections jumped in Colorado and nationwide in 2020, according to new data from the Centers for Disease Control and Prevention.

Cases of syphilis and gonorrhea have been rising for years in Colorado and most other states, and that continued in 2020 — with syphilis cases jumping more than 30% in the first year of the pandemic.

Chlamydia rates appeared to drop in Colorado, though experts were skeptical that it represented a real improvement.

The CDC's report didn't include HIV and other infections that can be transmitted sexually, like herpes or hepatitis C. Data from 2021 hasn't been finalized at the national level, and the state's numbers only run through 2019 at this point.

Gerardo Orozco-Pacheco, regional prevention and field services supervisor with the Colorado Department of Public Health and Environment, said a lack of testing during the early phases of the pandemic may have allowed infections like syphilis and gonorrhea to spread, because people didn't know to get treatment and notify their partners.

"We are definitely seeing an increase in STIs," he said.

In 2020, 26,137 people in Colorado tested positive for chlamydia; 9,686 for gonorrhea; and 1,785 for syphilis. Some people may have tested positive for more than one infection.

The state health department urged people who might be at risk of a sexually transmitted infection to get tested, whether at their doctor's office, through a county health department or by using a free at-home test kit.

The test kits, which come with instructions on how to swab orifices where a person has had sexual contact, have been available to order at cdphe.mybinxhealth.com since September 2020, but weren't widely promoted. An infectious disease specialist from the health department will follow up with anyone who tests positive to arrange treatment.

The only foolproof way to prevent sexually transmitted infections is not to have sex, but using condoms correctly and limiting partners reduce the risk. The three diseases covered in the CDC's report are caused by bacteria and can be cured with antibiotics.

People are often afraid to get tested or worried about the stigma if they have a sexually transmitted infection, which stops them from getting treatment that can head off serious health problems, Orozco-Pacheco said. Also, those who are dealing with problems that may seem more urgent, like worrying about paying their rent, may not prioritize talking to their doctors about their sexual health, he said.

"The data is very good at telling us where those barriers exist," he said.

Syphilis

Syphilis rates in Colorado increased by 32% from 2019 and more than quadrupled since 2011. Nationwide, the rate also increased substantially, reaching levels last seen in 1992.

While syphilis is still less common than other sexually transmitted infections, it's important to track because the consequences of an untreated infection can be "devastating," said Jill Hunsaker Ryan, executive director of the state health department.

In the early stages, syphilis causes a sore at the point where it entered (which may not be readily visible), followed by a rash and flu-like symptoms. Most people receive treatment before progressing to the final stage, when the bacteria have damaged the heart and brain.

Syphilis infection is particularly dangerous during pregnancy, because it increases the odds of stillbirth, death in infancy and certain disabilities. Treating the birthing parent (and any partners, to avoid reinfection) virtually eliminates the risk to the baby, but congenital syphilis rates have been rising nationwide since 2005.

While cases in infants remain rare, they have risen noticeably. In 2016, four Colorado infants were affected, but in 2020, 22 were. The increase wasn't explained by population growth.

"If mothers don't have access to prenatal care, it could be missed," Ryan said.

Gonorrhea

Gonorrhea followed a similar pattern to syphilis, with nationwide rates reaching levels last seen in 1991. The rate reached its low point in 2009 and has been rising since. Unlike in the '90s, however, about half of gonorrhea cases reported in 2020 were resistant to at least one antibiotic, making them more difficult to treat.

Colorado's gonorrhea rate rose about 1.2% from 2019 to 2020, which was one of the more modest state-level increases. The rate more than tripled between 2011 and 2020, however, which was the 11th-highest rate of increase.

Many people don't have symptoms of gonorrhea infection, though some experience discomfort while urinating, discharge from the vagina or penis, swollen testicles or vaginal bleeding between periods. People infected by anal sex may experience discharge, bleeding, or pain in the rectum.

Untreated infections can lead to long-term pain in the reproductive organs and infertility for both sexes, though women are at a higher risk of bad outcomes.

Chlamydia

Chlamydia rates have trended up since the CDC started tracking them in 1984, with occasional small drops. The 2020 decrease was the first since 2012.

Colorado's chlamydia cases were down 12% compared to 2019, but up 6.6% compared to 2011. The decrease likely reflects a lack of testing, rather than an actual drop in transmission, Ryan said. Chlamydia rarely causes symptoms in its early stages and is usually caught when people see a doctor for some other reason, so fewer medical visits in 2020 likely meant more missed cases, she said.

While most people don't have symptoms from chlamydia, some experience a burning sensation while urinating, discharge from the vagina or penis, or, rarely, swelling in the testicles. People who were infected via anal sex sometimes experience pain or bleeding in the rectum. Men rarely experience long-term problems from a chlamydia infection, but women are at risk of chronic pain or infertility.

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