Increasing gonorrhea and syphilis in Massachusetts

There has been a pretty shocking increase in both gonorrhea and syphilis cases in the past 20 years in Massachusetts (see file:///C:/Users/geoff/Downloads/MDPH%20DSTDP%20ClinAdv%20SyphGCIncr%20FINAL%2023Apr2018.pdf )

-- In the 1990s, the number of cases of infectious syphilis had decreased to about 100 per year, now is at more than 1000
-- similarly the number of cases of gonorrhea decreased to approximately 2000 per year and is now well over 7000.
-- In addition there have been increasing reports of serious complications:
    -- syphilis: ocular, otologic, other forms of neurosyphilis, syphilitic aortitis, congenital syphilis
    -- gonorrhea: including gonococcal ophthalmia neonatorum
-- MSM have a disproportionately higher burden of these infections, 75% of infectious syphilis and 21% gonorrhea cases
-- women of childbearing age are also having more infections, 5% of syphilis and 30% gonorrhea

recommendations:
-- screen more aggressively for these infections [eg, syphilis screening had become less common as the number of cases had decreased,  USPSTF recommendations for gonorrhea screening had pruned down to those sexually-active women age 24 or younger (though they do include “older women who are at increased risk for infection”, and they do exclude men given “insufficient evidence”)….]
-- MSM should be screened for HIV and syphilis, as well as gonorrhea and chlamydia at exposed mucosal sites (urine, rectal, oropharyngeal) every 3 months
-- offer preexposure prophylaxis to prevent HIV infection in men positive for syphilis or rectal STIs, and in others at risk for acquiring HIV [and, I would argue, we really should be pretty aggressive in assessing/providing preexposure prophylaxis]
-- make sure vaccinations are up to date, including HPV, hepatitis A and hepatitis B

so,
-- this is particularly troubling for many reasons:
    -- these infections can have long-term serious sequelae if not treated aggressively
    -- as noted in many other blogs, there is increasing risk of resistant gonorrhea infections, some now not responsive to any antibiotics we have regularly available (eg see http://gmodestmedblogs.blogspot.com/2016/07/gonorrhea-resistance-increasing.html  and http://gmodestmedblogs.blogspot.com/2018/04/antibiotic-overuse-in-animals-and.html  )
    -- clearly, the increasing occurrence of these infections reflect decreasing use of barrier protection, with potential exposure to very serious infections such as HIV. We should be reinforcing the use of barrier contraception (recent statistics, for example, suggest that only 20% of sexually active teens use a condom with another form of birth control). Even though HIV has become a much more treatable disease, people still die from it (especially if they don’t take medications on a regular basis), and it clearly involves taking long-term therapies and huge changes in individuals’ lives (medicalization, increased risk of cancers, pneumonia, other infections despite good HIV control with meds)
-- And, this brings up several major concerns in the US at this point:
    -- overall, serious infections tend to track with socioeconomic status, with increasing incidence as well as morbidity/mortality being associated with poor housing conditions, poor nutrition, increased income inequalities, stress, all of which are likely to get worse with Trump
    -- and, the attack on contraception services as well as projected rollbacks in the number of patients insured, are likely to decrease access to care and hence increase preventable infectious diseases, including access to immunization, as well as other preventable or controllable conditions
-- and, not related just to these specific infections, the absurd explicitly anti-scientific negation of climate change that seems to hold current sway in US politics, is likely to enhance an array of infections into areas (such as the US) that they had not previously been prevalent, including dengue, malaria, etc.​ (eg see https://www.cell.com/trends/parasitology/fulltext/S1471-4922(02)02432-7 )
-- one potential issue, brought up in a NY Times article many months ago, is the rather unfortunate combination of Trump’s global gag rule (which restricts US funding for international family planning services through foreign NGOs if they provide abortion services, counsel or refer for abortion, or advocate abortion, even if done with their own non-US funds. And this at the same time that the US is undermining  efforts to decrease global warming, which will lead to more arid, water-depleted regions through much of Africa, for example.  This potential combination of more population because of decreased access to family planning services and even less access to water is likely to lead to more global instability and more potential wars over access to water.

Indeed, we live in interesting times….