America’s STD Epidemic: The Sexual Health Crisis Nobody Is Talking About

The CDC reports more than 2.5 million combined new cases of chlamydia, gonorrhea, and syphilis annually in the United States — the highest recorded rates in history. Congenital syphilis, a disease that was nearly eliminated in the United States just two decades ago, has surged more than 900% since 2012. Gonorrhea strains increasingly resistant to all available antibiotics are emerging. The sexual revolution promised liberation. The STD epidemic is part of its ledger.

Records That Should Not Be Records

The United States has reported the highest-ever recorded rates of sexually transmitted infections for seven consecutive years running through the most recent CDC data. Combined cases of chlamydia, gonorrhea, and syphilis exceed 2.5 million annually. Syphilis cases in particular have surged at a rate that has shocked public health experts — total cases have increased by over 80% in the past five years, with primary and secondary syphilis — the most infectious stages — reaching their highest levels since 1950.

The most alarming dimension of the syphilis resurgence is its impact on infants. Congenital syphilis — which occurs when a mother with untreated syphilis transmits the infection to her child during pregnancy — has increased more than 900% since 2012. In 2022, more than 3,700 cases of congenital syphilis were reported, resulting in over 230 stillbirths and infant deaths. These are children who died or were permanently harmed by a disease that is preventable and treatable — a failure of both public health infrastructure and the behaviors that create exposure in the first place.

The Sexual Culture That Produces These Numbers

STD rates do not exist independently of sexual culture. They are a direct consequence of patterns of sexual behavior — specifically, the number of partners, the consistency of protection, and the frequency of testing and treatment. The hookup culture that has normalized casual, short-term sexual encounters without relationship context has dramatically increased the number of sexual networks through which infections can spread and has reduced the social norms — including committed monogamous relationships — that historically served as natural limits on STD transmission.

Dating apps have reorganized sexual behavior in ways that facilitate the rapid formation and dissolution of sexual connections — creating the kind of high-density sexual networks that epidemiologists identify as the primary drivers of STD surge. The sexual behaviors that these technological and cultural changes have normalized are not without consequence. The CDC’s annual STD surveillance report is, in part, a public health accounting of those consequences.

“We decimated the public health infrastructure for STD prevention over the past two decades, at the same time that sexual behavior patterns were changing in ways that increased transmission risk. We should not be surprised at the result. We should be honest about both causes.”

The Antibiotic Resistance Threat

Beyond current case counts, public health officials warn of an emerging threat that could make the current STD epidemic look manageable by comparison: the rise of antibiotic-resistant gonorrhea. Gonorrhea has already developed resistance to every antibiotic class that was previously used to treat it. Only a small number of treatment options remain, and strains resistant to those options have already been identified in multiple countries. The prospect of untreatable gonorrhea — a disease that infects hundreds of thousands of Americans annually — would represent a public health catastrophe.

The STD epidemic is both a public health failure and a cultural one. Rebuilding the public health infrastructure — testing, treatment, partner notification, and prevention education — is necessary but not sufficient. A culture that takes seriously the connection between sexual behavior and human health, relationship integrity, and the wellbeing of children born into its patterns would also take seriously what these numbers reveal about the choices Americans are making and their consequences.