Sexually transmitted diseases are on the rise in King County and the United States as a whole, reports show, with more than 2 million cases of chlamydia, gonorrhea and syphilis reported in the U.S in 2016. The largest increase was seen in people ages 15 to 24.
This probably comes as no surprise to anyone over the age of 35. After all, millennials are the worst generation—just ask the internet. (So entitled!)
But the real reason STDs are on the rise in millennials is way more complicated than just labeling the generation a bunch of derelict non-condom users who do whatever they want, says H. Hunter Handsfield, M.D., professor emeritus of medicine at the University of Washington Center for AIDS and STD.
“There’s a lot we don’t know about the actual details about how people are deciding about partnership and who they’re going to have sex and with or not and about condom use,” he says. “No expert can say we currently have all the explanation we need for the current rising STD rates.”
From a lack of proper sex education to advances in healthcare that are making it easier to choose sexual partners without fear, the true nature of the uptick is complicated.
Millennials probably aren’t just throwing caution to the wind
Chlamydia is the most common STD in the U.S., according to the Centers for Disease Control and Prevention. In King County, the rate of chlamydia was highest among 20- to 24-year-old women in 2015 and has been rising in that age group since 2007, according to a Public Health - Seattle & King County report. But rates have been on the decline among 15- to 19-year-olds since 2004.
National trends are similar: In 2016, there were 1,008,403 reported cases of chlamydia among 15- to 24-year-olds, which represents 63 percent of all reported cases, according to a CDC report.
This supports research that young people are waiting longer to have sex and having fewer partners, says Julie Dombrowski, M.D., M.P.H., an infectious diseases physician and deputy director of the Public Health – Seattle & King County HIV/STD program.
One theory with some validity is that sexually active singles, including millennials, may be more concerned about preventing pregnancy than they are about avoiding STDs, says Handfield. But the idea floating around that young people aren’t using condoms because they can just pop on in to the nearest drug store for emergency contraception doesn’t jive with him.
“I have a little bit of a problem with that in terms of my understanding of human behavior,” says Handsfield. “So many women are also on birth control pills or other forms of hormonal contraception, so I’m skeptical about the extent to which the average sexually active young person is so cavalier about pregnancy and the availability of emergency contraception.”
In addition, the large number of men who have sex with men in the national and local data set skews the numbers. Rates of some STDs, including syphilis and gonorrhea, are 10 to 20 times higher among this population than in the heterosexual population, says Handfield. This makes it difficult to make meaningful generalizations across a generation of varied sexual orientations, he says.
Abstinence-only education isn’t working
The FLASH curriculum used in Seattle and King County schools is a comprehensive sexual health education program that does not take an abstinence-only approach, says Dombrowski. But on the national scale, research shows that abstinence-only education doesn’t lower STD rates and actually leads to higher teen pregnancy rates in states that adopt it.
In other words, if you don’t provide access to the information young people need to live healthy sexual lives, you can’t expect them to make safe decisions, says Handsfield. A young adult who has never been taught about STDs and condom use may not be prepared when the “wait until marriage” ideal fails in the heat of the moment, he says.
And it’s not that millennials aren’t concerned about STDs—they may just not know to be concerned about all of them.
Handsfield is one of three experts who respond to inquiries for the American Sexual Health Association’s online Ask the Experts forum.
Most questions the forum receives are about viral STDs—HIV, herpes and HPV—and not chlamydia, gonorrhea or syphilis. So it’s possible that young people aren’t as aware of the risks associated with those diseases, which could be contributing to the rising rates, says Handsfield.
HIV isn’t the death sentence it once was
The CDC and King County reports show that gay, bisexual, and other men who have sex with men are disproportionately affected by STDs. In fact, men who have sex with men accounted for 80 percent of male syphilis cases in the U.S. in 2016. This population also had disproportionate rates of gonorrhea and chlamydia.
Experts believe that the rising rate of these bacterial STDs is partially the result of success in preventing another—HIV—says Dombrowski.
Antiretroviral medication transformed HIV from a death sentence to a chronic disease that people can live with for decades. It’s also more easily preventable. In 2011, researchers learned that taking antiretroviral medication is highly effective at preventing the transmission of HIV to someone else. And pre-exposure prophylaxis, or PrEP, a daily antiviral medication that prevents HIV, was approved for use in 2012.
This population not only has the greatest motivation to prevent HIV, but also the greatest knowledge of how you can do that through medications, says Handsfield. And they’re increasingly serosorting, choosing sexual partners of similar HIV status or people they know are on treatment. As a result, they may be opting out of using condoms or engaging in other behaviors that can increase the spread of other STDs, he says.
When you compare the timing of HIV treatment and prevention advancements with upticks in the rates of other STDs in King County, the logic adds up. Chlamydia rates, for example, increased slightly from 2007 to 2010 in men who have sex with men, and more drastically every year after 2011. In women and men who have sex with women, on the other hand, chlamydia rates have remained fairly consistent in the county since 2007.
While the current rising STD rates are concerning, Dombrowski says it’s important to recognize that it’s a problem that is coming on the heels of a huge public health success.