Responding to Rising STI Rates and Reproductive Health Care Barriers

Jennifer Middleton, MD, MPH
Posted on April 24, 2023

The prevalence of sexually transmitted infections (STIs) has been steadily increasing in the United States during the past decade, with more than 2.5 million cases of chlamydia, gonorrhea, and syphilis reported in 2021 by the Centers for Disease Control and Prevention (CDC). STIs can result in infertility, serious congenital infections, and permanent disability; each of us has a responsibility to respond to this crisis by providing accessible, nonjudgmental care for our patients’ sexual and reproductive health needs.

The COVID-19 pandemic likely contributed by exacerbating inequities in insurance coverage, lab supplies, and access to care, but stigma regarding sexual and reproductive health is also contributing. One in seven people in the United States feel uncomfortable discussing sexual health with a physician (and that number may be artificially low because of social desirability bias), and a sizable minority of physicians report discomfort discussing sexual health with transgender persons and/or persons with HIV. This 2020 AFP article on “Sexual Health History: Techniques and Tips” describes how to obtain a sexual attitude reassessment to identify personal beliefs and biases around sexuality that are affecting clinical care; the article also reviews creating a welcoming office environment, providing trauma-informed care, and examples of phrasing and questions to use. A thorough sexual history is necessary to identify all persons who will benefit from STI screening.

As STI rates increase, access to reproductive health care has been decreasing. Nearly one in four women in a U.S. survey reported difficulty identifying a health care provider to provide sexual and reproductive health care, and “barriers to reproductive health services were pervasive and disproportionately associated with reduced access for individuals identifying with historically marginalized groups.” The AAFP “supports access to comprehensive pregnancy and reproductive health services,” and the American College of Obstetrics and Gynecology has outlined recommendations to improve reproductive health access, including Medicaid expansion to ensure that lower-income people can have access to services. We can advocate for these policies in our local communities and with our elected representatives. The AAFP’s EveryONE Project provides additional tools and resources to eliminate health disparities in your community. Family physicians can also lead office quality-improvement projects to increase STI screening rates; this FPM series provides a step-by-step approach for success.

Each of us has a role to play in reversing this trend of worsening STI rates. If you’d like to read more, there’s an AFP By Topic on Sexually Transmitted Infections that contains a wealth of resources, including articles with updated guidance from the CDC, chlamydia and gonorrhea screening case studies, and this article on “Syphilis: Far from Ancient History.”