There has been a looming public health emergency with increased rates of sexually transmitted infections, such as syphilis, gonorrhea and chlamydia.  Other than not using condoms, what other factors may be associated with this increase?

1. Decrease in public health funding to sexually transmitted disease control and education programs.  There has been an estimated reduction of 40% in total governmental funding for STD control programs since 2002.  Fortunately, at the end of 2018, Congress passed a bill toward reversing the this decline.
2. Sex and use of illicit drugs such as methamphetamines (oral or IV) and heroin.  There is an increase association of drug use and high risk sexual activity (multiple partners, sex for drugs, and sex without condoms).  This is seen disproportionately in higher risk groups for STDs such as men who have sex with men (MSM) and in the homeless population.   
3. Possible associations with behavior changes in MSM who use Pre-exposure prophylaxis (PrEP) to prevent transmission of HIV.  Those who are on PrEP (tenofovir/emtricitabine) are contracted with prescribing physicians to get tested every 3 months for HIV, Gonorrhea, Chlamydia and syphilis.  Nevertheless, there have been some associations made with an increase in higher risk sexual behavior in a person for the first year after being prescribed PrEP, compared with before.  Since PrEP is an important breakthrough in interrupting the transmission of HIV,  additional emphasis should be placed on reducing “bare-backing” among those unaware of  each other’s STD testing status through condoms, rapid testing, and education.
4. The Use of Social Media Dating Apps.    There have been associations with social media going back to 1999, where a syphilis outbreak in San Francisco was associated with an online chatroom for MSM.  Now, in the age of “swipe left” or “swipe right”, these apps may allow for more casual sexual experiences – mainly for those who use them that way.

The link is to an article in the Salem Reporter about some of the associations with increases in STD’s in Salem, Oregon that featured interviews with several Marion County public health representatives, including me.