The National Coalition of STD Directors (NCSD) asked the National Academy of Public Administration (the Academy) to investigate and describe the scope and impact in the United States of three major, reportable STDs—specifically, chlamydia, gonorrhea and syphilis—and assess the effectiveness of current prevention and control programs.In response to the NCSD request, the Academy formed an expert panel and a professional study team to collect and review available information concerning STD trends and efforts to prevent and control the three STDs noted above. The study focused principally on federally funded intervention programs and current funding. A review of state and local programs, as well as clinical/epidemiological issues, was beyond the scope of this study. By providing a consolidated overview of the current state, this Academy study is intended to help NCSD and the other stakeholders in the STD community inform a national action strategy for reducing STD transmission rates and improving public health.
The study found that many of the observations of the Institute of Medicine's 1997 report, "The Hidden Epidemic", remained applicable in 2018. Social determinants of health and intersecting epidemics (or, "syndemics") continue to fuel ongoing outbreaks, and are complicated by emerging trends. A continued stigma surrounding STDs and sexual health in general has an adverse impact on patient access to care and preventive services.
The fractured state of the American healthcare system poses a significant obstacle to addressing the epidemic at large, resulting in vast variations across the nation in how STD prevention and treatment services are provided and funded. Constrained federal funding has affected research, evaluation, and support to state and local public health entities addressing the outbreaks on the ground level, compounded further by cuts at those levels. The conflict surrounding the Patient Protection and Affordable Care Act, and its accompanying Medicaid expansion, has disrupted reforms to service provision that were planned around original designs for the legislation, leaving gaps in prevention and control efforts.
The report identifies six actions to turn the tide of STD prevalence in the United States: