Taylor E. has been sexually active for four years, and has had as many partners, but she's never used a condom—not once. "I don't think about STDs very often," the 22-year-old from Iowa City says. "I know that I should test more often but it doesn't seem very pressing in my everyday life. I have always felt, although I know it's naive, that because I average only a partner a year it's unlikely I will catch something."
Recently, the Centers for Disease Control and Prevention found that rates of sexually transmitted diseases (STDs) are at an unprecedented high in the United States. New infections of chlamydia, gonorrhea and syphilis, the three most common STDs in the US, have reached the highest number ever, with people aged 15-24 and men who have sex with men seeing the most significant increases.
It's worth noting that it's actually possible that the rates of disease might not be actually rising, rather that detection is going up as people get tested more frequently courtesy of the Affordable Care Act. "People have access to the essential care that they need," says Raegan McDonald-Mosley, chief medical officer for Planned Parenthood. Better access to care leads to more routine testing, and could mean that healthcare providers are finding cases of STDs that would otherwise go undetected. This could explain the rise in detection of chlamydia and gonorrhea, which can be asymptomatic and therefore go undetected for a long period of time.
Regardless, it's now clear that STDs are more rampant than previously thought—and that something needs to be done. "Once an STD is in the population, it grows exponentially unless you address it," says Susan Wysocki, a sexual health expert who sits on the board of the American Sexual Health Association. Thing is, no one seems entirely sure how to address it. There are myriad possibilities for the rise in rates, and no real answers.
Although hook-up culture and casual sex promoted by apps like Tinder are oft-cited reasons behind the spike, research has shown that millennials actually have fewer partners than previous generations.
But notably, unprotected sex with those partners is really common. A survey by the CDC found that 74.5 percent of unmarried women ages 15 to 44 reported using a condom "none of the time" in 2013, up from 2002. "I don't know anyone who uses a condom every time," a 21-year-old woman who asked to remain anonymous told me.
"My main concern has always been preventing pregnancy," Taylor E. says. "An STD seems more manageable than an unplanned child." She describes taking her birth control pill religiously and keeps a box of pregnancy tests to quell any additional worry. In fact, as highly effective long-acting reversible contraceptives (LARCs) like IUDs and implants become more popular, sex without a condom does too. One study conducted by the CDC found that teens who use LARCs were 60 percent less likely to use a condom than their peers who used oral contraceptives.
A related element here is fear—or lack thereof. "One factor could be less concern about HIV risk," says Riley Steiner, a health scientist with the CDC and author of the LARC study. Wysocki agrees, saying, "back in the 80s it was really top-of-mind for gay men to use protection and it's not that way now." Despite advances in treatment of HIV and all STDs, however, there are serious consequences, many of which can go undetected until they've caused lasting problems—including neurological issues, vision problems and infertility, among many other things.
No matter what the reason for rising STD rates and low condom usage, all of the experts I spoke to agreed that more funding and better education are essential to addressing the epidemic. (No one mentioned improving the condom experience, but that seems like it would help, too.)
"We don't do enough in this country with sex education, talking about condom use and how prevalent STDs are," Wysocki says. "Young people will often think 'if this is important enough, if there is this epidemic of STDs, why didn't my health care provider mention it?'" Raegan McDonald-Mosley, chief medical officer for Planned Parenthood, agrees. "STD testing and education must be integrated as a normal part of basic healthcare," she says. "We have to do a better job of making sure that people are aware of the risk of STDs and the importance of condom use." Education is essential for doctors, too. "Providers need training and tools to effectively address both pregnancy and STD prevention within the same clinical visit," Steiner says.
"We have reached a decisive moment for the nation," says Jonathan Mermin, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Many of the country's systems for preventing STDs have eroded. We must mobilize, rebuild and expand services, or the human and economic burden will continue to grow."
Whether it's through education or via better funding for treatment centers, changing people's minds about the scariness factor of STDs might be the most important—and the toughest—challenge. "My friends and I often talk about healthy emotional relationships, sexual positions and behaviors, but rarely about STDs," Taylor says. "Those random ten-minute presentations we got in school seemed more like scare tactics than anything else. The reality of watching my friends go to the bar and pick up strangers seems harmless. Maybe they're just lucky, or maybe their partners are getting tested every time. I don't know."