Antibiotic-Resistant Gonorrhea, Congenital Syphilis, Budget Cuts—Oh My!

The ever-looming threat of the next big public health crisis is terrifying and that fear has been exploited by many cinematic dramas, such as Steven Soderbergh’s Contagion. But the Ebola epidemic had many U.S. agencies evaluating their preparedness to deal with the next crisis. What the DSTDP concluded was that not only are we lacking the infrastructure needed to handle an STD-related epidemic but that such a crisis is not too far off.

Dr. Gail Bolan, Director of DSTDP, described the most pressing concerns as threefold:

  1. Gonorrhea’s growing resistance to the last antibiotic we have to treat it
  2. The skyrocketing number of syphilis cases (including congenital syphilis)
  3. The dire under-staffing of field workers known as Disease Intervention Specialists (DIS)

The powers that be (namely the DSTDP and state/local health departments) have watched as gonorrhea—the second most common communicable disease in the U.S. after chlamydia— has grown resistant to antibiotic after antibiotic. But due to lack of funding and foresight, we are now using the last drug we have to treat it, with no new antibiotics waiting in the pipeline. Left untreated, gonorrhea can facilitate HIV transmission and lead to infertility in both men and women, as well as serious complications in pregnancy that can be passed on to the newborn. 1 And with a total of 333,004 cases reported in the U.S. in 2013 alone, those consequences can and will cause wide-spread devastation.2

Addressing the second concern, Director Bolan referred to the rising rates of congenital syphilis (transmission of the disease from mother to baby in utero or at birth) as the marker of a failed health system. Because we can screen for and effectively treat syphilis when it is caught early, there is no medical reason to be seeing such high rates of the disease. The explanation lies instead in the severe underfunding of national/state/local health agencies.

In order for STD public health programs to effectively respond to gonorrhea resistance, increasing syphilis, and any additional outbreaks, we need a bountiful outbreak response workforce. The Disease Investigators are the people on the ground that collect demographic information and perform contact tracing through anonymous partner notification. Their role is of vital importance in the effort to curb the spread of disease—yet, they are underpaid and spread too thin, with a single DIS covering the territory meant for several specialists.

So, are we ready for the next STD-related public health crisis?

No. No we are not. But we need to get ready (and get tested!).

For additional information on the budget request, please visit:

Zoe Kusintiz was a NWHN Intern in Summer 2015.

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