Sexually transmitted infections climb on Long Island

Sexually transmitted infections are spreading on Long Island, according to the state Department of Health.

In 2022, the last year for which data was available, there were 731 diagnoses of early syphilis on Long Island, continuing a sharp decadelong rise that brought the rate of infection to 27.2 per 100,000 people, according to the state’s Sexually Transmitted Infections Surveillance Report. That rate increased from 19 per 100,000 people in 2021.

Cases of chlamydia, the most common sexually transmitted infection tracked in the report, ticked up to 9,487. Diagnosed gonorrhea cases fell slightly to 2,006, bucking a statewide increase.

Across New York, the highest rates of sexually transmitted infections, or STIs, were found in young people, non-Hispanic Black people and men who have sex with men, the report found. Nationally, according to the Centers for Disease Control and Prevention, cases of the three STIs increased 1.9% from 2018 to 2022. 

Pandemic played a role

The report’s authors attributed some of New York’s increases to the COVID-19 pandemic, which “severely disrupted” public health efforts to prevent and control sexually transmitted infections in 2020 and 2021. Experts said other factors may also be at play.

Among the factors: the popularity of dating apps, which allow for casual, sometimes anonymous sexual encounters; nationwide shortages of the drug Bicillin, commonly used to treat syphilis; and the success of HIV/AIDS drug therapies that may have caused people to be less vigilant for STIs in general.

Long Island’s rates of infection for the three STIs were significantly lower than statewide rates or that for New York City, but there is significant local variation in rates, said Dr. Joseph McGowan, who oversees HIV services for Northwell Health. McGowan said areas of higher incidence of infection included parts of Freeport, Glen Cove, Hempstead, Massapequa, Roosevelt, Westbury and Uniondale in Nassau County. Bay Shore, Central Islip, Huntington Station and Wyandanch had the highest incidence in Suffolk County.

In many of those areas, according to experts, poverty has historically been a social determinant of poor health, with higher rates for a range of negative health outcomes, from infant mortality to high blood pressure, often coupled with reduced access to primary care and health insurance. 

Poverty factors

“If you have areas that have poverty, poor education, low socioeconomic status, all of those contribute to a higher incidence of disease,” said Dr. Brian Harper, chief medical officer and vice president for diversity, equity, and inclusion for the New York Institute of Technology. Harper formerly served as Suffolk County health commissioner and helped lead Nassau County’s HIV/AIDS and STI prevention work. 

Public health officials on Long Island said they are using a variety of strategies to combat rising rates of STIs.

Strategies include “an increase in epidemiological surveillance, disease forecasting capabilities, provider and community outreach, and sexual health education,” Alyssa Zohrabian, a spokeswoman for the Nassau County Department of Health, said in an email.

In Suffolk, the health department’s STI Control Unit does outreach and contact tracing, spokeswoman Grace Kelly-McGovern said in an email. Screening, diagnosis and treatment is available at nine clinics across the county run by a nonprofit, Peekskill-based Sun River Health. The department also partners with health care providers at correctional facilities, drug treatment programs, and youth and family programs to raise awareness of STIs, Kelly-McGovern said.

The pandemic’s effects on STI screening were widespread, according to experts.

“Community based screening … was essentially shut down during that lockdown year,” McGowan said.

Public health resources stretched

Many public health resources shifted toward combating the pandemic, McGowan said. “It took some time to get those programs back and running again.”

Changes in the public health approach to HIV/AIDS may have also played a role in the spread of infections. In recent years, as the CDC shifted much of its efforts to combat HIV in the state to New York City, McGowan said “a lot of testing and surveillance dollars” for STIs were concentrated there. “The rest of the state lost a lot of capacity to reopen and support those programs,” he said.

And drug therapies that turned HIV/AIDS from a lethal disease to a serious but manageable chronic condition may be associated with decreased awareness of sexually transmitted infections and riskier behavior, said Martine Hackett, a Hofstra University associate professor of public health and community health.

“As the nature of HIV has changed,” Hackett said, “we’re seeing less education around other STIs.”

People getting infections “might not be as aware of their risk” as they were in the past, and one proven protective measure, condom use, “is no longer as prevalent as it once was,” she said.

In general, Hackett said, spending for contact tracing for STIs, an important public health tool, has also fallen.

STI budget cuts

As part of the debt ceiling negotiations last June, Congress rescinded $400 million of $1 billion to hire additional STI program employees. That led some states to cut their STI budgets, but Cadence Acquaviva, a spokeswoman for the state health department, said in an email that the state’s contact tracing resources for STIs has not changed. The state receives $2.48 million in federal funds for STI prevention and control, Acquaviva said. 

Elizabeth Finley, spokeswoman for the National Coalition of STD Directors, told Newsday in 2023 that over the past 20 years, federal STI funding had been cut 40%, taking into account inflation.

Some prevention and control work face obstacles, said Dr. Wilson Miranda, surveillance director for the state health department’s Office of Sexual Health and Epidemiology, AIDS Institute. 

Some apps used to arrange sexual encounters allow people to use “handles — they don’t use their real name — so that makes it very difficult for our contact tracers,” Miranda said, adding that some school districts may be reluctant to teach sexual education.

“We live in a tough climate now,” he said. “Some schools might not be comfortable, some parents might not be comfortable. But just because you don’t talk about it, doesn’t mean these diseases don’t exist.”

At early stages, the STIs may cause ulcers, inflammation or sometimes no symptoms at all, making detection and treatment difficult. Untreated, they can contribute to miscarriages, sterility or other serious health problems. Congenital syphilis, which occurs when a mother with the infection passes it to her baby during pregnancy, is of particular concern to public health workers because it indicates a lack of prenatal care and can cause birth defects with lifelong complications or death to the infant.

There were 51 such cases in New York State in 2022, according to the report. Nationwide, more than 10 times as many babies were born with syphilis in 2022 than in 2012, the CDC has said.

Reason for hope

Still, several doctors believe there is reason for hope in new treatments like DoxyPEP, an antibiotic that has been shown to significantly reduce the chance of an STI infection after sex, or in strategies like expedited partner treatment. Approved by the state in 2020, it allows health care providers to give medication or a prescription to patients diagnosed with certain STIs to deliver to their partners so they can be treated without requiring an examination, said Dr. Cynthia Friedman, Suffolk Health Department’s director of public health. 

Harper, of NYIT, said officials and health care providers could turn to a proven model in the public outreach done during the HIV/AIDS epidemic in the late 1980s and early 90s, targeting community leaders and gathering places.

“You go out and physically speak to people,” he said, recalling one conference he arranged for barbers and beauticians. “We did condom demonstrations. We walked them through the process of how the virus was being transmitted.” 

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, said health care providers, especially those treating young people, should read the state report as a call to action, and also ask a few basic questions of every patient: “How many sexual partners do you have, have you been tested recently, do you have any symptoms?”

Asking those questions, she said, “should be part of routine care.”