An epidemic of sexually transmitted infections that saw rates spike on Long Island and across the nation in recent years may be slowing, but experts on Long Island said they were nowhere near declaring victory.
According to data for 2023 released this week by the Centers for Disease Control, more than 2.4 million STIs were reported nationally in 2023, but diagnoses for gonorrhea dropped for a second year, and rates of syphilis - a potentially incapacitating infection that can spread through sexual contact or from mothers to babies during pregnancy - increased by only 1% after years of double-digit increases.
"This is the first time we've really seen documentation of a slowing of the STI epidemic in many years," said Dr. Bradley Stoner, the director of the Division of STD Prevention, in an interview. "This seems to be an inflection and we're committed to keeping the pressure on, pushing to turn things around."
The CDC did not break out most data for county or region, but for New York State in 2023, there were 12,393 cases of all stages of syphilis, or a rate of 63.3 cases per 100,000 people. By both measurements, those numbers were the lowest in three years.
But not all the trends were going in the right direction.
For example, last year across the state there were 67 cases of congenital syphilis, an infection that is potentially fatal for babies if not treated, compared to 51 in 2022 and 41 in 2021.
According to the latest published state Department of Health Data, the number of Long Islanders newly diagnosed with early syphilis, when the disease is most infectious, was 731 in 2022: roughly six times what it was in 2011.
Statewide in 2023, according to the CDC, for the other two major infections tracked by public health officials, gonorrhea and chlamydia, there were 46,102 and 109,284 cases, respectively. The rates of both infections have risen steadily in recent decades.
A spokeswoman for the state Department of Health did not comment.
Stoner attributed improved national rates to factors including educational outreach through community groups, delivery of service by healthcare providers and new tools including point-of-care tests for syphilis and Doxy PEP, an antibiotic course that can reduce the risk of infection when taken after sex.
But Dr. Joseph McGowan, HIV services medical director at Northwell Health, said he hadn't seen a noticeable decline in STI cases this year, and that rates for some infections were still historically high.
In New York in 2022, about 9,300 people were diagnosed with early syphilis. That category combines primary and secondary syphilis diagnoses with diagnoses of a syphilis infection that has progressed in the first year, according to state Department of Health's definition. The total is about 15 times higher than what it was in 2000.
Staffers at Garden City-based nonprofit Family & Children's Association, which tests people like those seeking treatment for substance abuse and gay men on Fire Island, said they also saw no reason for celebration.
"My sense of it is that it has not [dropped]," said Dr. Jeffrey Reynolds, the group's president and CEO, in a phone interview. "And if anything, we have seen a spike in infections."
Public awareness of STIs is lower than it was at the height of the HIV/AID epidemic in the 1980s and 90s, Reynolds said, and safer sex commercials and billboards are less prevalent.
"That has given people, especially young people, a false sense of security that safer sex isn't as important as it was, say, 20 years ago, when AIDS cases were still climbing," he said.
Another factor, Reynolds said, was a shortage of testing sites, and some primary care providers continued discomfort about having conversations about safe sex with patients.
Alyssa Zohrabian, a Nassau County Department of Health spokeswoman, wrote in an email that "While we are pleased with the decline in some STI rates, we recognize the ongoing need to raise awareness about sexual health."
Two advancements have enhanced STI prevention in Nassau County, she wrote: "New York State added third-trimester syphilis screening for pregnant individuals, and the CDC released guidelines for prescribing Doxycycline," the antibiotic. "These measures have led to increased syphilis screenings and more people using Doxy PEP," she wrote.
Suffolk's County Department of Health Services has since 2022 led a Congenital Syphilis Prevention Initiative, agency spokeswoman Grace Kelly-McGovern wrote in an email. That initiative partners "staff, community-based organizations, and stakeholders, to inform clinicians who work with at-risk women of childbearing age about best practices," she wrote.
The department also works with a state planning group to prepare medical providers and community-based organizations to combat the rise of maternal and congenital syphilis.
In a phone interview, Dr. Brian Harper, chief medical officer and vice president for diversity, equity, and inclusion for the New York Institute of Technology, said the latest CDC data appeared to show "that the numbers are going in the right direction," especially for syphilis.
Continued federal funding - in fiscal 2023, Congress appropriated $1.4 billion to CDC for prevention and control of STIs and other contagious diseases - is crucial to the efforts of local health officials, said Harper, who formerly served as Suffolk County health commissioner and helped lead Nassau County's HIV/AIDS and STI prevention work.
"Ultimately, when it comes to STIs, you need workers on the ground, with grassroots efforts to do proper contact tracing, and you have to be fairly aggressive to make sure you get people when they're in the communicable stage," Harper said.