STIs are on the rise — Femtech can help
Written by Elizabeth Gordon and Melissa Barall
Rates of sexually transmitted infections (STIs) are on the rise in the US with an overall increase of 7% in reported cases from 2017 - 2021. Covid-19 exacerbated many factors contributing to the increased rates; however, instead of seeing rates decline with the return of screening and testing, numbers have continued to climb. In 2021, the US recorded more than 2.5 million STI cases.
STIs include more than twenty-five infections, curable or incurable, passed from one person to another through sexual contact or bodily fluids. The most common STIs are human papillomavirus (HPV), chlamydia, syphilis, gonorrhea, herpes, trichomoniasis, and HIV/AIDS.
STIs are more prevalent in underserved and marginalized communities, however females are disproportionately impacted both in the prevalence of infection (for many, but not all STIs) as well as long-term, often serious health consequences. Left untreated, STIs can cause an increased risk of HIV infection, pelvic inflammatory disease (PID), cervical cancer, infertility, ectopic pregnancy, and adverse fetal and neonatal outcomes.
According to the CDC’s most recent report, three STIs that have particularly negative health outcomes for females are surging. Chlamydia and gonorrhea rates have increased by more than 4% in 2021 compared to 2020. Most alarmingly, syphilis and congenital syphilis rates increased by 32% from the previous year.
Why do STIs predominately impact females?
STIs can impact anyone, regardless of their sex, but there are several factors that put females more at risk for certain STIs and their associated health complications.
Anatomy
Women’s bodies are uniquely conducive to STIs. The vaginal microbiome and thin lining of the vagina make it easier for pathogens to infect females.
Bacterial vaginosis (BV), a highly common condition affecting almost 30% of US women can also increase susceptibility to STIs. Women with more severe BV, have up to a 2.7-fold increase in the likelihood of STI infection.
Cultural and social factors
Women may be more likely to experience barriers to accessing healthcare, including STI prevention, testing, and treatment. Over 20% of women in the US live below the poverty line and more than 19 million women live in contraceptive deserts defined as areas with fewer than one health center for every 1,000 women in need of publicly funded contraception.
Although sexually transmitted infections are quite common, shame and stigma still prevent many people from being tested or telling partners about their infection early enough to prevent its spread.
Lack of symptoms
Some STIs may not cause any symptoms in women, or their symptoms may be mild or easily overlooked, leading to delayed diagnosis and treatment.
Additionally, males, often unknown carriers of STIs, are not encouraged to get tested without the presence of symptoms. Men also do not usually have regular health checkups during the years where rates of infection are the highest. While STIs are common in all age groups across the US, more than half of all reported cases of chlamydia, gonorrhea, and syphilis are among young people ages 15 - 24.
Lack of education + community support
Sexual health education funding continues to decrease with detrimental effects on younger populations. On a recent sexual health knowledge test administered by the CDC, the average score amongst Americans was 35%, a failing grade by educational standards. Condom use dropped from the top contraceptive tool for 75% of males in 2011 to 42% of males in 2021 most likely due to a perceived lack of risk.
Additionally, funding for community programs has failed to scale with the increased prevalence of diseases in all areas. Title X funding is down 10% from the 2010 peak, as of 2022.
Delayed diagnosis and treatment
Early diagnosis and prompt treatment are crucial in managing the transmission of STIs. However, in 2018, only 27% of women were tested for STIs by their doctors. This could be due to a lack of education, access to testing services, or absence of symptoms. However, a recent survey of over 1000 US women revealed that of the 70% who have had a vaginal infection in the last year, only 37% were able to get a diagnosis and appropriate treatment after one visit to a physician. A disproportionate number of Hispanic women compared to White women said it took a long time to get an appointment with their healthcare provider and that it took several visits to find appropriate treatment.
In addition to low rates of regular STI screening, delayed diagnosis, and treatment there is also an increase in drug resistance among STIs, including gonorrhea, even in the world’s wealthiest countries.
Opportunities for Innovation
The prevention of STIs requires a holistic approach that promotes sexual health and expands access to comprehensive health services. While an increase in public funding to develop and implement well-designed school and community programs is crucial, it won’t address the immediate need to decrease STI spread.
Thankfully, many private Femtech and healthcare companies are rising to meet this health challenge, creating innovations that educate about STIs, encourage prevention, and increase access to testing.
Prevention
Digital reproductive and sexual health apps or platforms like Chava and O.School are reaching the younger generation in a way that feels safe and accessible. The high level of personalization available within the apps makes the experience relevant and more effective for specific populations.
Promoting safer sexual practices, wearables maker Lorals offers underwear that prevents the spread of STIs during oral sex. Female-founded condom companies like Jems are also breaking the status quo and filling gaps in a market that has long-overlooked sustainability and female pleasure.
Screening
Improving rapid testing and treatment capabilities, as well as making STI screenings part of routine preventive care, is a critical step in combating the rising rates of STIs.
Visby Medical is helping healthcare providers improve point-of-care testing, getting patients answers and treatment as quickly as possible with their rapid PCR test.
Companies like BD are working to end the cycle of repeat visits, misdiagnosis, and delayed or ineffective treatments by creating an assay that uses the same sample to test for vaginitis and the three most prevalent non-viral STIs.
Ash and imaware provide end-to-end platform solutions that enable remote diagnostic testing for healthcare providers.
In the telehealth market, TBD Health, 28 Health, Nurx, and WHISPA are making at-home STI testing and treatment more convenient, accessible, and inclusive.
Treatment
Although research in STIs has evolved, a critical remaining challenge is the development of safe and effective vaccines. Vaccines currently exist for only two common STIs: HPV and Hepatitis B. Research to develop vaccines against herpes and gonorrhea is advancing but not complete. A vaccine candidate for chlamydia has entered early clinical trials and research studies into vaccines for syphilis and trichomoniasis are in earlier stages of development.
All efforts should be made to advance scientific research and build the pipeline of STI diagnostics and treatments. One promising avenue is that learnings from the rapid creation of the vaccine for Covid-19 could speed up the development of vaccines for these pervasive STIs.
As we look toward the future, Femtech will play an important role in personalizing the approach to STI prevention, diagnosis, and treatment. By creating targeted solutions that address the gaps in education, care, and treatment, there is hope for the future of lowering the burden of STIs on the female population.
About the Authors
Elizabeth Gordon is a Femtech copywriter and content strategist, Director of content strategy and communications at FemHealth Insights and the FemTech Focus podcast.
Melissa Barall is an emerging writer in the Femtech space, inspired by innovative ideas and people and seeking equity and optimization for women’s care. She works in investor relations for a financial firm and has multiple women’s health and wellness certifications.
