Data Shows STDs on the Rise as Condom Use Declines
Amid a sharp rise in gonorrhea and syphilis cases, condom use in the United States is on the decline.
Preliminary data from the Centers for Disease Control and Prevention (CDC) indicates that 2.5 million cases of sexually transmitted diseases (STDs) like chlamydia, gonorrhea and syphilis were reported in 2021.
While rates of chlamydia fell from 1.7 million to 1.6 million between 2017 and 2021, infection rates for gonorrhea and syphilis climbed steadily during the same time period. In the past year, reported syphilis cases soared 26 percent, bringing the total to heights not seen since 1948.
Concurrently, condom use among certain groups—including males and adolescents—is declining. A government family planning report for 2021 revealed that condoms were the most common contraception method for 75 percent of men in 2011, but that figure is down to 42 percent of men in 2021. Church & Dwight, the manufacturer of Trojan condoms, cited a trend of falling sales of condoms in its 2021 annual investor report.
The Youth Risk Behavior Survey from the CDC also has indicated that condom use among youth, for both females and males, has declined for the past decade. According to the survey, only 54.3 percent of high school students reported using a condom the last time they had sex, down from 61.1 percent in 2009.
"It’s not a huge change but it is a change in the wrong direction," said Jeffrey Klausner, M.D., a clinical professor of population and public health sciences at the Keck School of Medicine at the University of Southern California, Los Angeles.
Why condom use is on the decline
So what’s really behind the drop in condom use?
Klausner—who also was the deputy health officer and director of STD Prevention and Control Services at the San Francisco Department of Public Health—said the reasons vary depending on what group you’re talking about.
"Among young, sexually active heterosexuals, there may have been a decline due to increased access to other forms of contraception," Klausner said.
The CDC youth survey data confirms the decline in condom use coincides with a slight uptick in hormonal birth control methods, such as IUDs, patches, shots, birth control pills and vaginal rings. In 2019, about 31 percent of high school students reported using hormonal birth control, compared to 25 percent in 2013.
Whereas, for men who have sex with men, the introduction of more effective treatments and prevention methods for HIV may come into play.
"There also may be a decline due to people's loss of fear about AIDS, as AIDS has become more treatable and more preventable," Klausner noted.
Pre-exposure prophylaxis (PrEP), a drug that, if taken daily, reduces the risk of contracting HIV by 90 percent or more, may be playing a role in driving down condom use. Since the pill was approved in the U.S. for the prevention of AIDS in 2012, several studies have suggested people who used the pill daily are less likely to use condoms.
A research study in Australia found a rapid increase in PrEP use between 2013 and 2017 was accompanied by an "equally rapid" decrease in consistent condom use. The research fits with other studies carried out in San Francisco and The Netherlands indicating similar trends.
"The flip side of [improved prevention methods and decreased fear of AIDS] is an increase in sexual behaviors associated with increased spread of chlamydia, gonorrhea or syphilis," Klausner said.
He added that STDs like chlamydia, gonorrhea and syphilis tend to be less feared because they can be treated.
"Even though many [STDs] are curable, [if] untreated they can lead to complications like pelvic inflammatory disease, chronic pain, pelvic abscess and infertility in both males and females," Klausner warned.
How to promote safer sex
What can be done to promote safe sex and combat the decline in condom use?
Justin Lehmiller, Ph.D., a Kinsey Institute research fellow and host of the "Sex and Psychology Podcast", believes the answer starts with comprehensive sex education.
"Sex education has never been great in the United States and, in recent years, it has become increasingly politicized," said Lehmiller. "The result is that far too many people are never learning what they really need to know about sex, including how to protect themselves (and their partners)."
Klausner agrees, adding that an important piece of the solution is to begin comprehensive sex education earlier.
"As with preventative behaviors, regular condom use [must] start at as young an age as possible," he said.
Klausner advocates for including education about condom use in curriculums as early as middle school.
"It’s important to introduce [young students] to condoms and how they work and how to use them correctly and consistently," Klausner said.
He also calls for condom distribution, especially in places like bars and clubs where people might go to meet new sex partners, but also in everyday venues such as hair salons and barbershops.
"One of the best ways to increase condom use is to make them more accessible," he said.
Acknowledging the problem of longstanding dismal approval ratings of condom usage, Klausner suggested alternative measures to promote safer sex.
"We can encourage people to get a regular check-up and make sure they know what they're being tested for," he suggested.
He also cited "exciting new data" on the use of an antibiotic called doxycycline, which can be used within three days after condomless sex to help prevent chlamydia, syphilis and gonorrhea. Research indicates doxycycline can reduce the risk of chlamydia and gonorrhea by more than 60 percent.
Ultimately though, when it comes to preventing STDs, Klausner and Lehmiller remain ardent proponents of condom use.
"There are a lot of different safe sex tools out there, but condoms and other barrier methods (like dental dams) are really crucial in any safer-sex campaign," said Lehmiller. "While PrEP and the HPV vaccine are incredible tools for protection against some specific STIs, that still leaves a number of other common infections on the table, which is why barrier methods are so, so important. Currently, there just isn’t an alternative tool that provides the same kind of protection."
To combat the issue of condoms’ unpopularity, Klausner advocated framing condom use in the context of better sex.
"I used to work for the CDC, and we had different kinds of training videos that gave people tips on how to talk to partners about how to use condoms," Klausner said. "[In the videos], people talked about how condom use made them feel safer and actually enabled them to have a more complete and richer orgasm."
Lehmiller also believes there’s valuable work to be done when it comes to incorporating pleasure into safe sex messaging.
"Safe sex and pleasurable sex are often discussed separately, which can give the impression that these things are incompatible, but they aren’t!" said Lehmiller. "Instead of just focusing on how condoms can prevent STIs and unintended pregnancies, we can talk about things such as how the act of putting a condom on can be done in a sexy, erotic way. Likewise, we can emphasize how feeling safe and protected can make us feel sexier and more uninhibited because we’re able to set our minds at ease."