We set out to discover the regions of the world with the lowest rates of sexually transmitted disease (STD). What we actually discovered took us by surprise!
STDs Are On the Move & Spreading Faster Than Ever
Across the globe, STD rates are rising at an alarming rate. More than 1 million sexually transmitted diseases are acquired every day, worldwide. More than 500 million people are estimated to have a genital infection with herpes simplex 1, and more than 290 million women have human papilloma virus (HPV infection 1).
Chlamydia, drug-resistant gonorrhea and syphilis are on the rise in the United States and other nations, creating an epidemic that has health officials extremely concerned. The amount of people with HIV has increased, although some attribute the higher numbers to the fact that fewer people are dying from it.
Among developed nations, the United States has the highest STD rate. One of the reasons why STDs are exploding in America is a rise in condomless sex among men who have sex with men. Some attribute this risky behavior to:
- Success in treating HIV and PrEP (pills that can prevent HIV)
- Dating apps like Tinder and Grindr that make sex more available and anonymous
- The Great Recession, which resulted in cuts to public health funding.
Regions that have low STD rates, like Vermont and Croatia, have certain traits in common:
- Available resources
- A commitment to health and sexual education
- And an effort to de-stigmatize STDs
Read on to learn about world regions with the highest and lowest rates of four common STDs and why some of them are on the rise.
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Since the beginning of the HIV (human immunodeficiency virus) epidemic, more than 70 million people have been infected with HIV.
THE GOOD: Bosnia is the country with the lowest HIV rate in the world, with only 350 reported cases as of 2016. Their low rate may be attributable to their educational programs, which are intended to reduce HIV-related stigma. With support and funding from the United Nations Development Programme, as well as from the Global Fund to Fight AIDS, Bosnia has been working to prevent and treat AIDS since 2006.
The second-lowest HIV rates are found in Croatia, which has 1,500 reported cases as of 2016. Croatia has monitored the HIV/AIDS situation since their first case was reported in 1985. The Croatian National Programme for HIV/AIDS emphasizes health education in the general sense, especially focusing on populations with high risk behaviors. Croatia plans to continue with current prevention, awareness and control measures. These strategies have proven effective in reducing risk of HIV infection.
In America, Vermont has the lowest HIV rate with 122 out of every 100,000 people infected. Vermont is one of the healthiest states when it comes to sexual health and it has many available resources.
THE BAD: On the other end of the spectrum is Swaziland, Africa, which has the highest HIV rate in the world. Over a quarter of the population, 220,000 people, are infected with HIV. Two of the factors that contribute to the high HIV rate are (1) high levels of discrimination and stigma, which prevent people from accessing services; and (2) the highly mobile population. Some positive news is that Swaziland is making progress in its battle. The number of new infections among adults has nearly halved since 2011, thanks to successfully increasing the number of people accessing antiretroviral treatment. It has also increased its own domestic funding to respond to the epidemic.
In America, Washington, DC is struggling with the HIV epidemic. According to the Centers for Disease Control and Prevention (CDC), the District leads the nation in the rate of HIV infection. As of 2017, 2,665 out of every 100,000 people are infected with the disease.
DRUG USE & HIV: HIV infections in America have actually dropped 18 percent in six years, according to the CDC, with the biggest decline among IV drug users. Officials worry, however, that the opioid crisis will soon offset these strides.
Indeed, intravenous drug use is a huge problem in the fight against HIV. Not only is the virus transmitted through reused needles, but injection drug users also engage in high-risk sexual behavior which facilitates transmissions.
In some Brazilian cities, 60% of IV drug users are HIV positive. Not surprisingly, Brazil is the country with the highest HIV infection rate in Latin America. The Brazilian government continues to provide free needle exchanges in order to reduce HIV transmission.
Chlamydia is often symptomless, which makes it difficult to diagnose and easy to spread. It also gives it another nickname: The Great Imitator.
It can affect not just the genitals, but also the anus, throat, and eyes.
THE LOWEST RATES IN THE WORLD: According to the World Health Organization (WHO), the European Region of the world, which includes the Russian Federation and the United Kingdom, has the lowest chlamydia rates at 8.9 million cases. Alternatively, the Western Pacific Region, which includes Mongolia, China and Australia, reports the highest rates: 60 million cases.
THE CHLAMYDIA CAPITAL OF EUROPE: Although the European Region has the lowest rate, one of its countries, Iceland, is the chlamydia capital of Europe. With 618 cases per 100,000 people, Europeans have come to call chlamydia “the Reykjavik Handshake.” Iceland has the highest rate of Hepatitis B and C in Europe, as well. Iceland is well-known for its casual sexual culture, which believes in sex first, dating (perhaps) later.
STATE-SIDE NUMBERS: Although chlamydia rates have stabilized in Europe, they are on the rise in the United States. The amount of cases per 100,000 went from 251 in 2000 to 497 in 2016. The CDC notes that the statistical increase may be partially due to increased testing, rather than an actual jump in cases.
Alaska is the state with the highest chlamydia rate. 771 out of every 100,000 people are infected. Alaska has a very high syphilis and gonorrhea rate as well.
Washington DC has an even higher chlamydia rate than Alaska: 1083 cases per 100,000 people. By contrast, Vermont and New Hampshire have the lowest chlamydia rates.
Gonorrhea: AKA The Clap
Gonorrhea is a bacterial infection that affects the genitals and, if left untreated, can lead to pelvic infections, inflammation of the heart valves, arthritis, and eye infections.
BY THE NUMBERS
About 78 million new cases of gonorrhea are reported worldwide each year.
The most concerning aspect of gonorrhea is that it is becoming treatment-resistant. More than 60% of countries surveyed around the world have reported cases that resist last-resort antibiotics, according to WHO. Three months ago, Public Health England reported its first multi-treatment resistant strain of gonorrhea.
THE HIGHS: The highest rate is in the Western Pacific Region, with over 35 million reported cases. The Russian Federation had the highest rate in Europe as of 2015. Still, the rate of gonorrhea in the United States is far higher than any European nation.
In 2016, a total of 468,514 cases of gonorrhea were reported in the United States. Mississippi is the state with the most cases of gonorrhea: 672 out of every 100,000 people are infected. Incidentally, Mississippi ranks number three for cases of chlamydia, and number seven for syphilis. “We don't know exactly why they are so high here, but there are definitely ways to prevent STDs”, said Dr. Taylor Banahan. “I have a feeling that the population here isn't doing a great job with those things.”
AND THE LOWS: The lowest incidences of gonorrhea are found in the Eastern Mediterranean and European Regions, according to WHO. As of 2012, Luxembourg had one of the lowest gonorrhea rates in Europe. Vermont has the lowest rate of gonorrhea, with only twenty cases per 100,000 people.
Syphilis: AKA Bad Blood
Syphilis is a bacterial infection that can be fatal if not treated. Its symptoms include rash, swelling of the lymph nodes, and a feverish state. Left untreated it can cause strokes, paralysis, blindness numbness, meningitis, dementia, heart disease, and even death.
RISING BACK UP: In the 90s, syphilis was on the decline in the developed world due to widespread antibiotic use, but in the past 18 years rates have been increasing in the US, the UK, Australia, Canada and Europe, mostly among men who have sex with men.
In Canada, the rate of infectious syphilis increased by 85.6% between 2010 and 2015. “Ten years ago, syphilis was virtually eliminated in North America, but there’s been an outbreak in the last few years across Canada and especially in the bigger urban settings,” deputy medical health officer Dr. Johnmark Opondo says. “It’s high-risk behaviour associated with multiple partners and it’s spreading through multiple sexual networks. It’s predominant among men who have sex with men, but some of those men also have sex with women, so it’s a concern for everyone.”
THE MOST INFECTED REGIONS: In Europe, the Republic of Moldova and the Russian Federation are the countries with the highest syphilis rate. Meanwhile, Washington DC has the highest syphilis rate in America, with 85 out of every 100,000 infected.
It's worth noting that we discussed DC's high chlamydia and HIV rates earlier. Washington, D.C. has earned the top spot in the nation for the highest rates of sexually-transmitted diseases.
THE LEAST INFECTED: According to WHO, as of 2012, syphilis rates were lowest in the European and Eastern Mediterranean regions. The lowest rate of syphilis is in Croatia, which also has the lowest HIV rate and emphasizes health education.
Wyoming has the lowest syphilis rate of any U.S. state, with just 1.2 cases per 100,000 people. Wyoming has a state program that offers free or low-cost STD screenings, as well as condom distribution services that make protection available to people throughout the state. Coincidence?
Can We Find The Cure?
Regions with a commitment to health education, resources, STD destigmatization—and the funding to provide these services—are faring better in the fight agains STDs; but even they’re not immune to this epidemic.
Despite its generally low STD rate, Vermont is also seeing an increase in chlamydia, gonorrhea, and syphilis that has health officials worried. While Bosnia has a great commitment to sexual education and awareness, health officials are noting that many 15 to 24 year olds are involved in high-risk behavior such as injecting drugs and having unprotected sex.
WHO calls STDs a “major burden of disease” worldwide and has developed three global health sector strategies for STDs. These strategies are aimed at all countries across the world, and highlight the importance of investment in research and innovation.
With the continued decrease in CDC STD funding in America, officials warn that the epidemic is going to get much worse. Research, sex education, accessible disease testing, public awareness—and the funding to provide them—are crucial for fighting the global STD issue.