Sexually Transmitted Infections Plague Minnesotans Across the Age Spectrum
Minnesotans contracted sexually transmitted infections (STIs) more in 2015 than in any other year in the 21st century. According to the Centers for Disease Control and Prevention (CDC), incidence rates (the number of new cases) of chlamydia, gonorrhea, and syphilis have all risen since 2000. Worryingly, this trend holds true across almost the entire age spectrum, from high schoolers to seniors and everyone in between. Though the Minnesota Adolescent Sexual Health Report (ASHR) detailed how sexual health practices improved for Minnesotan high schoolers, STIs still spread far too rapidly in Minnesota this century.
Minnesotans suffer more from STIs now than they used to
Regardless of how we slice the data, Minnesotans have contracted more STIs recently. Chlamydia incidence rose in Minnesota from 164 per 100,000 in 2000, to 389 per 100,000 in 2015. Minnesotans aged 15 to 29 were hit the hardest. For 15 to 19-year olds and 25 to 29-year olds, one out of a hundred Minnesotans contracted chlamydia; for 20 to 24-year olds, one of fifty. The same age groups, as well as those in their thirties, also experienced higher incidence rates of gonorrhea and syphilis.
Every single adult age cohort experienced a rise in STI incidence since 2000. Chlamydia rates nearly quintupled for Minnesotans in their forties and early fifties. Syphilis rates in 2000 never grew past a sole case per 100,000 people; in 2015, only Minnesotans 65 and older remained under that threshold.
Of course, age is only one way to examine Minnesota’s growing STI epidemic. Black Minnesotans, Native Americans, and Native Hawaiian or Pacific Islanders experienced higher incidences of STIs than other races or ethnicities. Racial disparities in STI rates are correlated with a number of factors, such as differences in access to quality health care, increased poverty, or geographic isolation.
In Minnesota, incidence rates for different STIs vary based on gender. For instance, chlamydia rates in women roughly doubled the rates in men, but that disparity may belie a statistical propensity for young women to seek care for sexual health more often than young men. Women and men experienced similar incidence rates of gonorrhea over the past 16 years, while men contracted syphilis more than women—rates of infection are higher in populations of men that have sex with men.
STI incidence also varies by geography. Both Hennepin County and Ramsey County historically struggled with high incidences of STIs. In Greater Minnesota, experiences ranged from routinely healthy to perpetually high rates of STIs. Counties with universities often had higher incidence rates of chlamydia and gonorrhea than counties without a university. Beltrami County, which includes Bemidji State, had the fourth-highest rate of chlamydia and the eighth-highest rate of gonorrhea in 2015. Counties that include parts of Tribal Reservations also had higher rates of STIs—Mahnomen County (home to the White Earth tribe) topped the state in both chlamydia and gonorrhea incidence rates in 2015.
On the other end of the spectrum, the following counties had no cases of syphilis since 2000, and were among the 20 lowest average incidence rates of chlamydia and gonorrhea: Lac Qui Parle, Lake, Lake of the Woods, Pipestone, Redwood, Swift, and Wadena.
Teens pregnant less often, but suffer from more STIs
Because rates of STIs in teens have risen most sharply since 2000, let’s focus on how teens fared on sexual health metrics. Minnesota teens improved markedly on unintended pregnancies. Teen pregnancies have plummeted since 2000; from 1990, pregnancy rates for 15 to 17 year olds dropped by 77%, and by 63% for 18 to 19 year olds.
Reduced teen pregnancies and births correlate with increased use of intrauterine devices (IUDs) and implants, which are the most effective reversible methods of contraception available. Teens are also having less sex overall. In 1998 23% of ninth graders reported an instance of sexual intercourse; by 2016, only 11% reported sexual intercourse. And teens today discussed pregnancy prevention and STI prevention with each of their sexual partners more often than teens back in 1998. Unfortunately less sex and higher IUD use have not correlated with fewer STIs.
Minnesota teens and young adults seem to be having more sex without condoms. Ninth graders used condoms less often in 2016 than at any time since 1998. Since IUDs drastically reduced the risk of unintended pregnancy, young people perhaps conflate pregnancy prevention with STI safety. Other developments in HIV/AIDS prevention, like the life-saving PrEP treatment that protects partners of HIV+ people from contracting HIV, maybe provide a similar false sense of security from other STIs.
Unclear paths forward, but we need a comprehensive shift
STIs are a problem for truly every single subgroup of Minnesotans at or near adulthood. People of all races, ethnicities, genders, religions, ages, and sexual orientations are all susceptible to the higher prevalence of STIs than in the past, so interventions that only target high-school-aged people will likely fail to stem the tide.
Regulations for sexual education already come up short in Minnesota. Though 80% of schools teach sex ed with an emphasis on multiple methods of contraception, abstinence-only courses still see the light of day. Squeamish parents may also, by law, excuse their children from sex education. Children need the most comprehensive information possible—particularly those raised by sexually uneducated parents. Tinder and Grindr are less than a decade old; unprotected sex in nursing homes has exploded; and, LGBTQ issues and affirmative consent are just now becoming priorities. In an age when attitudes towards sex are as varied and diverse as our population, the needs of specific populations radically change. Minnesotans need as much good sex education as they can get.
One country could definitely be the model for introducing condoms to people of all ages. Thailand vastly reduced birth rates and HIV incidence via a massive public health campaign to distribute condoms across the entire country. The sort of candor and humor in that campaign definitely saved lives in Thailand, and it could do the same here.