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Alabama — and the rest of the nation — saw a significant drop in reported STDs in 2020. That doesn’t mean, however, that cases have actually declined – and if the 2021 numbers are any indication, the opposite is likely to be the case.
STDs in Alabama increased dramatically between 2020 and 2021, according to data from the Alabama Department of Public Health. But cases are not evenly distributed across the state.
STDs by county
STD rates vary widely by county, with some areas recording rates of over 22 cases per 1,000 people and others having fewer than three cases per 1,000. You can see the rate by each county in Alabama on the map below.
[Can’t see the map? Click here.]
The Black Belt region — one of the poorest regions in the country — recorded some of the highest STD rates in the state in 2021. Each of the six Alabama counties with the highest STD rates was in the Black Belt, including densely populated Montgomery County, home of the state capital, with a rate of 18.7 cases per 1,000 residents, the second highest in Alabama.
Jefferson County, home of Birmingham and the most populous county in Alabama, saw nearly 15 cases per 1,000, the seventh-highest rate in the state. Mobile County, the second largest county in Alabama, ranks just under the top 20 for the STD rate at 11.8 per 1,000 residents. Madison County, home to Huntsville — Alabama’s largest city — ranked 25th out of 67 counties with an STD rate of 10.3 per 1,000.
Each of these large counties recorded a higher rate than the state as a whole, which stood at 9.9 cases per 1,000.
The COVID dip
STD cases statewide were up in 2021, particularly cases of chlamydia, by far the most common type of STD in the state. But gonorrhea and syphilis cases also increased.
[Can’t see the chart? Click here.]
ADPH reports that there were more than 31,400 chlamydia cases in Alabama in 2021, up from 27,000 in 2020. That’s a difference of more than 4,000 cases, or a 16% increase. The 2021 figure is a slight increase from pre-pandemic levels, and overall STD cases have been rising steadily since the middle of the last decade.
according to dr However, Jodie Dionne, an associate professor of medicine in the Department of Infectious Diseases, the year-over-year difference from 2020 to 2021 is likely not due to a big change in actual cases, but rather a big change in testing diseases at the University of Alabama in Birmingham.
“As of March 2020, there has been a roughly 25% drop in STI testing,” she said. “That’s because clinics were closed.”
COVID-19 has shut down nearly every aspect of life, including STD testing. The Centers for Disease Control and Prevention is also warning against taking the 2020 numbers too literally as screenings and other complications from the pandemic fall across the country.
But just because clinics were closed and testing stopped, doesn’t mean STDs weren’t spreading. And in many cases, testing is key, as many STDs go undetected without a test.
“Most STIs, especially in women, are asymptomatic,” Dionne said. “If we don’t do these tests, we miss out on new infections because most people feel fine.”
And if testing is down 25%, experts fear missing 25% of cases, she said.
But there is at least one good thing that has come out of the pandemic – the advent of at-home testing. COVID-19 home testing kits are now widely available in the United States, and this mindset shift could spread to other forms of health diagnostics, Dionne said. That includes a future where people can test themselves for sexually transmitted diseases from the comfort of their own homes.
Dionne mentioned ADPH’s statewide pilot program, which currently has limited resources but is experimenting with these home tests.
“These aren’t complicated tests — just like a COVID test,” she said. “Often people prefer to make them themselves.”
Have an idea for a data story about Alabama? Email Ramsey Archibald at [email protected]and follow him on Twitter @Ramsey Archibald. Read more data stories from Alabama here.
