SIOUX FALLS, S.D. — Public health officials in Minnesota and the Dakotas are concerned about the number of reported sexually transmitted diseases in their states and the effect of limited testing and attention during the COVID-19 pandemic.

While sexually transmitted diseases case counts are at or near record highs, public health officials in the region say the COVID-19 pandemic limited testing in 2020, likely masking what could be an even more serious situation — especially with a rising surge of gonorrhea cases.

Here's a summary of the key concerns in those three states:

  • Minnesota: While STD cases fell slightly year over year in 2020, that wasn't particularly encouraging for state health officials, who also marked a decline in testing as the COVID-19 pandemic limited access and led to a nationwide shortage in testing supplies.
  • North Dakota: The state reported its first congenital syphilis cases in a decade in 2020, marking a concerning appearance of the STD in the unborn.

  • South Dakota: South Dakota is experiencing a syphilis outbreak, with cases about 10 times higher than usual — about 500 so far in 2021 compared to a usual yearly reported total of 50-60 cases.

How much difference did the pandemic make to STD testing and case counts? Probably quite a lot, according to the Centers for Disease Control and Prevention. Data collected by the agency found that reported STD cases nationwide plummeted in March-April 2020 and then significantly rebounded later in the year.

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The CDC identified three possible reasons for the trend line in a July report: Reduced screening because many health care clinic limited in-person visits or were closed, many state and local health department staffers had to switch from STD work to COVID-19 work and stay at home orders in some states may have limited STD transmission.

Local public health officials in the region echo the CDC's concerns.

Minnesota

The COVID-19 pandemic definitely affected STD tracking in Minnesota. It led to limited testing at two major STD clinics in the population-heavy Ramsay and Hennepin counties, said Christine Jones, the STD, HIV and TB section manager for the Minnesota Department of Health, and also caused a nationwide shortage of testing supplies.

So the 2020 data — showing a slight decrease in reported STD cases — might not accurately reflect the state of STDs in Minnesota.

"We do believe the pandemic definitely may have impacted those rates, because of access to testing and care that was impacted by the stay at home orders," Jones said.

Even though reported STD cases declined overall, gonorrhea cases climbed 27%. It's not clear why there were more reported gonorrhea cases. In Minnesota, 74% of the cases were reported in the Twin Cities metro and suburban areas, and 41% were reported among those 15-21 years old.

And while it's not exactly clear why Minnesota's gonorrhea case count is rising, that also matches a nationwide trend.

"One of the things I think may have contributed to some of the increasing rates historically is the abstinence-only sex education in schools," she said. "So there just was not talk about prevention of STDs, I think that could have played a role into it."

But a sea change in the cultural conversation about STDs, powered by public health campaigns, changing social conventions and additional testing, might also mean cases that might otherwise have gotten ignored are now getting reported, she said.

"If you look for something more, you're going to find more of it, which is actually a good thing," Jones said. "We like to see that, because hopefully that equates to folks getting treated sooner."

North Dakota

In North Dakota, the number of reported STD cases slipped in 2020 from the previous year, but limited access to testing in the early days of the pandemic may have contributed to the reduced case count, said Shari Renton, HIV/STD/viral hepatitis surveillance coordinator at the North Dakota Department of Health.

"The concerning thing is, even though we know there were decreases in testing for gonorrhea, we still saw an increase," she said. "And that's what we're seeing nationwide as well — gonorrhea is increasing at really an alarming rate."

Renton said due to the department-wide response to the COVID-19 pandemic, it couldn't follow up with gonorrhea cases like it usually would, which could have contributed to the increase in gonorrhea cases.

Still, while STD cases remain sky high in historical terms, 2021 is tracking to roughly match the lower case count of 2020.

The Department of Health is working to remind health care providers about new treatment guidelines for gonorrhea, and "pushing hard" for pregnant women to get tested three times for syphilis during pregnancy.

That's to address another particular concern: three syphilis cases in 2020 were congenital cases, the first reported in North Dakota in a decade, matching a rising national concern.

"It's definitely increasing, and that's a big priority for our health department, is just really to stop that transmission of syphilis to infants," Renton said.

South Dakota

A woman shoots a blaster at sexually transmitted diseases in this comic book-like illustration included in the "Got It Covered" public health campaign produced by the South Dakota Department of Health to educate and provide resources to state residents about the rising number of STDs reported in the state. (Submitted / South Dakota Department of Health)
A woman shoots a blaster at sexually transmitted diseases in this comic book-like illustration included in the "Got It Covered" public health campaign produced by the South Dakota Department of Health to educate and provide resources to state residents about the rising number of STDs reported in the state. (Submitted / South Dakota Department of Health)

As of Nov. 11, there have been 511 reported cases of syphilis in South Dakota so far in 2021. That's more than 10 times higher than most recent years, or 1,011% higher than the median year-to-date 5 year average of 46. Gonorrhea and chlamydia cases are up as well, though not as much.

"Really, we had a fairly syphilis naïve population previously," said Angela Jackley, assistant administrator of disease prevention services at the South Dakota Department of Health. "We didn't have a lot to compare it to; we had few syphilis cases."

The Health Department's investigations found that of those who have tested positive for syphilis and gonorrhea, more than half are using drugs.

"They're not using condoms, they're having sex while they're intoxicated," she said.

Of particular concern are case spikes in Pennington, Todd and Minnehaha counties. The Health Department is promoting STD testing, including via social media and holding large testing events in the higher-risk communities, including the state's jail population.

"We're out there, we're testing and treating," Jackley said.

Of additional concern: the Health Department is finding more cases of congenital syphilis. But Jackley said the department has caught and helped treat 75% of the cases it's discovered. It's encouraging health care providers to regularly screen for STDs as part of routine health exams and in prenatal care.