Alabama is among the leading states in sexually transmitted diseases (STDs), and the number of cases continues to rise. The situation is particularly concerning in Jefferson County, as it recorded the highest number of cases in 2016-2017. According to the Centers for Disease Control and Prevention (CDC), sexually transmitted infections (STIs) have become the 6th greatest health concern in Alabama.
The rates of most common STDs, including syphilis, chlamydia, and gonorrhea, are at an all-time high in the USA, as per a 2019 report from the CDC. Between 2017 and 2018, nearly 2.5 million cases were reported for the three abovementioned STDs. The report suggests that over 1.7 million chlamydia, 115,045 syphilis, and 583,405 gonorrhea cases were reported during this period.
In Alabama, two urban areas, Birmingham and Montgomery, were ranked among the top 20 cities in the USA that reported the highest STDs rates. This includes HIV and the three common STDs. In contrast, Huntsville and Mobile have listed among the top 100 worst US cities in STDs prevalence. It must be noted that Alabama has the 4th highest gonorrhea infection rate in the USA.
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The inclining number of congenital syphilis cases in Alabama a concerning issue for the state’s Department of Public Health as it had grown from 2 in 2013 to 20 in 2020. Reportedly, Alabama had 14 cases of congenital syphilis in 2019 and 20 cases in 2020, recording an increment rate of 35.5 cases/100,000 live births.
From 2019 to 2020, congenital syphilis cases in Alabama, marking a 143% increase. That’s quite a serious issue considering that congenital syphilis is preventable easily if early detection and treatment are ensured. Pregnant women must get themselves tested at least once every trimester and 30 days prior to delivery to make sure the unborn child doesn’t get infected with congenital syphilis.
The Alabama Department of Public Health encourages healthcare providers to screen all pregnant women vulnerable to syphilis infection, assess all pregnant females for symptoms, signs, or history of syphilis, and test them for syphilis at their first prenatal visit, then at 28 weeks, again at 32 weeks and before delivery.
It is one of the most pressing issues in Alabama because untreated syphilis during pregnancy may cause miscarriage, premature birth, stillbirth, death soon after birth, neurological/physical defects in the newborn, and low birth weight. Infants born with congenital syphilis can have severe anemia, deformed bones, and enlarged spleen and liver. They may also be born with jaundice and brain/nerves-related health issues like deafness, blindness, and skin issues like rashes and meningitis.
In Alabama, STD/HIV home testing kits are also available by mail, particularly for men who have sex with men, transgender people, and people on PrEP therapy. People can request one test after every 3 months.
Across the state, it is possible to get tested for STDs for people of all ages due to the widespread network of screening facilities. The problem is that given its stigmatic nature, people refrain from getting tested and end up increasing the risk proportion for the entire community. Therefore, it is essential to get tested for STDs if you are sexually active.
According to the Alabama State Public Health Department, chlamydia is a commonly prevalent STI in Alabama and the USA. It is caused by the chlamydia trachomatis bacterium. It is the most commonly reported STI in both Alabama and the United States.
Gonorrhea is caused by Neisseria gonorrhoeae bacterium and is the 2nd most common STI in Alabama. The state reported the country’s 2nd highest rate for new infections trailed only Louisiana. Syphilis is caused by Treponema pallidum bacterium, and it is another commonly reported STI in Alabama. However, the state reportedly has a low rate of new primary and secondary (P&S) syphilis cases compared to the national statistics. These are the most infectious and life-threatening stages of syphilis.
Innerbody, an online medical and wellness testing platform, used CDC’s 2018 STD surveillance report to determine the overall STD rates across the USA. The assessment factored in HIV, chlamydia, gonorrhea, and syphilis. The study indicated that the two largest cities in Alabama, Montgomery, and Birmingham had the fifth and 20th highest STDs rates in the country in 2018. Montgomery metro reportedly had 2,400 STD cases/100,000 people. Five other Alabama cities made to the list, including Huntsville, which ranked 79th with 1,400 cases/100,000, and Mobile ranked 49 with 1,300 cases/100,000 people. Tuscaloosa ranked 57 with over 12,00 cases Decatur ranked 69 with less than 1,200 cases/100,000 people.
As per the STD surveillance report for January to March 2021, Black people reported the highest number of chlamydia cases compared to other races/ethnicities in Alabama. In 2018, there were 12,157 reported chlamydia cases among blacks, while so far, in 2021, the number is 2,264. Compared to 41% of all cases in the state back in 2018, there are already 32.4% cases reported in Alabama among blacks. It is worth noting that the data is for the first three months of 2021.
In contrast, whites reported 3,997 (13.6%) in 2018, and in 2021, the total new diagnoses so far are 781 (11.2%). Hispanics reported 556 chlamydia infections in 2019 with 1.9% of all cases, and in 2021, the total diagnoses are 133 with 1.9% of all cases. Gender-wise, in 2018, the reported chlamydia diagnoses among males was 9,013, and in 2021 it is 2,113. Conversely, females reported 20,285 cases in 2018, and in 2021, there have been 4,829 chlamydia diagnoses.
Gonorrhea infections among blacks are also on the rise compared to other races. In 2018, the number of gonorrhea infections was 6,222, with 48% of all cases in the state, while until March 2021, there have been 1.489 cases so far, which is 40% of all cases.
Whites reportedly accounted for 1,820 cases or 14.0% of all diagnoses in 2018, whereas in 2021, they have 429 or 11.7% diagnoses so far. Hispanics had 133 or 1% of all cases in 2018, and in 2021 there have been 27 gonorrhea diagnoses. In 2018, males reported 6,655 or 51% of all gonorrhea diagnoses, while in 2021, their rate is 50%, with 1,864 cases overall. Comparatively, females reported 48% of all infections in the state with 6,262 cases in 2018, and in 2021 they account for 48% of total gonorrheal infections with 1,798 cases.
Regarding P&S syphilis, black Alabamians reported 322 or 70% of all cases in 2018. In 2021 there have been 64 or 67% cases so far. In whites, the number of P&S syphilis diagnoses was 120 or 26% in 2018 while this year, they have reported 20 cases or 21% of all cases by March. Hispanics reported 4 cases in 2018, and 3 cases are reported by March 2021, marking 1.3% and 3.2% of all cases, respectively. Males reportedly had a higher proportion of P&S syphilis cases in 2018, with 81% of all cases compared to 71% among females. The situation is not too different. Currently, males have reported 74% cases, whereas females have 25% cases of syphilis.
STIs can be transmitted via sexual contact with an infected person. In Alabama, the Division of STI Prevention and Control of the ADPH is responsible for carrying out disease investigations and partner notifications for gonorrhea, chlamydia, syphilis, HIV, and trichomoniasis. This division’s long-term goals include reducing STI incidence and their sequela to improve STI services integration into clinical care across the state’s healthcare system. Furthermore, the division aims to increase STI services’ access for most at-risk population segments and reduce the threat of antibiotic-resistant emerging STIs, congenital syphilis, and gonorrhea.
Moreover, the Alabama Department of Public health, with its 67 health departments, operates free and secretive/confidential STD clinics across the state. The department offers free testing and treatment facility for HIV, chlamydia, syphilis, and gonorrhea.
The Alabama Department of Public Health Division of Sexually Transmitted Disease Prevention and Control collaborated with Binx Health to implement home delivery STD/HIV test kits via mail. This initiative aims to promote STD/HIV testing among individuals at home to strengthen the STD/HIV control and prevention program in the state. There are particular criteria residents in Alabama have to meet to receive the testing kits. This facility is available to people who identify themselves as transgender people, men who have sex with men, and people on PrEP therapy.
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