Sexually transmitted diseases have hit crisis levels and are on the rise in America, according to new data from the Centers for Disease Control and Prevention (CDC). The data show that total chlamydia, gonorrhea, and syphilis cases hit an all-time high in 2017 with nearly 2.3 million cases reported to CDC, surpassing the total reported to CDC for 2016 by more than 200,000 cases. Here are nine things you should know about the current STD crisis in America.

1. Sexually transmitted diseases (STDs)—also called sexually transmitted infections (STIs) or venereal disease (VD)—are infections passed from one person to another through sexual contact. The causes of STDs are bacteria, parasites, yeast, and viruses. There are more than 20 types of STDs, including chlamydia, genital herpes, gonorrhea, HIV/AIDS, HPV, syphilis, and trichomoniasis (aka, “trich”). Some diseases, such as Zika and Ebola, can be spread sexually but are not commonly classified as STDS since they are more often spread through ways other than sex.

2. Gonorrhea is caused by infection with the Neisseria gonorrhoeae bacterium, which infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. According to the CDC, gonorrhea diagnoses increased 67 percent overall (from 333,004 to 555,608 cases according to preliminary 2017 data) and nearly doubled among men (from 169,130 to 322,169). Increases in diagnoses are also being found among women, with cases going up for the third year in a row (from 197,499 to 232,587). The highest reported rates of infection are among sexually active teenagers, young adults, and African Americans.

3. Gonorrhea has become increasingly resistant to nearly every class of antibiotics used to treat it, except to ceftriaxone, the only remaining highly effective antibiotic to treat gonorrhea in the United States. In 2015, CDC began recommending health-care providers prescribe a single shot of ceftriaxone accompanied by an oral dose of azithromycin to people diagnosed with gonorrhea. Azithromycin was added to help delay the development of resistance to ceftriaxone. New CDC findings, however, show that emerging resistance to azithromycin is now on the rise in laboratory testing. “We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” says Gail Bolan, M.D., director of CDC’s Division of STD Prevention.

4. Syphilis is an STI that is divided into stages—primary, secondary, latent, and tertiary—with different signs and symptoms associated with each stage. A person with primary syphilis generally has a sore or sores at the original site of infection. Symptoms of secondary syphilis include skin rash, swollen lymph nodes, and fever. Primary and secondary syphilis are the most infectious stages of the disease, but the signs and symptoms can be mild and they might not be noticed. Primary and secondary syphilis diagnoses have increased 76 percent (from 17,375 to 30,644 cases). Men who have sex with men made up almost 70 percent of primary and secondary syphilis cases where the gender of the sex partner is known in 2017. Men who get syphilis are also at high risk of being diagnosed with HIV in the future. Syphilis can be cured with antibiotics, though treatment will not undo any damage that the infection has already caused.

5. Chlamydia can infect both men and women, but is most harmful to women, since it can cause serious, permanent damage to a woman’s reproductive system. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb). While it is curable with antibiotics, most people who have chlamydia have no symptoms and may not be aware they have the STD until it has already caused permanent damage. This disease remained the most common STD reported to CDC. More than 1.7 million cases were diagnosed in 2017, with 45 percent among 15- to 24-year-old females.

6. Genital herpes is caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Genital herpes is common in the United States, with more than one out of every six people aged 14 to 49 years old having the STD. There is no cure for herpes, though medication can prevent or shorten outbreaks. (Oral herpes is usually caused by HSV-1 and can result in cold sores or fever blisters on or around the mouth. However, most people do not have any symptoms. Most people with oral herpes were infected during childhood or young adulthood from non-sexual contact with saliva.)

7. Human Papillomavirus (HPV) is the most common STI, with 79 million Americans, most in their late teens and early 20s, infected with HPV. There are many different types of HPV, and some types can cause health problems including genital warts and cancers. While HPV can be prevented through vaccination, there is no treatment for the virus itself.

8. HIV (human immunodeficiency virus) is the virus that can lead to acquired immunodeficiency syndrome (AIDS). HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Unlike some other viruses, the human body can’t get rid of HIV completely, so those infected with HIV have it for life. People who have other STDs are more likely to get HIV, when compared to people who do not have STDs. In 2015, there were an estimated 38,500 new HIV infections. Men who have sex with men are the most susceptible risk group, representing an estimated 26,200 of these new HIV infections.

9. STDs are a pro-life issue because they can affect development of a baby in the womb, be transmitted to the child during the birthing process, and even cause infant death. For instance, in 2016 there were 628 cases of congenital syphilis among newborns, with more than 40 deaths and severe health complications among the babies who survived. “This is a completely preventable problem,” Gail Bolan, director of CDC’s Division of STD Prevention, told CNN last year. “Every baby born with syphilis represents a tragic public health system failure. All it takes is a simple STD test and antibiotic treatment to prevent this tragedy from occurring.”

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