Philly has the highest STI rate in the country – improving sex education in schools and access to home testing could lower rates

Philadelphia ranks first among U.S. cities in the number of new sexually transmitted infections (STIs), according to the latest data from the Centers for Disease Control and Prevention.

This is an improvement from fifth place in 2023 and puts Philadelphia ahead of four cities that were previously higher ranked: Memphis, Tennessee; Jackson, Mississippi; New Orleans and St. Louis.

Among 15- to 24-year-olds in Philadelphia, syphilis cases have increased 30% since 2019, while gonorrhea cases have increased 18%. Chlamydia cases have decreased 13% in this age group compared to pre-pandemic levels, but remain high.

As a professor of public health, I research sexual health issues and disparities among Black men who have sex with men and other marginalized groups. I work directly with these communities to research and develop health interventions that meet their needs.

I know that quality sex education and access to confidential STI testing are two important barriers to young people’s sexual health.

Sex education in schools

In the United States, sex education is mandatory in elementary and secondary schools in 28 states and Washington DC. These programs are usually comprehensive and include education about sexually transmitted diseases.

However, Pennsylvania is not one of these states.

Pennsylvania state law requires schools to offer classes on the prevention of HIV and AIDS and other “life-threatening and communicable diseases” – but it does not specify sexually transmitted diseases.

Each school district in the state can decide which instructional materials to use to meet the requirements. This information does not have to be medically accurate or supported by evidence-based research.

Furthermore, schools are not required to talk about topics such as consent, sexual orientation and gender identity, or healthy sexual relationships.

Abstinence-based vs. comprehensive

The lack of more specific policies and standards led to controversial sex education classes in the Wallingford-Swarthmore school district in suburban Philadelphia in 2018. A 17-year-old student filed a complaint with the school district because the RealEd “relationship education program” she attended advised avoiding kissing and cuddling because it could lead to hormone deficiencies and “make it harder to bond with a future spouse.”

Other students reported that the curriculum taught them that having too many sexual partners makes them “less sticky” – like a reused piece of tape – and prevents them from having healthy relationships.

Research suggests that education programs that emphasize abstinence do not reduce the incidence of sexually transmitted diseases and HIV. In some cases, they may even lead to an increase in cases of sexually transmitted diseases.

In contrast, studies have shown that comprehensive sex education programs in schools have led to less sexual activity, increased contraceptive use, and fewer teen pregnancies. These comprehensive programs are medically accurate and age-appropriate, and provide adolescents with comprehensive sexual health knowledge that goes beyond HIV, STDs, and abstinence.

It is not clear whether comprehensive education programs directly lead to a reduction in sexually transmitted diseases, but research shows that comprehensive education consistently leads to increased safer sex practices.

While the Philadelphia School District does not provide specific policies regarding sex education, it confirmed via email that all 218 schools in the district (excluding alternative and charter schools) use select lessons from the sex education curriculum, “3Rs: Rights, Respect, Responsibility,” as part of health classes for grades K-12.

In addition, the Office of Health, Safety and Physical Education works closely with a grant-based program called Promoting Adolescent Student Health (PASH). The program “focuses on reducing adolescent risk behaviors that lead to unintended pregnancy, sexually transmitted diseases and HIV” at 17 focus schools in the city.

Confidential testing and other strategies

Since Philadelphia lacks tailored, comprehensive sex education programs for all school-age youth, here are some evidence-based strategies that can be implemented to reduce the rate of new STI infections.

Other relevant courses: Current sex education programs could cover a wider range of sexual health topics, such as healthy communication and sexual pleasure. Curricula could also be adapted and implemented for younger age groups, and health professionals could work directly with students to determine what they want to include in a sex education program. Providing the information online can help make it more accessible and up-to-date.

LGBTQ+ inclusive curricula: LGBTQ+ youth are often more vulnerable to sexually transmitted diseases due to stigma and lack of access to culturally positive health care. They are also more likely to experience harmful outcomes in abstinence-only programs and to reject comprehensive sex education programs that are not tailored to their needs. Research shows that comprehensive sex education programs that consider the needs of LGBTQ+ youth and are implemented before youth become sexually active have much better outcomes.

Testing at home: Testing can slow the spread of STIs, and home testing in particular can address concerns many young people have about confidentiality and access. Research has shown that young people want home STI and HIV screening kits that are affordable and convenient.

Affirmation of health care: I also believe it is important that healthcare providers receive education and training on how to provide culturally positive sexual healthcare to young people. This includes ensuring providers are able to have conversations with patients of different racial or ethnic backgrounds, sexual orientations and gender identities that they may find uncomfortable.

Comprehensive treatment: Researchers who conducted a study of over 5,000 teens ages 16 to 17 in Philadelphia recommend that health care professionals implement what they call an “STI Care Continuum” to improve STI screening and treatment among young people. This means that teens with STI symptoms not only get tested and treated, but also receive resources for contact tracing and prevention counseling and get retested.

Regarding testing, national guidelines recommend that health care providers screen all women ages 25 or younger annually for chlamydia and gonorrhea. For young men who have sex with men, at least annual testing for chlamydia, gonorrhea, and syphilis is recommended.

If schools, communities, health care professionals, and other groups pursued these strategies simultaneously and together, I believe the STI rate among Philadelphia’s youth would decline significantly.