A discussion of STI rates, barriers, and home screenings with Damian Alagia III, MD

Framing sexually transmitted infections (STIs) as a large-scale problem often obscured by percentages, Damian Alagia, III, MD, MS, MBA, FACS, Chief, Hospital and Health Systems, and Senior Medical Director, Advanced Diagnostics / Women's Health, Quest Diagnostics, argued that universal, non-judgmental testing is central to reaching reproductive-age women.^1,2

Alagia said absolute figures convey the scale more effectively than rates, noting over 1.5 million patients annually with chlamydial infections, some 190,000 patients with syphilis, and nearly 4,000 babies with congenital syphilis, in 2024 data from the Centers for Disease Control and Prevention (CDC).²

According to CDC data as of September 2025, overall STI cases in 2024 are 13% higher compared to a decade prior. However, Algia said that figure doesn’t represent the full story.

"When we talk about percentages, I think it sterilizes the true underlying issues," he said. "When you're looking at those kind of numbers, millions of men and women and other individuals with these STIs, it really brings it home: This is a big problem that we need to address."

Making testing universal

Alagia identified stigma as a central barrier and endorsed an opt-out model that removes the need for patients to request testing.

"I think the most important part of this is non-judgmental access and testing," he said. "Nobody wants to be told they have syphilis, or nobody wants to go in and ask for a test, so I think that the best way to do that is to make it universal in kind of an opt-out situation, so that they don't have to ask for the test."

He noted that a universal approach also addresses clinician discomfort.

"A lot of doctors, male and female, are uncomfortable talking about sexual health. Maybe they don't have the time. Maybe they don't have the resources. Maybe they're just uncomfortable," Alagia said. Making testing routine, he added, lets clinicians enter the care pathway without assumptions about a patient's relationships or sexual history, letting them know, "‘We're just going to take care of you, and part of taking care of you includes general testing,’” he said.

Structural barriers and home-based testing

Alagia cited a referenced 13% increase against structural factors that keep women from engaging the health care system, including geographic gaps in care, insurance barriers, and fears among some patients about testing or immigration consequences.

To address these, he pointed to home-based testing.

"Through innovations we're bringing a lot of this testing into the home," he said, spanning both STI and HPV testing, in settings where patients need not discuss anything to be screened.

"We need to enter all these conversations with a commitment to the human part of this, and it's not just the medical access," Alagia said, adding that greater commitment is needed to the health and well-being of mothers and babies. He also added that no health care group is better positioned to do so.

“All of my colleagues, all of my ob-gyns, the level of commitment that these individuals have to patient care is unsurpassed… They’re all committed to care, and what they are interested in is lowering the barriers to care,” he said.

References:

1. Damian “Pat” Alagia, III, MD, MS, MBA, FACS, FACOG. Quest Diagnostics. Accessed July 20, 2026. https://www.questdiagnostics.com/healthcare-professionals/clinical-experts-education/clinical-experts/d-alagia-iii
2. Sexually Transmitted Infections Surveillance, 2024 (Provisional). Centers for Disease Control and Prevention. Published September 24, 2025. Accessed July 20, 2026. https://www.cdc.gov/sti-statistics/annual/index.html