Since January 2025, the new United States (US) administration has significantly altered the global health landscape through a series of policy changes and funding cuts. This includes the suspension of foreign aid assistance and the withdrawal of the US from the World Health Organization (WHO). These actions have halted life-saving work across the globe and have been challenged by multiple lawsuits. Additional domestic funding cuts to the US Department of Health and Human Services, including the National Institutes of Health and Centers for Disease Control and Prevention (CDC) have threatened invaluable research and health promotion programs, globally. These policy and funding shifts have had—and will continue to have drastic impacts on the field of sexually transmitted infections (STIs), threatening all research, development, and prevention efforts.
In 2020, the WHO estimated that there were more than 374 million new infections of chlamydia, gonorrhea, syphilis, or trichomoniasis among people aged 15 to 49 years. When left untreated STIs can lead to infertility, pelvic inflammatory disease, cancers, and increased transmission and acquisition of HIV.
While various prevention options are currently available to address STIs, including condom usage, comprehensive testing and treatment strategies remain imperative. Current testing options are limited as many diagnostics are prohibitively expensive, which leaves many resource-limited settings dependent on syndromic management: treatment based solely on symptoms. However, because many STIs are asymptomatic, presenting with little to no symptoms, infections remain under-detected and misdiagnosed when using a syndromic management approach. Additionally, the lack of affordable diagnostics leads to the misuse and overuse of antibiotics since STI symptoms, including vaginal discharge and pain when urinating, are seen with many other infections and conditions.
Vaccines provide an alternative prevention option for STIs. Currently available are vaccines that protect against human papillomavirus (HPV) and hepatitis B with several vaccines under development to prevent chlamydia, gonorrhea, syphilis, and herpes infections. However, 2025 funding cuts and policy directives by this new US administration threaten the overall vaccine development process and the broader STI landscape in the US and globally. Among the major impacts:
- Funding Cuts Threaten STI Research and Development
- Reduction of Key STI Positions and Elimination of Laboratory Resources Threaten Prevention Efforts
- Vaccine Development and Implementation at Risk
Funding Cuts Threaten STI Research and Development
The NIH and CDC support research, development, and implementation activities for STIs, globally. Recent funding cuts have led to the termination of grants that examined vaccine attitudes to better address and understand increased beliefs that vaccines are unsafe, a global phenomenon that is leading to a rise in vaccine preventable diseases. Grants studying the use of doxycycline to prevent bacterial STIs (DoxyPEP) in cisgender women were also cut. So far, DoxyPEP has been shown to help prevent chlamydia and syphilis in gay, bisexual, and other men who have sex with men and transgender women, and researchers were testing if it works for cisgender women too. Without this funding, cisgender women lose access to a possible prevention option.
These funding cuts have also impacted studies focused on clinical trials and implementation science research aimed at identifying new prevention techniques to lower the spread of STIs and develop, evaluate, and introduce new diagnostics to increase the proportion of people tested, diagnosed, and treated if they have an infection.
Implications
The future of STI research funding remains uncertain. Current funding cuts have stopped important work to provide people with options and access to STI prevention, detection, and treatment services. Furthermore, these funding cuts jeopardize the development and equitable implementation of new vaccines, diagnostics, and other prevention tools to address rising infection rates. Without this key funding, many more people will acquire an STI and experience outcomes of untreated infections which can include infertility, pelvic inflammatory disease, and cancers.
Reduction of Key STI Positions and Elimination of Laboratory Resources Threaten Prevention Efforts
The Division of STD Prevention (DSTDP) at the CDC supports research, policy development, and implementation efforts to prevent STIs. In April 2025, the DSTDP STI Laboratory and Disease Intervention and Response Branch (DIRB) were eliminated. This resulted in the loss of nearly 30 laboratory scientists and 50 field experts. In the past 15 years, CDC-funded State and local STI programs prevented more than 6 million cases of syphilis, gonorrhea, and chlamydia and more than 2,500 STI-attributable HIV infections, saving $2.7 billion dollars in lifetime direct medical costs.
Implications
DIRB field staff were strategically embedded within health departments across the US and often served as first responders to help contain outbreaks for STIs and other emerging infections including Ebola, Zika, Mpox, and COVID-19. Because of these eliminations, the US might not be ready to address and prevent future outbreaks. Additionally, with CDC funding cuts there will be fewer resources available to help provide free and confidential STI testing and treatment, possibly putting additional financial burdens on people seeking these services.
Antibiotic Resistance Surveillance
The CDC’s STI lab was involved in several projects to better detect, treat, and prevent STIs, globally. The Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) is a collaboration between the WHO, CDC, and WHO collaborating centers on STIs, which aims to strengthen surveillance for antibiotic resistant gonorrhea. Additionally, the lab managed the national repository of gonorrhea surveillance isolates with 50,000 unique samples, the largest in the world. This Gonococcal Isolate Surveillance Project (GISP) was established in 1986 to monitor trends in antibiotic resistant gonorrhea and to establish an evidence-based approach for the selection of new treatments. This work helps to inform treatment recommendations and slow the spread of resistance.
Implications
The elimination of the CDC STI lab along with the US withdrawal from WHO threatens our global response in slowing the spread of antibiotic resistant gonorrhea. Additionally, the US will be unable to detect if and when gonorrhea because resistant to new treatment options.
Syphilis Proficiency Training
The CDC provided syphilis proficiency testing for laboratories across the world. Proficiency testing is vital to ensure that regional laboratories maintain high standards of accuracy in diagnosing infections. This method checks regional laboratories performance using a qualified external facility, in this case the CDC. Data from this program is then used to improve syphilis testing services, globally.
Implications
The CDC is currently unable to provide syphilis proficiency testing with the elimination of the STI lab. Additionally, syphilis is one of the harder STIs to diagnose. Once a person acquires syphilis, they will continue to test positive for the infection even after treatment, meaning tests are needed to differentiate between new and old cases. Current tests can be hard to interpret, underscoring the need for proficiency testing to ensure consistent and accurate results across labs. The ability for laboratories to accurately detect and diagnosis syphilis is now threatened, which could lead to an additional increase in cases.
Development and Evaluation of New Diagnostics
The CDC STI lab and American Public Health Laboratories (APHL) collaborated on the development of a Syphilis Serum Repository. Specimen from this repository were used in the development and evaluation of syphilis tests. The CDC STI lab partnered with developers to advance point-of-care diagnostics for the detection of chlamydia and gonorrhea. Additionally, the CDC STI lab evaluated the performance and accuracy of new tests to inform implementation in public health laboratories.
Implications
STI rates have continued to increase globally. The CDC STI lab provided necessary resources to advance the development of new diagnostics. With the elimination of this lab, there are key gaps in the development and evaluation of STI diagnostics threatening access to new tools, globally.
PEPFAR Funded Labs Provide Infrastructure for STI Testing
While funding for the US President’s Emergency Plan for AIDS Relief (PEPFAR) remains uncertain as of May 6, 2025, so does the infrastructure for STI testing and surveillance. PEPFAR, and US funding broadly, has historically supported laboratory networks in low- and middle-income countries to develop and build lab capacity by providing equipment and expertise. Many labs integrated STI testing, expanding accessibility and surveillance efforts. If PEPFAR funded labs are unable to support the integration of STI testing, availability of these tests will become even more limited.
Implications
If PEPFAR funded labs do not receive the necessary funding, STI testing in low- and
middle-income countries will be severely compromised. These labs play a critical role in diagnosing infections like chlamydia, gonorrhea, and syphilis, which are often asymptomatic and require laboratory confirmation. Without adequate resources, test availability will become even more strained, delaying treatment, and increasing transmission rates. Any loss of PEPFAR funding will roll back years of progress in STI testing efforts.
Vaccine Development and Implementation at Risk
In March 2025, the US administration signaled a desire to cut funding to Gavi, the Vaccine Alliance, who have worked to vaccinate half the world’s children against deadly diseases. As part of this work, Gavi provides vaccines that protect against HPV, one of leading causes of cervical cancer, the fourth most common cancer among women. In 2022, there were more than 600,000 cases of cervical cancer, globally, which led to about 350,000. About 94% of these deaths occurred in low- and middle-income countries. The HPV vaccine is known to prevent more than 90% of HPV related cancers including cervical. Because of Gavi’s efforts, HPV vaccination coverage increased from 4% in 2019 to 16% in 2023 among 57 lower-income countries. Defunding Gavi leaves millions of adolescent girls and women at risk for acquiring HPV and developing cervical cancer.
Additionally, women living with HIV are up to six times more likely to develop invasive cervical cancer, highlighting the importance of vaccination and cervical cancer screening among this population. PEPFAR funded programs, including Go Further, have recognized the importance of ending AIDS and cervical cancer through integration cervical cancer screening, treatment, and vaccination services within existing HIV treatment and women’s health platforms. However, funding cuts threaten the progress of programs.
Implications
Many countries are reporting decreases in cervical cancer rates because of successful HPV prevention and treatment programs including HPV vaccination and cervical cancer screening. Funding cuts to these key programs threatens the lives of millions of people who could die from a cancer that is preventable with just one dose of a vaccine.
Additionally, hepatitis B, an infection that kills more people each year than AIDS-related illnesses. Because hepatitis B control efforts are currently underfunded, this infection continues to spread. Hepatitis B can be acquired at birth and the majority of infants who catch the virus develop chronic hepatitis B with many dying severe liver disease. Gavi supports a program aimed at increasing hepatitis B vaccination at birth. The majority of this effort is focused in Africa as the country accounts for 63% of all new hepatitis B infections annually while 18% of newborns in the region receives the hepatitis B birth dose.
Implications
Gavi funding cuts will continue to leave many infants at risk for acquiring hepatitis B, which can lead to cirrhosis and liver cancer. This will disproportionately impact African countries where in 2022, 3.6 million children under the age of 5 years in the region accounted for 64% of all children living with chronic hepatitis B.
Finally, recent funding cuts to research threated the overall development and advancement of vaccine research for STIs like chlamydia, gonorrhea, herpes, and syphilis. The NIH has been a leading funder in this space but faces substantial budget cuts that could impact vaccine research and development. Additionally, these cuts have already resulted in the termination of grants focused on vaccine hesitancy and research identifying ways to promote vaccination. These funding cuts stall scientific innovation and compromise efforts to curb rising STI rates.
What’s Next?
There is an urgent need for the US to reconsider recent funding and policy shifts that have led to a reduction of funding for research, development and implementation of programs focused on the prevention, detections and treatment of STIs.
The reduction of key STI positions, elimination of laboratory resources, and uncertainty of future funding threatens STI research and prevention efforts globally. There is currently a loss of STI expertise, reduced capacity to monitor antimicrobial resistance and outbreaks, and delays in the development and implementation of new diagnostics and vaccines. Additionally, industry and private researchers and developers relied on publicly available STI surveillance and expertise to inform their product development pipelines. With key STI testing and surveillance programs in flux, these products, including new vaccines and diagnostics, are now at serious risk of being shelved indefinitely unless a strong business case is made.
These reductions and eliminations jeopardize the health of everyone as STIs know no borders. We urge the following actions by the US government:
- Invest in STI research to improve testing, treatment, and prevention efforts.
- Reinstate the CDC STI lab to enhance monitoring, outbreak response, and diagnostic innovation.
- Sustain US support for PEPFAR to maintain lab infrastructure and ensure comprehensive cervical cancer prevention and treatment services including HPV vaccination.
- Fully fund Gavi to deliver lifesaving vaccines like HPV and hep B.