The number of people in the U.S. with an STD recently hit an unprecedented high. Data released in October revealed that in 2015, there were increases in all nationally reported STDs for the second year in a row. There were 1.5 million reported cases of chlamydia — the highest number of STD cases ever reported to the government — and people between the ages of 15 and 24 accounted for the largest number of infections.
For starters, only 22 states and the District of Columbia mandate both sex education and HIV education, and many schools provide an abstinence-only curriculum. Sex-education classes often focus largely on preventing unintended pregnancies and less on preventing infections, which may explain why young people today are not as fearful of STDs as previous generations. They were too young to remember the emergence and spread of HIV — the time when a diagnosis was equivalent to a death sentence — and advancements in medication and treatments of STDs and HIV may also offer a sense of security.
“There’s a lack of fear,” says Dr. John Steever, an assistant professor of pediatrics at the Mount Sinai Adolescent Health Center in New York City. But that doesn’t mean that an STD no longer can cause severe health complications, adds Steever. “That lack of forward-thinking is what we are running up against.” Indeed, even as tremendous progress has been made with HIV, not every STD can be treated with a simple round of medication — some strains of gonorrhea, for instance, are already resistant to the antibiotics used to treat it. In 2006 the CDC had five treatment options it recommended for gonorrhea, but now the agency says there’s only one.
People ages 15 to 24 accounted for half of all gonorrhea cases reported in the U.S. in 2015.
Another factor contributing to the rise in teen STDs is the fact that many classes focus almost exclusively on heterosexual sex. “Sex education has to be relevant to the kids you are seeing,” says Steever. “To drone on about condoms for pregnancy prevention can fall on deaf ears for LGBTQ communities. We need sex education that is appropriate for the audience it is trying to reach.”
It’s also possible that the increase in STD screening has led to more reported cases. It wasn’t until 2000, for instance, that all 50 states and the District of Columbia required reporting of chlamydia, says Dr. Eloisa Llata, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC)’s division of STD prevention.
Today the CDC recommends that women under 25 who are sexually active or have a new partner should get yearly chlamydia and gonorrhea tests, and those results are all registered nationally. For sexually active gay and bisexual men, the CDC advises an annual test for syphilis, chlamydia, gonorrhea and HIV. Still, many young people don’t get tested for STDs: a May 2016 report found 42% of 3,953 adolescents and young adults who had sex and did not get tested assumed they were not at risk for an infection. Talking about STDs and how to prevent them at home and at school can help. “Everyone should talk more — and more openly — about STDs in order to raise awareness and reduce stigma,” says Llata.
This article originally appeared on Time.com.