UW, WA Department of Health show it’s possible to test wastewater for STIs
Our take
This is solid news coming out of UW and the Washington State Department of Health – wastewater testing for STIs? It sounds a little sci-fi, but the potential impact is incredibly real. The ability to monitor infection rates through wastewater offers a new layer of public health surveillance, potentially catching outbreaks earlier and more discreetly than traditional testing methods. It builds on the increasing use of wastewater analysis for things like tracking COVID-19, demonstrating a broadening application of this technology. We’ve seen WSU contribute to innovative data analysis with their From weather data to smarter farms with WSU system, showing how data collection and AI can unlock valuable insights – this is a similar principle at play, just focused on a different critical area. And it’s exciting to see UW researchers continue to lead the way in data-driven solutions, as highlighted in their involvement with the UW researchers lead and support new ‘AI-for-Science’ Genesis Mission awards – this really underscores the state's commitment to pushing the boundaries of scientific discovery.
The beauty of wastewater surveillance is its inherent anonymity. Traditional STI testing relies on individual participation, which can be hindered by stigma, lack of access, or simply not knowing you need to be tested. Wastewater testing bypasses these barriers, providing a population-level snapshot without requiring anyone to actively engage. While the research focused on Chlamydia trachomatis, the methodology is likely adaptable to other STIs, potentially offering a powerful tool for preventing the spread of infections and improving overall public health outcomes. It's worth noting this doesn’t replace clinical testing; rather, it acts as an early warning system, allowing public health officials to target resources and interventions more effectively. Think of it as a low-key, continuous check-in on community health. It’s also a really practical application of existing technology, leveraging infrastructure already in place to gather valuable data.
Of course, there are challenges to consider. The accuracy of wastewater testing can be affected by factors like population density, wastewater treatment processes, and even weather patterns. Data interpretation will require careful analysis and modeling to account for these variables. Plus, ethical considerations around privacy and data security need to be addressed proactively. It’s not a perfect solution, but the benefits of early detection and proactive intervention likely outweigh the risks, especially when compared to the current system. The focus on chlamydia is a good starting point – it’s a common infection with significant long-term health consequences if left untreated, making early detection particularly impactful. Ultimately, this is about empowering public health officials with better data to make informed decisions and protect the well-being of our communities.
Looking ahead, it’ll be interesting to see how widely this approach is adopted beyond Washington state. Will other states and public health agencies invest in the infrastructure and expertise needed to implement wastewater surveillance programs? And how will this technology evolve to detect a broader range of STIs and other public health threats? It’s a smart, preventative approach that could significantly reshape public health monitoring, and it’s a space to watch closely as the science continues to develop.
A city’s sewers say a lot about its residents. Sick people often shed pathogens in their waste, adding traceable amounts of bacteria and viruses into wastewater. Testing that wastewater offers a simple, low-cost way to monitor the spread of disease — a practice that began with polio in the 1940s and became more widespread during the COVID-19 pandemic. Today, the CDC’s wastewater monitoring program tests for a variety of common and emerging viruses.
American public health agencies don’t routinely test wastewater for sexually transmitted infections, but new research led by the University of Washington and the Washington State Department of Health found that such methods could be used to effectively identify Chlamydia trachomatis, the bacteria that causes chlamydia.
The study, published Aug, 7 in ACS ES&T Water, could help public health agencies better identify and respond to increased spread of chlamydia and other STIs, which are notoriously underreported in traditional data. The researchers specifically explored wastewater’s potential as a community monitoring tool, and not as a way to identify cases or trace pathogens back to individual people or locations.
“STIs are known for being underreported because of a lot of factors, especially stigma and the prevalence of asymptomatic cases,” said co-lead author Erica Fuhrmeister, assistant professor of environmental and occupational health sciences and of civil and environmental engineering at the UW. “Wastewater is cool because it’s population level. You don’t need people to go to the doctor and seek out treatment to know that there are people in a community shedding specific pathogens.”
Working in collaboration with local health jurisdictions, researchers collected frequent samples from influent wastewater at five wastewater treatment plants across Washington state and six neighborhood-level sewer sites near Seattle. Collection sites ranged from a large, high-population urban area to a rural treatment plant serving fewer than 5,000 people. Researchers masked the specific names and locations of sample locations to protect the privacy of people and communities.
Researchers tested wastewater samples for the pathogens that cause three common STIs: chlamydia, syphilis and gonorrhea. C. trachomatis was the most prevalent pathogen across all test sites. The bacteria that cause gonorrhea and syphilis were found far less frequently, despite data showing confirmed cases of those diseases in the associated areas.
Further research could reveal why tests captured C. trachomatis more consistently than other STI-causing bacteria and explore the study’s limitations, which included people moving between sewer sites and the influence of demographics.
The researchers are also eager to investigate several trends they observed in the data, such as spikes in pathogen concentration occurring near the winter holidays and after Valentine’s Day.
Among the neighborhood collection sites was a small, densely populated area adjacent to a college campus. More than 87% of residents were young people between 18 and 34 years old, a population considered high-risk for STIs. Clinical health records showed very low case counts of chlamydia, but researchers consistently detected C. trachomatis in wastewater samples.
That gap could indicate underreporting driven by stigma or asymptomatic cases. It also gives public health officials an opportunity to react to a previously unknown increase in infection activity.
“From a public health perspective, data like this allows us to elevate awareness that this pathogen is here and spreading in the community, even if cases aren’t presenting to clinics or providers are not identifying the infections in their patients,” said co-lead author Breanna McArdle, program manager of the Washington State Department of Health’s wastewater surveillance program. “A small amount of wastewater can tell you so much about the community while simultaneously filling gaps in the traditional methods we monitor disease activity.”
A full list of co-authors is available with the paper.
This research was funded in part by the Epidemiology and Laboratory Capacity Infectious Diseases Cooperative Agreement from the U.S. Centers for Disease Control and Prevention.
For more information, contact Fuhrmeister at efuhrm@uw.edu.
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