A recent report from the Center for Disease Control found that a record number of STIs—more than 2.3 million cases of gonorrhea, syphilis, and chlamydia—were diagnosed across the U.S. in 2017.

Shocked? You might be, considering the conflicting reports that more people are refraining from sex. How are people getting STIs if they’re not having sex? Not to mention that we know more about the dangers of STIs and have a better understanding of taking preventive measures to avoid them than ever before. But if you ask sexual health care professionals, they’re not too surprised.

“This is the fourth consecutive year of increases in the rates of syphilis, chlamydia, and gonorrhea,” says Gillian Dean, M.D., senior director of medical services at Planned Parenthood Federation of America. “Which makes it clear that too many people aren’t getting the health care and education they need to keep themselves healthy.”

While there could be tons of factors contributing to the spike, sexual health professionals believe that where you live matters. If you don’t live in an area with proper sexual health facilities, you might not be getting tested—therefore, you probably don’t even know you have one. “Some communities are more negatively affected by STIs, due to historical and structural oppression that lead to barriers to education and health care,” Dean says.

Take, for example, Alaska: the state with the highest rates of chlamydia and gonorrhea in the country.

Tanya Pasternack, M.D., the Alaska state medical director for Planned Parenthood of the Great Northwest and the Hawaiian Islands, notices a striking difference between the areas of Alaska where Planned Parenthood is accessible versus the rural areas where clinics are scarce. According to her, the Yukon-Kuskokwim Delta and Norton Sound (both regions in Alaska) saw the highest rates of chlamydia and gonorrhea in 2017.

“The closest hospitals in these areas are Bethel and Nome, respectively, which means that many people need to travel significant distances by boat, air, or even snow machine to get basic health care,” Pasternack says. In contrast, southeast Alaska and the Anchorage area have some of the lowest STI rates due to easier access to educational resources and health centers.”

While not having the resources to get tested and learn about STIs is one thing, having access to these amenities and not taking advantage of them is another. The CDC found high STI rates in states like California (No. 1 in syphilis!) and New York—two states that both have big metropolitan cities with plentiful resources. “The access to health clinics is definitely easier and more affordable here,” says Adeeti Gupta, M.D., founder of Walk In GYN Care in New York. “It’s the awareness of the need to be tested that is lacking.”

Gupta finds that people are hesitant to get tested for two reasons: They assume they don’t have an STI because they’re not showing symptoms, and they’re reluctant to have the dreaded talk with their partners.

Women, in particular, avoid getting tested. In fact, a report from Quest Diagnostics found that 27 percent of women don’t feel comfortable talking to their doctors about STIs.

“Even at our centers, sometimes it’s impossible to track down some patients with positive results,” Gupta says. “I don’t think people understand how serious this is and what long-term implications STIs can have on a woman’s body and future.”

But the scary thing is, just because you don’t feel like you have an STI doesn’t mean you don’t have one—often the symptoms are hidden.

The only way to find out if you’ve contracted one is to get tested. The CDC recommends getting tested once a year. “STI tests are generally quick, simple, and painless—and completely confidential,” Dean says. “Rapid HIV tests can provide results in as fast as 20 minutes from just a swab inside the mouth.” And if you happened test positive for gonorrhea, syphilis, or chlamydia, they’re treatable with antibiotics.

Lastly, be honest about your sexual history with your partners—before you get in the sheets. While birth control methods such as the pill and IUDs are great for preventing pregnancy, only condoms can stop STIs from transferring (fun fact: that same Quest study found that 39 percent of participants don’t use condoms—eek!).

“Part of combatting STI rates is helping people get comfortable with talking about STIs with partners, using protection, and getting tested as a normal, healthy part of a good sex life,” Dean says.

Bianca Mendez is a writer in New York covering health, sex, relationships, and beauty. Follow her on Instagram @biancammendez and Twitter @biancamendezz.