Sexually Transmitted Diseases (STDs)The following information is courtesy of the CDC. This information focuses primarily on Chlamydia, gonorrhea, and syphilis. At the bottom of the page is more information about other sexually transmitted diseases. Chlamydia: Expanded Screening Efforts Result in More Reported Cases, But Majority of Infections Remain Undiagnosed Chlamydia remains the most commonly reported infectious disease in the United States. In 2004, 929,462 chlamydia diagnoses were reported, up from 877,478 in 2003. Even so, most chlamydia cases go undiagnosed. It is estimated that there are approximately 2.8 million new cases of chlamydia in the United States each year.1 The national rate of reported chlamydia in 2004 was 319.6 cases per 100,000 population, an increase of 5.9 percent from 2003 (301.7). The increases in reported cases and rates likely reflect the continued expansion of screening efforts and increased use of more sensitive diagnostic tests, rather than an actual increase in new infections. Impact on Women
African-American women are also disproportionately impacted by chlamydia. In 2004, the rate of reported chlamydia among black females (1,722.3) was more than 7.5 times that of white females (226.6). Because case reports do not provide a complete account of the burden of disease, researchers also evaluate chlamydia prevalence in subgroups of the population to better estimate the true extent of the disease. For example, data from chlamydia screening in family planning clinics across the United States indicates that roughly 6 percent of 15- to 24-year-old females in these settings are infected. Importance of Screening Because chlamydia is most common among young women, CDC recommends annual chlamydia screening for sexually active women under age 26, as well as older women with risk factors such as new or multiple sex partners.5 Data from a study in a managed care setting suggest that chlamydia screening and treatment can reduce incidence of PID by over 50 percent.6 Unfortunately, many sexually active young women are not being tested for chlamydia, in part reflecting a lack of awareness among some providers and limited resources for screening.5,7 Recent research has shown that a simple change in clinical procedures coupling chlamydia tests with routine Pap testing can sharply increase the proportion of sexually active young women screened.8 Stepping up screening efforts is critical to preventing the serious health consequences of this infection, particularly infertility. While screening is critical for sexually active young women, improved testing and treatment among men could help reduce transmission to women. The availability of urine tests for chlamydia may be contributing to increased detection of the disease in men, and consequently the rising rates of reported chlamydia in men in recent years (from 99.6 in 2000 to 147.1 in 2004).
Health Consequences of Chlamydia Chlamydia Statistics Although chlamydia in women is a widely distributed STD among all racial and ethnic groups, trends in positivity in women screened in HHS Region X show consistently higher chlamydia positivity among minorities (Figure P). In 2004, the rate of chlamydia among African-American females in the United States was more than 7 times higher than the rate among white females (1,722.3 and 226.6 per 100,000, respectively) (Table 11B). The chlamydia rate among African-American males was more than 11 times higher than that among white males (645.2 and 57.3 per 100,000 population, respectively). Chlamydia - Positivity among women tested in family
planning clinics by race and ethnicity: Region X, 1988-2004
Gonorrhea is the second most commonly reported infectious disease in the United States, with 330,132 cases reported in 2004. From a high of 467.7 cases per 100,000 population reported in 1975, the U.S. gonorrhea rate fell to 113.5 in 2004 (a 76% decline) the lowest recorded level since reporting began in 1941. More recently, from 2003 to 2004, the rate fell 1.5 percent (from 115.2 cases per 100,000 population to 113.5). Like chlamydia, however, gonorrhea is substantially under diagnosed and under reported, and approximately twice as many new infections are estimated to occur each year as are reported.1
Racial Disparities Persist African Americans remain the group most heavily affected by gonorrhea. While the rate of gonorrhea among blacks fell 3.0 percent from 2003 to 2004, the reported 2004 rate per 100,000 population for blacks (629.6) was 19 times greater than for whites (33.3). In 2003, the rate for blacks was 20 times higher than the rate for whites. American Indians/Alaska Natives had the second-highest gonorrhea rate in 2004 (117.7, up 14.8% from 2003), followed by Hispanics (71.3, up 2.3% from 2003), whites (33.3, up 2.1% from 2003), and Asians/Pacific Islanders (21.4, down 3.2% from 2003). Ethnic minorities in the United States have traditionally had higher rates of reported gonorrhea and other STDs, in part a reflection of limited access to quality health care, poverty, and higher background prevalence of disease in these populations. Drug Resistance Increasing In Communities Across the United States Drug resistance is an increasingly important concern in the treatment and prevention of gonorrhea.10 CDC monitors trends in gonorrhea drug resistance through the Gonococcal Isolate Surveillance Project (GISP), which tests gonorrhea samples (isolates) from the first 25 men with urethral gonorrhea attending STD clinics each month in sentinel clinics across the United States (28 cities in 2004).11 Overall, 6.8 percent of gonorrhea isolates tested through GISP in 2004 demonstrated resistance to fluoroquinolones, a leading class of antibiotics used to treat the disease, compared to 4.1 percent in 2003 and 2.2 percent in 2002. Resistance is especially worrisome among men who have sex with men (MSM), where resistance was eight times higher than among heterosexuals (23.8% vs. 2.9%). In April 2004, CDC recommended that fluoroquinolones no longer be used as treatment for gonorrhea among MSM. Fluoroquinolones are also not recommended to treat gonorrhea in anyone in California and Hawaii, where fluoroquinolone-resistant cases have been widespread for several years. Outside of these states in 2004, 17.8 percent of gonorrhea isolates among MSM were resistant to fluoroquinolones, while resistance among heterosexuals remained low at 1.3 percent.
Health Consequences of Gonorrhea Gonorrhea Statistics In 2004, 69.6% of the total number of cases of gonorrhea reported to CDC occurred among African-Americans (Table 21A). In 2004, the rate of gonorrhea among African-Americans was 629.6 cases per 100,000 population, among American Indian/Alaska Natives the rate was 117.7, and among Hispanics the rate was 71.3. These rates are 19, 4, and 2 times higher, respectively, than the rate among whites in 2004 of 33.3 cases per 100,000 population. The rate of gonorrhea among Asian/Pacific Islanders in 2004 was 21.4 cases per 100,000 population (Figure 15, Table 21B). From 2000 through 2004, gonorrhea rates among African-Americans declined by 19.1% (778.1 and 629.6 cases per 100,000 population, respectively). During the same period, gonorrhea rates increased by 19.8% among whites, 19.4% among American Indian/Alaska Natives, and 3.8% among Hispanics, and decreased by 19.9% among Asian/Pacific Islanders (Table 21B). Gonorrhea rates in 2004 among African-American men were 26 times higher than among white men. Gonorrhea rates in 2004 among African-American women were 15 times higher than among white women (Figure Q). Gonorrhea rates in 2004 were highest for African-Americans aged 15-24 years among all racial, ethnic, and age categories. In 2004, African-American women aged 15-19 years had a gonorrhea rate of 2,790.5 cases per 100,000 females. This rate was 14 times greater than the 2004 rate among white females of similar age (201.7). African-American men in the 15- to 19-year-old age category had a 2004 gonorrhea rate of 1,390.1 cases per 100,000 males, which was 37 times higher than the rate among 15- to 19-year-old white males of 37.9 per 100,000. Among 20- to 24-year-olds in 2004, the gonorrhea rate among African-Americans was 17 times greater than that among whites (2,487.2 and 149.0 cases per 100,000 population, respectively) (Table 21B). Although gonorrhea rates decreased for most age and race/ethnic groups during the 1980s, they did not decrease for African-American adolescents during this period; African-American 15- to 19-year-old females did not show a decrease in rates until 1991 (Figure R). Decreases among 15- to 19-year old African-American males did not begin until 1992 (Figure S). From 2000 to 2004, gonorrhea rates among 15- to 19-year-old African-American females and males decreased 19.7% and 25.5%, respectively. Gonorrhea - Rates by race/ethnicity and sex, 2004 Gonorrhea - Rates among 15- to 19-year-old females by
race and ethnicity: United States, 1981-2004 Gonorrhea - Rates among 15- to 19-year-old males by race
and ethnicity: United States, 1981-2004
Syphilis: Cases Increase for Fourth The rate of primary and secondary (P&S) syphilis the most infectious stages of the disease decreased throughout the 1990s, and in 2000 reached an all-time low. However, over the past four years the syphilis rate in the United States has been increasing. Between 2003 and 2004 alone, the national P&S syphilis rate increased 8 percent, from 2.5 to 2.7 cases per 100,000 population; during this time, reported P&S cases in the United States increased from 7,177 to 7,980. Overall, increases in P&S syphilis rates between 2000 and 2004 were observed only among men. The rate of P&S syphilis among males rose 81 percent between 2000 and 2004 (from 2.6 to 4.7), and 11.9 percent between 2003 (4.2) and 2004. Notably, in 2004 for the first time in over 10 years the rate among females did not decrease, remaining at 0.8. Between 2003 and 2004, the rate of congenital syphilis (i.e., transmission from mother to child) decreased 17.8 percent (from 10.7 to 8.8 per 100,000 live births), likely reflecting the substantial reduction in syphilis among women that has occurred over the past decade.
Rising Rate Driven By Cases Among Men
Recent Declines Among African Americans Possibly Reversing In 2004, the P&S syphilis rate among blacks increased for the first time in more than a decade 16.9 percent from 2003 to 2004 (from 7.7 to 9.0), with the most significant increases among black men. Between 2003 and 2004, the syphilis rate among black males increased 22.6 percent (from 11.5 to 14.1), while the rate among black women rose 2.4 percent (from 4.2 to 4.3). In addition, the male-to-female ratio for blacks rose from 2.7 in 2003 to 3.3 in 2004, suggesting increases among black MSM. Racial gaps in syphilis rates are narrowing, with rates in 2004
5.6 times higher among blacks than among whites, a substantially
lower differential than in 2000, when the rate among blacks was 24
times greater than among whites. This narrowing reflects both
declining disease rates among African Americans and the significant
increases among white men in recent years. Continued progress in
eliminating this disease
will require an ongoing commitment to syphilis education, testing,
and treatment in all populations affected. Syphilis remains a public health problem in metropolitan areas with large populations of MSM. For the third consecutive year, San Francisco had the highest P&S rate of any U.S. city in 2004 (45.9). Other leading cities include Atlanta, Georgia (34.6); Baltimore, Maryland (33.2); New Orleans, Louisiana (16.4); St Louis, Missouri (14.1); Detroit, Michigan (13.5); Washington, D.C. (12.2); Dallas, Texas (11.6); Jersey City, New Jersey (10.8); and Chicago, Illinois (9.7). Health
Consequences of Syphilis Cities with Highest Reported Rates of P&S
Syphilis, 2004 Primary and Secondary Syphilis Statistics The syphilis epidemic in the late 1980s occurred primarily among heterosexual, minority populations.1 During the 1990s, the rate of primary and secondary (P&S) syphilis declined among all racial and ethnic groups (Figure 31). During 2000-2004, the rate continued to decline among African-Americans, but the overall rate of P&S syphilis and rates among non-Hispanic whites, Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives increased; increases in P&S syphilis occurred only among men and the most rapid rate of increase occurred among non-Hispanic white men during this time (Table 34B). Between 2003 and 2004, the rates of primary and secondary syphilis increased 11% in white men, 17% in African-American men and increased slightly (2%) among African-American women (Table 34B). Rates continued to increase among Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives. In 2004, 41% of all cases of P&S syphilis reported to CDC occurred among African-Americans and 40% of all cases occurred among non-Hispanic whites (Table 34A). The 2004 rate for African-Americans was 6 times greater than the rate among non-Hispanic whites (Table 34B). In 2004, the incidence of P&S syphilis by sex among African-Americans was highest among women aged 20-24 years (13.4 cases per 100,000 population) and among men aged 25-29 (34.6 cases per 100,000 population) (Table 34B). In 2003, African-American men in the 35-39 age group had the highest rates. Between 2003 and 2004, P&S syphilis rates for African-Americans in every age group increased. (Table 34B). In 2004, 16% of all cases of P&S syphilis reported to CDC occurred among Hispanics (Table 34A). The rate of P&S syphilis among Hispanic men increased 12% (from 4.9 to 5.5 cases per 100,000 population) between 2003 and 2004. The rate among Hispanic women remained essentially unchanged (0.7 cases per 100,000 population). The rate among Hispanics in 2004 was 2 times greater than the rate among non-Hispanic whites. The incidence of P&S syphilis among Hispanics was highest among women aged 20-24 years (1.9 cases per 100,000 population) and among men aged 35-39 years (14.0 cases per 100,000 population) in 2004 (Table 34B). Congenital Syphilis Statistics In 2004, the rate of congenital syphilis (based on the mother's race/ethnicity) was 26.7 cases per 100,000 live births among African-Americans and 16.2 cases per 100,000 live births among Hispanics. These rates are 16 and 10 times greater, respectively, than the 2004 rate among non-Hispanic whites (1.7 cases per 100,000 live births), respectively (Figure W, Table 44).
Below are several of the most commonly asked about sexually transmitted diseases. Click on each for more information.
Bacterial Vaginosis For more information:Centers for Disease Control and Prevention The CDC has several web pages with helpful information about the prevention of sexually transmitted diseases. This includes the 2004 Surveillance Report which has statistics California DHS STD Control Branch Publications This website offers up-to-date California STD morbidity data,
surveillance reports, California Lab Survey, and California STD
treatment guides.
228 S. Muskogee Avenue Tahlequah, OK 74464 |
|
Women,
especially young women, are hit hardest by chlamydia. Studies have
found that chlamydia is more common among young women than young
men, and the long-term consequences of untreated disease for women
are much more severe. The chlamydia case rate for females in 2004
was 3.3 times higher than for males (485.0 vs. 147.1). However, much
of this difference reflects the fact that women are far more likely
to be screened than men. Females ages 15 to 19 had the highest
chlamydia rate (2,761.5), followed by females ages 20 to 24
(2,630.7).
Increasing
cases of
