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Sexually Transmitted Disease Surveillance 1995
Division of STD Prevention September 1996 U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention Division of STD Prevention Atlanta, Georgia 30333 Copyright Information All material contained in this report is in the public domain and may be used and reprinted without special permission; citation to source, however, is appreciated. Suggested Citation Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1995. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1996. Copies can be obtained from Information Technology and Services Office, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333 or by telephone at (404) 639-1819. The reports for 1993 through 1995 are now available electronically on CDC WONDER. For information about registering for CDC WONDER, please contact CDC's Information Resource Management Office at (404) 332-4569. These reports are also available from the Internet via the CDC home page address http://www.cdc.gov. Centers for Disease Control and Prevention David Satcher, M.D., Ph.D. Director National Center for HIV, STD, and TB Prevention Helene D. Gayle, M.D., M.P.H. Director Division of STD Prevention Judith N. Wasserheit, M.D., M.P.H. Director Preface Sexually Transmitted Disease Surveillance, 1995 presents statistics and trends of sexually transmitted diseases (STDs) in the United States through 1995. It is intended as a reference document for program managers, health planners, researchers, investigators, policy makers, and others who are concerned with the public health implications of these diseases. The STD surveillance systems operated by state and local STD control programs are the sources of most of the information in this publication. These systems are an integral part of program management at all levels of STD prevention and control in the United States. The role of these surveillance systems is to provide program managers with the disease burden and trend information necessary for problem definition, priority setting, resource allocation, and program evaluation. Sexually Transmitted Disease Surveillance, 1995 is an annual publication, and figures and tables in this edition supersede those in earlier publications of these data. Sexually Transmitted Disease Surveillance, 1995 consists of four parts. The National Profile contains figures that provide an overview of the STD situation in the United States. The accompanying text identifies major findings and trends for selected STDs. The Special Focus Profiles contain figures and text describing STDs in selected subgroups and populations that are a focus of national and state prevention efforts. The Detailed Tables provide statistical information about STDs at the state, city, and national levels. The Appendix provides information about the sources and limitations of the data used to produce this report. Selected figures and tables in this document include a reference point that is used to monitor progress toward some of the Healthy People 2000 (HP2000) national health status objectives for STDs (1). The original HP2000 health status objectives were developed in 1989 and revised in 1995. The revisions are used as reference points in this edition of Sexually Transmitted Disease Surveillance, 1995. Any comments and suggestions that would improve the usefulness of future publications are appreciated and should be sent to Director, Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02, Atlanta, Georgia, 30333. (1) Department of Health and Human Services. Healthy People 2000: Midcourse Review and 1995 Revisions. U.S. Department of Health and Human Services, Public Health Service. U.S. Government Printing Office, Washington, D.C., 1995. Acknowledgments Publication of this report would not have been possible without the contributions of the State and Territorial Health Departments and the Sexually Transmitted Disease Control Programs, who provided morbidity data to the Centers for Disease Control and Prevention. This report was prepared by the following staff members of the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention: Susan Bradley, Sharon Clanton, Martha R. Cowart, Darlene Davis, Kathleen B. Dry, Melinda L. Flock, Kimberly K. Fox, Samuel L. Groseclose, Alesia Jester-Harvey, William C. Levine, Debra Mosure, Russ Roegner, Karen L. Southwick, Margaret B. VanNorden, and Diane M. Vitro. Dedication We dedicate this volume to our colleague and friend, Martha R. Cowart. After 30 years of government service, Mrs. Cowart is retiring. She has been an integral member of the team producing this report. We wish her the best in the years ahead. Geographic Divisions of the United States Figure_GEO. Geographic Divisions of the United States National Overview of Sexually Transmitted Diseases, 1995 The logo on the cover of Sexually Transmitted Disease Surveillance, 1995, is a reminder of the multifaceted, national dimensions of the morbidity, mortality, and costs that result from sexually transmitted diseases (STDs) in the United States. It highlights the central role of STD prevention in improving women's and infants' health, and in promoting HIV prevention. Organized, collaborative efforts among interested, committed public and private organizations are the keys to reducing STDs and their related health burdens in our population. Several observations for 1995 are worthy of note. States have recognized the programmatic importance of collecting and sharing reliable information on efforts to reduce the number of genital Chlamydia trachomatis infections in the population. In 1994, through the efforts of the Council of State and Territorial Epidemiologists (CSTE), chlamydia became a nationally notifiable condition. The development of improved state and federal data bases will ultimately result in better planning, priority setting, and evaluation of chlamydia control efforts. In 1995, the reported number of cases of chlamydial infection (477,638) exceeded the reported number of cases of gonorrhea (392,848) in the United States. This occurred amid growth in chlamydia control programs nationwide, together with continuing commitments to sustain gonorrhea prevention programs that began in the 1970s. In 1995, for every chlamydia case detected and reported in males, almost 6 cases were detected in females. This discrepancy is attributable to screening strategies that focus on women because they are asymptomatic in the majority of cases. Male sex partners of infected women may be treated prophylactically for chlamydia without a diagnostic laboratory test, but current surveillance systems are limited in their ability to document the treatment of male partners. Using local, state, and federal resources, chlamydia prevention programs targeting asymptomatic women have been established throughout the country. Chlamydia positivity rates from these screening and treatment programs illustrate the widespread distribution of chlamydial infection throughout the United States. Large-scale screening projects in Public Health Service Region X (Alaska, Idaho, Oregon, and Washington) and elsewhere have consistently shown that the highest rates of chlamydial infection in women are in adolescents. In addition, examination of chlamydial screening results for rural and urban disadvantaged women aged 16-24 years entering the U.S. Job Corps shows that chlamydia is highly prevalent among these economically disadvantaged young women, and geographically widespread. Monitoring chlamydia positivity rates in selected populations, in addition to traditional morbidity surveillance, shouldallow us to better quantify the reservoir of infection in both women and men. Data on gonorrhea for 1995 suggest that the annual decreases that have been evident since the mid-1970s are continuing. The 1995 gonorrhea rate of 149.5 is the lowest rate since the early 1960s but is above the revised Healthy People 2000 (HP2000) objective of 100. The average annual decreases in gonorrhea over the previous 10 years have been about 20 cases per 100,000 population per year. The decrease in reported cases between 1994 (165.1 per 100,000) and 1995 was 15.6 cases per 100,000. With respect to gender, the 1995 gonorrhea rate decreased from the 1994 rate by 11.8% among males (158.6), and by 6.9% among females (140.3). Decreases were greater among the youngest age groups: 10- to 14-year-olds (males: 21.3%; females: 12.1%), and 15- to 19-year-olds (males: 15.5%; females: 6.4%). Because men with gonorrhea are usually symptomatic and seek medical care, trends among males are a good measure of disease incidence. Trends in women are largely determined by screening practices. It is possible that expansion of chlamydia screening programs for women (especially for younger women) is having an indirect, beneficial effect on gonorrhea detection and treatment, as well. As for chlamydia, rates of gonorrhea in women are particularly high in adolescents, with the highest rates being among 15- to 19-year-olds. With regard to antimicrobial resistance, a growing number of Neisseria gonorrhoeae isolates tested through the Gonococcal Isolate Surveillance Project have demonstrated decreased susceptibility to ciprofloxacin, one of the currently recommended treatments for gonorrhea. However resistance to ciprofloxacin remains rare (0.2%). The 16,500 cases of primary and secondary (P&S) syphilis reported in 1995 were the fewest cases reported in the United States since 1960. The P&S syphilis rate of 6.3 per 100,000 population is above the revised HP2000 objective of 4 per 100,000. Syphilis remains a problem only in selected areas of the country. In 1995, 69% of U.S. counties did not report any syphilis cases. A comparable percent (68%) of counties did not report any syphilis cases in 1994. In 1995, P&S syphilis rates exceeded 4 per 100,000 in 588 counties (19% of total counties). These counties accounted for 89% of all reported P&S syphilis cases. Most notably, 84% (492 of 588) of these counties were located in the South. In addition, 13 of the 18 states/areas with P&S syphilis rates greater than 4 per 100,000 were located in the South. These data suggest that comprehensive syphilis prevention efforts focused in the South may dramatically reduce the number of U.S. syphilis cases by the end of the decade. When we examine STD statistics by race/ethnicity, we continue to see very wide discrepancies among racial/ethnic groups. For example, gonorrhea rates among black adolescents (15-19 years of age) are more than 26 times greater than the rate among white adolescents. The rate of P&S syphilis among blacks is nearly 60 times that in whites; P&S syphilis among Hispanics is about 4 times that in whites. Congenital syphilis has decreased nationally in recent years. However, in 1995, of the 1,534 reported cases with known race/ethnicity of the mother, blacks and Hispanics accounted for 91% of all reported cases, while accounting for only 21% of the female population. Although there are no known biologic reasons to explain why racial or ethnic factors alone should alter STD risk, race and ethnicity in the United States serve as risk markers that correlate with other more fundamental determinants of health status such as socioeconomic status, access to quality health care, and health care seeking behavior. Reporting biases may also play a role in race differentials.
