Public Health Impact

Surveillance data show higher rates of reported STDs among some minority racial or ethnic groups when compared with rates among whites. Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health status such as poverty, access to quality health care, health care seeking behavior, illicit drug use, and living in communities with high prevalence of STDs. Acknowledging the disparity in STD rates by race or ethnicity is one of the first steps in empowering affected communities to organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of STDs reported to state and local health departments (see Appendix). In many areas, reporting from public sources, (for example, STD clinics) is thought to be more complete than reporting from private sources. Since minority populations may utilize public clinics more than whites, differences in rates between minorities and whites may be increased by this reporting bias. However, prevalence data from community-based surveys such as the National Health and Nutrition Exam Survey (NHANES) and AddHealth confirm the existence of marked STD disparities.^1,2

Completeness of Race/Ethnicity Data

Chlamydia - In 2006, 26.3% of reports on chlamydia cases were missing race or ethnicity (Table A1).

Gonorrhea - In 2006, 21.6% of reports on gonorrhea cases were missing information on race or ethnicity (ranging by state from 0.0% to 46.8%).

Syphilis - In 2006, only 4.1% of reports on syphilis cases were missing information on race or ethnicity (ranging by state from 0.0% to 33.3%).

To adjust for missing data, cases for which information is unknown are redistributed according to the distribution of cases in which race or ethnicity is known. This process may exacerbate the reporting bias.

Observations

Chlamydia

All racial and ethnic groups except Asian/Pacific Islanders reported increases in chlamydia rates from 2005 to 2006. From 2002 to 2006, chlamydia rates increased by 17.2% among African Americans; 23.7% among American Indian/Alaska Natives; 12.7% among Hispanics; and 20.6% among whites (Table 11B). Rates decreased by 5.9% among Asian/Pacific Islanders.

African Americans - In 2006, approximately 47% of all chlamydia cases occurred among African Americans (Table 11A). Overall, the rate of chlamydia among African Americans in the United States was more than eight times that among whites. The rate of chlamydia among African-American women was more than seven times higher than the rate among white women (1,760.9 and 237.0 per 100,000 population, respectively) (Figure O, Table 11B). The chlamydia rate among African-American men was more than 11 times higher than that among white men (741.2 and 66.0 per 100,000 population, respectively).

American Indian/Alaska Natives - In 2006, the chlamydia rate among American Indian/Alaska Natives was 797.3 cases per 100,000 population, over five times higher than the rate among whites (153.1).

Asian/Pacific Islanders - In 2006, the chlamydia rate among Asian/Pacific Islanders was 132.1 cases per 100,000 population, a decrease from the 2005 rate of 148.4.

Hispanics - In 2006, the chlamydia rate among Hispanics was 477.0 cases per 100,000 population, three times higher than the rate among whites (153.1).

Gonorrhea

All racial and ethnic groups except Asian/Pacific Islanders saw slight increases in gonorrhea rates from 2005 to 2006. Despite this slight increase in 2006, between 2002 and 2006, the gonorrhea rate among African Americans declined by 7.7% (from 713.7 in 2002 to 658.4 cases per 100,000 population in 2006). During the same five year period, gonorrhea rates increased by 22.9% among American Indian/Alaska Natives,17.7% among whites, 11.8% among Hispanics, and decreased by 1.4% among Asian/Pacific Islanders (Table 21B).

From 2005 to 2006, gonorrhea rates among 15- to 19-year-old African-American women and men increased for the second consecutive year (Figures Q and R).

African Americans - In 2006, approximately 69% of the total number of reported cases of gonorrhea occurred among African Americans (Table 21A). In 2006, the rate of gonorrhea among African Americans was 658.4 cases per 100,000 population. Overall, the rate of gonorrhea among African Americans in the United States was 18 times greater than that among whites.

In 2006, the gonorrhea rate among African-American men was 25 times higher than that among white men; the gonorrhea rate among African-American women was 14 times higher than that among white women (Figure P).

In 2006, gonorrhea rates were highest for African Americans aged 15 to 19 and 20 to 24 years among all racial, ethnic, and age categories. African-American women aged 15 to 19 years had a gonorrhea rate of 2,898.1 cases per 100,000 women. This rate was 14 times greater than the 2006 rate among white women of similar age (208.7). African-American men in the 15-to 19-year-old age category had a 2006 gonorrhea rate of 1,503.8 cases per 100,000 men, which was 39 times higher than the rate among 15- to 19-year-old white men of 38.4 per 100,000. Among those aged 20 to 24 years, the gonorrhea rate among African Americans was 16 times greater than that among whites (2,560.7 and 165.0 cases per 100,000 population, respectively) (Table 21B).

American Indian/Alaska Natives - In 2006 the gonorrhea rate among American Indian/Alaska Natives was 138.3 which was four times higher than the rate among whites in 2006 of 36.5 cases per 100,000 population.

Asian/Pacific Islanders - In 2006 the gonorrhea rate among Asian/Pacific Islanders was 21.1 cases per 100,000 population which was nearly two times lower than the rate among whites.

Hispanics - In 2006, the gonorrhea rate among Hispanics was 77.4 which was two times higher than the rate among whites.

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred primarily among heterosexual and minority populations.^3,4 During the 1990s, the rate of P&S syphilis declined among all racial and ethnic groups (Figure 32). Between 2002 and 2006, the rate of P&S syphilis increased among all racial and ethnic groups.

African Americans - Between 2005 and 2006, the rate of P&S syphilis among African Americans increased 16.5% (from 9.7 to 11.3). In 2006, 43.2% of all cases of P&S syphilis reported to CDC were among African Americans and 38.4% of all cases were among non-Hispanic whites (Table 33A). Compared to whites, the overall 2006 rate for African Americans was 5.9 times higher (Table 33B). In 2006, the P&S rate among African-American men was more than five times higher than that among white men; the rate among African-American women was more than 16 times higher than that among white women. In some age groups, particularly 15-19 year old African-American men, disparities have increased markedly in recent years as rates of disease have increased (Figure U).

American Indian/Alaska Natives -Between 2005 and 2006, the rate of P&S syphilis among American Indian/Alaska Natives increased 37.5% (from 2.4 to 3.3). In 2006, 0.8% of all cases of P&S syphilis reported to CDC were among American Indian/Alaska Natives (Table 33A). Compared to whites, the 2006 rate for American Indian/Alaska Natives was 1.7 times higher (Table 33B).

Asian/Pacific Islanders - Between 2005 and 2006, the rate of P&S syphilis among Asian/Pacific Islanders increased 18.2% (from 1.1 to 1.3). In 2006, 1.8% of all cases of P&S syphilis reported to CDC were among Asian/Pacific Islanders (Table 33A). Compared to whites, the 2006 rate for Asian/Pacific Islanders was 0.7 times higher (Table 33B).

Hispanics - Between 2005 and 2006, the rate of P&S syphilis among Hispanics increased 12.5% (from 3.2 to 3.6). In 2006, 15.8% of all cases of P&S syphilis reported to CDC were among Hispanics (Table 33A). Compared to whites, the 2006 rate for Hispanics was 1.9 times higher (Table 33B).

Congenital Syphilis

In 2006, the rate of congenital syphilis (based on the mother's race/ethnicity) was 24.2 cases per 100,000 live births among African Americans and 15.4 cases per 100,000 live births among Hispanics. These rates are 15.1 and 9.6 times higher, respectively, than the 2005 rate among whites (1.6 cases per 100,000 live births) (Figure V, Table 40).

¹ Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med 2007; 147(2):89-96.

² Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004; 291(18):2229-2236.

³ Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941 through 1993. Sexually Transmitted Diseases 1996;23:16-23.

⁴ Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. The changing epidemiology of syphilis. Sex Transm Dis 2005;32:S4-S10.

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Page last modified: November 13, 2007
Page last reviewed: November 13, 2007
Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention