Sexually Transmitted Diseases  >  Surveillance & Statistics  >  Indian Health Surveillance Report, STDs 2004

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Summary of Data

Sexually transmitted diseases (STDs) remain a major public health challenge in the U.S. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, CDC estimates that 19 million new infections occurred in 2000, almost half of them among young people ages 15 to 24.¹³ In addition to the physical and psychological consequences of STDs, these diseases also exact a tremendous economic toll. Direct medical costs associated with STDs in the U.S. are estimated at $13 billion annually.¹⁴

This report summarizes 2004 national data and trends for chlamydia, gonorrhea, and primary and secondary syphilis (P&S) among American Indians and Alaska Natives (AI/AN). AI/AN are one of the smallest racial groups in the U.S.—according to Census 2000, AI/AN comprise between 0.9%-1.5% of the total U.S. population15— but are disproportionately affected by STDs. In 2004, reported rates of chlamydia, gonorrhea, and P&S among AI/AN were 2 to 6 times higher than comparable rates for whites.³

Chlamydia

Across all races and ethnicities, chlamydia remains the most commonly reported infectious disease in the U.S. In 2004, 16,741 chlamydia diagnoses were reported among AI/AN, up from 15,964 cases in 2003. The national AI/AN rate of reported chlamydia in 2004 was 705.8 cases per 100,000 population, an increase of 5% from 2003 (672.2 cases per 100,000 population). The 2004 chlamydia rate among AI/AN was 2.2 times higher than the U.S. rate (319.6 cases per 100,000 population).

Large Disparity Between IHS and U.S. Rates

Among AI/AN residing in the IHS service area, the overall IHS chlamydia rate in 2004 was 727.8 cases per 100,000 population, which was 2.3 times higher than the corresponding U.S. rate; 3 IHS Areas—Aberdeen, Alaska, and Billings—had chlamydia rates 4.9 to 6 times higher than the U.S. rate. The determinants for these disparities among reported chlamydia rates are unclear. For all populations, recent 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.

Young Women Especially Affected

Compared to men, chlamydia rates are higher among women and reflect the fact that women are far more likely to be screened for this infection. Chlamydia rates among women are highest among those ages 15-24 years. In 2004, the overall IHS rate among women ages 15-24 years was 4,363.7 cases per 100,000 population, which was 1.6 times higher than the corresponding U.S. rate (2,654.7 cases per 100,000 population). For individual IHS Areas, chlamydia rates among women 15-24 years ranged between 1,130.8 cases per 100,000 population in the California Area to 10,599.3 cases per 100,000 population in the Aberdeen Area.

Gonorrhea

Gonorrhea is the second most commonly reported infectious disease in the U.S. In 2004, 2,858 gonorrhea diagnoses were reported among AI/AN, up from 2,489 cases in 2003. The national rate of reported gonorrhea in 2004 among AI/AN was 117.7 cases per 100,000 population, an increase of 14.8% from 2003 (102.5 cases per 100,000 population). The 2004 gonorrhea rate among AI/AN was slightly higher than the U.S. rate (113.5 cases per 100,000 population).

Overall IHS Rates Stable, Similar to U.S. Rates

Since 1998, gonorrhea rates for the overall IHS population have remained stable, while the U.S. gonorrhea rates have declined. In 2004, the overall IHS and U.S. gonorrhea rates were similar (110.0 and 113.5 cases per 100,000 population, respectively). Nationally, gonorrhea rates in 2004 were at the lowest levels recorded since reporting began in 1941.

High Gonorrhea Rates in 3 IHS Areas

Reported gonorrhea rates in 2004 for 3 IHS Areas—Aberdeen, Alaska, and Phoenix—were 1.6 to 2.4 times higher than the U.S. rate. In 2004, the Aberdeen Area had the highest gonorrhea rate (273.2 cases per 100,000 population); 4 IHS Areas—Albuquerque, Billings, California, and Tucson— had rates <50% of the U.S. rate. For the overall IHS population in 2004, gonorrhea rates were higher for women (147.8 cases per 100,000 population) compared to men (72.4 cases per 100,000 population).

Primary and Secondary Syphilis (P&S)

The rate of primary and secondary syphilis (P&S) in the U.S. decreased throughout the 1990s, and in 2000 reached an all-time low. However, over the past 4 years both the U.S. and AI/AN syphilis rates have been increasing. Between 2003 and 2004, the AI/AN P&S rate increased 14.3%, from 2.8 to 3.2 cases per 100,000 population; comparatively, the U.S. P&S rate increased 8% from 2.5 to 2.7 cases per 100,000 population. In 2004, 77 P&S diagnoses were reported among AI/AN, up from 69 in 2003.

IHS Cases Primarily Occurring in the Southwest

In 2004, 55 of 60 (92%) P&S cases diagnosed within the IHS service area occurred in 3 IHS Areas in the Southwest—Navajo, Phoenix, and Albuquerque; 7 IHS Areas had no P&S cases in 2004. IHS cases in the Southwest have been increasing since 2001. During 2003-2004, among all IHS Areas, the greatest P&S rate increase occurred in the Albuquerque Area (94% increase from 5.0 to 9.7 cases per 100,000 population); the Navajo Area had the largest number of P&S cases (34) diagnosed in 2004.

IHS Cases Evenly Distributed Between Men and Women

For overall IHS cases in 2004, the P&S male-to-female rate ratio was 0.9, which indicates a similar number of P&S cases occurring among AI/AN men and women. In contrast, the U.S. P&S male-to-female rate ratio in 2004 was 5.9, which indicates a disproportionate number of P&S cases occurring among men compared to women; this disparity reflects recent syphilis outbreaks in the U.S. which have primarily occurred in large cities among men who have sex with men (MSM). Though P&S male-to-female rate ratios vary by IHS Area, these data suggest different patterns of transmission for syphilis among AI/AN compared to the general U.S. population.

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