Sexually Transmitted Diseases  >  Tracking the Hidden Epidemics 2000 (1999 data)

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Frequently Asked Questions

• Are STDs increasing or decreasing in the United States?
• What are the most serious STDs in women?
• Can the most serious STDs infect babies?
• What are the most common STDs among teens?
• What are STD trends in teens?
• What are the most common STDs among men who have sex with men?
• What areas of the country have the greatest problems with STDs?
• Are STDs more common among racial and ethnic minorities? If so, why?
• What are the economic costs of STDs in the United States?

Are STDs increasing or decreasing in the United States?

It depends on the disease. The latest scientific data suggest that chlamydia has declined in areas with screening and treatment programs, but remains at very high levels. For the first time in nearly two decades, gonorrhea is on the rise, increasing more than nine percent from 1997 to 1999, after a 72 percent decline from 1975 to 1997. An increase in drug-resistant gonorrhea has been seen in Hawaii and in small clusters in other states. Syphilis, in both adults and infants, has declined overall and is now at an all time low, presenting an opportunity for elimination of the disease. In October 1999, CDC launched the National Plan to Eliminate Syphilis in the United States. Chancroid also has declined steadily since 1987 (DSTDP, CDC, 2000).

Genital herpes continues to increase, spreading across all social, economic, racial and ethnic boundaries, but most dramatically affecting teens and young adults (Fleming, 1997). With an estimated 20 million people in the United States currently infected with human papillomavirus (HPV), this viral STD also continues to spread. An estimated 5.5 million people become newly infected with HPV each year (Cates, 1999).

What are the most serious STDs in women?

By far, women bear the greatest burden of STDs, suffering more frequent and more serious complications than men. Ten to 20 percent of women with gonorrhea and chlamydia develop one of the most serious complications, pelvic inflammatory disease (PID). PID can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy. Many different organisms can cause PID, but most cases are associated with gonorrhea and chlamydia.

HPV also can result in severe consequences for women. Infection with certain types of HPV place women at increased risk for cervical cancer.

In addition, women who are infected with an STD while pregnant can have early onset of labor, premature rupture of the membranes, or uterine infection before and after delivery. STD-related syndromes- like bacterial vaginosis-may cause harm to infants through their association with premature birth. Preterm birth is the leading cause of infant death and disability in the United States, and there has been no reduction in more than 20 years. It is estimated that 30 to 40 percent of excess preterm births and infant deaths are due to STDs and bacterial vaginosis (Goldenberg, 1996).

Can the most serious STDs infect babies?

Many STDs can be passed from an infected woman to fetus, newborn, or infant, before, during or after birth. Some STDs-like syphilis-cross the placenta and infect the fetus during its development. Other STDs-like gonorrhea, chlamydia, genital herpes, and genital HPV infection-are transmitted from mother to child as the infant passes through the birth canal. HIV infection can cross the placenta during pregnancy, can infect the newborn during the birth process, or unlike other STDs, can infect a child as a result of breast feeding.

If an STD in a pregnant woman is detected soon enough, precautions can often be taken so that the disease is not spread to the baby. Newborns infected with syphilis and herpes may suffer severe consequences not completely relieved by treatment, including neurologic damage and death. Gonorrhea and chlamydia can cause prematurity, eye disease, and pneumonia in infants.

What are the most common STDs among teens?

Teens are at high behavioral risk for acquiring most STDs. Teenagers and young adults are more likely than other age groups to have multiple sex partners, to engage in unprotected sex, and, for young women, to choose sexual partners older than themselves. Moreover, young women are biologically more susceptible to chlamydia, gonorrhea and HIV.

Chlamydia and gonorrhea are the most common curable STDs among teens. Curable STDs are typically caused by bacteria that can be killed with antibiotics. However, if these diseases remain undetected and untreated, they can result in severe health consequences later in life. Among teens, it is not uncommon to see more than five percent of young men and five to 10 percent of young women infected with chlamydia (Mertz, CDC, 1998). Rates of gonorrhea are highest in females 15 to 19 years of age and in males 20 to 24 years of age.

The prevalence of herpes increases with age. Since this disease stays within the body once acquired, the older people are, the more likely they have been infected. The rate of new infections for herpes and HPV-both viral STDs-is typically highest during the late teens and early twenties. Among women under the age of 25, studies have found that 28 to 46 percent are typically infected with HPV. Between 15 to 20 percent of young men and women have become infected with herpes by the time they reach adulthood.

What are STD trends in teens?

Syphilis, hepatitis B, and chancroid are declining among teens and other age groups. Chlamydia is likely going down in areas where there is screening and treatment among teens at family planning clinics and school-based screening programs. In areas where these services are not available, the disease may be increasing. Herpes was increasing among teens through the early 1990s. Currently, the data are not available to tell us whether HPV, trichomoniasis, or bacterial vaginosis are increasing, but these diseases are extremely widespread.

What are the most common STDs among men who have sex with men?

Researchers estimate that men who have sex with men (MSM) still account for 42 percent of new HIV infections annually in the United States and for 60 percent of all new HIV infections among men. Several recent studies have pointed to high, and increasing, levels of other STDs among MSM.

One 26-city study, the Gonococcal Isolate Surveillance Project, reported that from 1994 to 1999, the proportion of gonorrhea cases among MSM more than doubled from six to 13 percent. An STD clinic in Washington, D.C., serving a large number of gay and bisexual men reported that gonorrhea cases increased 93 percent from 1993 to 1996, with 82 percent of these cases among MSM.

In King County, Washington-which includes the city of Seattle-researchers reported marked increases in both gonorrhea and syphilis cases among MSM. Most notably, while the county had no cases of early syphilis in 1996, 88 cases were report-ed between 1998 and the first half of 1999, 85 per-cent of which were in gay and bisexual men. These men reported having multiple partners and frequently engaging in unprotected anal intercourse.

What areas of the country have the greatest problems with STDs?

Herpes and HPV are widespread throughout the nation, showing very little regional variation. Chlamydia is also extremely common across geographic boundaries, but is on the decline in regions where effective screening and treatment programs are in place. Chlamydia remains most widespread among women in the southern region of the country. The south also faces the highest rates of both gonorrhea and syphilis. The high rates of STDs in the south may be due to high rates of poverty and lack of access to quality health care.

Are STDs more common among racial and ethnic minorities? If so, why?

Although STDs like chlamydia, HPV, and herpes are widespread across racial and ethnic groups, STD rates tend to be higher among African Americans than white Americans. Reported rates of some STDs, like gonorrhea and syphilis, are as much as 30 times higher for African Americans than for whites. This disparity is due, in part, to the fact that African Americans are more likely to seek care in public clinics that report STDs more completely than private providers. However, this reporting bias does not fully explain these differences. Other important factors include the distribution of poverty, access to quality health care, health-seeking behaviors, the level of drug use, and sexual networks with high STD prevalence.

Moreover, the level of prevention education may vary widely across communities. In some areas, community-based efforts may be widespread across social, educational, and religious organizations, but in others, STD prevention may not yet be a high priority. Efforts are underway to increase both public and private sector HIV and STD prevention efforts in communities at risk throughout the nation. Yet, research demonstrates that some groups at very high risk still lack even basic information about STD prevention (Bunnel, CDC, 1998).

What are the economic costs of STDs in the United States?

STDs are associated with both direct and indirect costs. Direct costs include expenditures for medical and non-medical services and materials, such as physician services, laboratory services, hospitalization, transportation, and medical supplies. Indirect costs mainly include lost wages due to illness or premature death. STDs also result in intangible costs related to pain, suffering, and diminished quality of life. In 1994, the direct and indirect costs of the major STDs and their complications were estimated to total almost $17 billion annually.

 

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