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.

Notifiable STDs

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 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.

In 2005, 22.2% of reports on gonorrhea cases were missing information on race or ethnicity (ranging by state from 0.0% to 50.7%), and 26.3% of reports on chlamydia cases were missing race or ethnicity (Table A1). To adjust for missing data, cases in 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. Only 4.8% of syphilis cases were missing race or ethnicity.

Observations

Chlamydia

In 2005, 41.6% of all chlamydia cases occurred among blacks, 28.8% occurred among whites, and 18.1% occurred among Hispanics (Table 10A). The rate of chlamydia among black females in the United States was more than seven times higher than the rate among white females (1,729.0 and 237.2 per 100,000 population, respectively) (Figure O, Table 10B). The chlamydia rate among black males was more than 11 times higher than that among white males (717.8 and 63.6 per 100,000 population, respectively).

Gonorrhea

In 2005, approximately 68% of the total number of cases of gonorrhea reported to CDC occurred among African Americans (Table 20A). In 2005, the rate of gonorrhea among African Americans was 626.4 cases per 100,000 population, among American Indian/Alaska Natives the rate was 131.7, and among Hispanics the rate was 74.8. These rates are 18, 4, and 2 times higher, respectively, than the rate among whites in 2005 of 35.2 cases per 100,000 population. The rate of gonorrhea among Asian/Pacific Islanders in 2005 was 25.9 cases per 100,000 population (Figure 17, Table 20B).

All racial and ethnic groups saw slight increases in gonorrhea rates from 2004 to 2005. Despite this slight increase in 2005, between 2001 and 2005, the gonorrhea rate among African Americans declined by 17.8% (762.0 and 626.4 cases per 100,000 population, respectively). During the same five year period, gonorrhea rates increased by 28.4% among American Indian/Alaska Natives,19.7% among whites, 6.4% among Hispanics, and 5.3% among Asian/Pacific Islanders (Table 20B).

In 2005, gonorrhea rates among African-American men were 24 times higher than among white men; gonorrhea rates among African-American women were 14 times higher than among white women (Figure P).

In 2005, 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 15-19 years had a gonorrhea rate of 2,814.0 cases per 100,000 females. This rate was 14 times greater than the 2005 rate among white females of similar age (204.7). African-American men in the 15- to 19-year-old age category had a 2005 gonorrhea rate of 1,417.5 cases per 100,000 males, which was 36 times higher than the rate among 15- to 19-year-old white males of 39.7 per 100,000. Among 20- to 24-year-olds, the gonorrhea rate among African Americans was 15 times greater than that among whites (2,452.9 and 161.0 cases per 100,000 population, respectively) (Table 20B).

From 2001 to 2004, gonorrhea rates among 15- to 19-year-old African-American females and males decreased 21.0% and 22.4%, respectively. However, both groups saw slight increases from 2004 to 2005 (3.3% and 4.2%), the first increases for these groups in recent years (Figures Q and R).

Primary and Secondary Syphilis

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 32). From 2001 to 2005, the overall rate of P&S syphilis and rates among non-Hispanic whites, Hispanics, and Asian/Pacific Islanders increased; the rates among American Indian/Alaska Natives fluctuated; and the rates among African Americans decreased between 2001 and 2003, but then increased between 2004 and 2005.

Between 2004 and 2005, the rates of primary and secondary syphilis increased 11.4% among African Americans; 12.9% among African-American men and 4.8% among African-American women (Table 32B). Between 2004 and 2005, P&S syphilis rates for African Americans in most age groups increased. (Table 32B).

Between 2004 and 2005, the rates of primary and secondary syphilis increased 6.5% among Hispanics; from 5.4 to 5.5 among Hispanic men and from 0.7 to 0.9 among Hispanic women (Table 32B). Between 2003 and 2004, P&S syphilis rates for Hispanics in most age groups increased. (Table 32B).

In 2005, 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 32A). Compared to non-Hispanic whites, the 2005 rate for African Americans was 5.4 times higher, and for Hispanics, 1.8 times higher (Table 32B).

In 2005, the rate of P&S syphilis among African Americans was highest among women aged 20-24 years (13.5) and among men aged 25-29 (38.2) (Table 32B). For Hispanics, the rate was highest among women aged 20-24 years (2.9) and among men aged 35-39 years (14.0) (Table 32B).

Congenital Syphilis

In 2005, the rate of congenital syphilis (based on the mother's race/ethnicity) was 25.9 cases per 100,000 live births among African Americans and 13.4 cases per 100,000 live births among Hispanics. These rates are 19.9 and 10.3 times higher, respectively, than the 2005 rate among non-Hispanic whites (1.3 cases per 100,000 live births) (Figure V, Table 40).

¹ 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.