Other Sexually Transmitted Diseases

Chancroid

Since 1987, reported cases of chancroid declined steadily until 2001. Since then, the number of cases reported has fluctuated (Figure 42, Table 1). In 2007, 23 cases of chancroid were reported in the United States. Only eight states reported one or more cases of chancroid in 2007 (Table 41). Although the overall decline in reported chancroid cases most likely reflects a decline in the incidence of this disease, these data should be interpreted with caution since Haemophilus ducreyi, the causative organism of chancroid, is difficult to culture and, as a result, this condition may be substantially under-diagnosed.^1,2

Human Papillomavirus

Persistent infection with high risk human papillomavirus (HR-HPV) can lead to development of anogenital cancers (i.e., cervical cancer). In June 2006, a quadrivalent HPV vaccine was licensed for use in the United States. The vaccine provides protection against types 6, 11, 16, and 18. Types 6 and 11 are associated with genital warts while types 16 and 18 are oncogenic types associated with anogenital cancers.

Sentinel surveillance for cervical infection with high-risk human papillomavirus types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, or 68 was conducted in 26 STD, family planning and primary care clinics in six locations (Boston, Baltimore, New Orleans, Denver, Seattle and Los Angeles) as part of an effort to estimate national burden of disease and inform prevention programs such as vaccine programs in the U.S. Testing was performed using a commercially available test for HR-HPV DNA (Hybrid Capture 2, Qiagen, Gaithersburg, MD). Results from 2003-2005 document an overall HR-HPV prevalence of 23%. Prevalence in STD clinics was 27%, 26% in family planning clinics, and 15% in primary care clinics. Prevalence by age group was: 14 to 19 years 35%; 20 to 29 years 29%; 30 to 39 years 13%; 40 to 49 years 11%; and 50 to 65 years 6%.³

Preliminary results from the sentinel surveillance project from 2003-2004 also report PCR-based HPV type-specific prevalence estimates for types 16 and 18. Overall prevalence of infection with HPV types 16 or 18 was 8%. Prevalence of HPV 16 or 18 by age group was: 16% in 14 to 19 year olds; 10% in 20 to 29 year olds; 3% in 30 to 39 year olds; 2% in 40 to 49 year olds and 1% in 50 to 65 year olds.⁴

National population-based data were also obtained from the National Health and Nutrition Examination Survey (NHANES) identifying prevalence of both HR-HPV and low-risk HPV (LR-HPV, which is associated with development of anogenital warts) in the civilian, non-institutionalized female population of the U.S., 2003-2004 (Figure 43). The overall HPV prevalence including high- and low-risk types, was 26.8% (95% confidence interval (CI): 23.3-30.9) among U.S. females aged 14 to 59 years. HPV vaccine preventable types 6 or 11 (low-risk types) or 16 or 18 (high-risk types) were detected in 3.4% of female participants; HPV-6 was detected in 1.3% (95% CI: 0.8-2.3), HPV-11 in 0.1% (95% CI: 0.03-0.3), HPV-16 in 1.5% (95% CI: 0.9-2.6), and HPV-18 in 0.8% (95% CI: 0.4-1.5) of female participants.⁵

Data from the National Disease and Therapeutic Index (NDTI) suggest that genital warts (Figure 44) as measured by initial visits to physicians offices, may be increasing. The NHANES 1999-2004 survey years demonstrated that 5.6% (95% CI: 4.9-6.4) of sexually active 18-59 year olds self-reported a history of a genital wart diagnosis.⁶

Pelvic Inflammatory Disease

For data on Pelvic Inflammatory Disease (PID), see the Special Focus Profile on Women and Infants.

Herpes Simplex Virus (HSV)

Case reporting data for genital herpes simplex virus are not available. Trend data are based on estimates of the initial office visits in physicians' office practices for these conditions from the National Disease and Therapeutic Index (NDTI) (Figure 45 and Table 42).

National trend data on the seroprevalence of HSV-2 among those aged 14 to 49 years from the NHANES survey years 1999-2004 were compared with survey years 1988-1994. Seroprevelance decreased from 21% (95% CI: 19.1-23.1) in 1988-1994 to 17.0% (95% CI: 15.8-18.3) in 1999-2004. When including data on blacks and whites from NHANES survey years 1976-1980, blacks had higher seroprevalence than whites for each survey period and age group⁷ (Figure 46). In 1999-2004, the overall percentage of survey participants who reported having been diagnosed with genital herpes was 3.8%.⁷

While HSV-2 seroprevalence is decreasing, most persons with HSV-2 have not been diagnosed. Increasing visits for genital herpes, as suggested by NDTI data, may indicate increased recognition of infection.

Trichomoniasis

Case reporting data are not available for trichomoniasis and trend data for this infection is limited to estimates of initial physician office visits from NDTI (Figure 47 and Table 42). NHANES data from 2001-2004 demonstrated an overall prevalence of 3.1% (95% CI: 2.3-4.3), with highest prevalence observed among blacks 13.3% (95% CI: 10.0-17.7).⁸

 

¹ Schulte JM, Martich FA, Schmid GP. Chancroid in the United States, 1981–1990: Evidence for underreporting of cases. MMWR 1992;41(no. SS-3):57–61.

² Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. J Infect Dis 1998;178:1795–8.

³ Datta SD, Koutsky L, Ratelle S, et al. Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003–2005. Ann Intern Med 2008 Apr 1;148(7):493–500.

⁴ Datta SD, Koutsky L, Ratelle S, et al. Type-Specific High-Risk HPV Prevalence from the HPV Sentinel Surveillance Project, US, 2003–2005 [Abstract no. P-099]. In Program and abstracts of the International Human Papillomavirus Meeting, Prague, Czech Republic, September 2006.

⁵ Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, Markowitz LE. Prevalence of HPV infection among females in the United States. JAMA 2007 Feb 28;297(8):813–9.

⁶ Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts among 18- to 59-year-olds in the United States, national health and nutrition examination survey, 19992004. Sex Transm Dis 2008 Apr;35(4):357-60.

⁷ Xu F, Sternberg MR, Kottiri BJ, McQuillan G, Lee FK, Nahmias AJ, Berman SM, Markowitz LE. Trends in Herpes Simplex Virus Type 1 and Type 2 seroprevalence in the United States. JAMA 2006 Aug 23/30 (8):964-973.

⁸Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman, S, Markowitz LE. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 20012004. Clin Infect Dis 2007 Nov 15;45(10):1319-26.