STDs in Racial and Ethnic Minorities

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 population-based surveys such as the National Health and Nutrition Examination Survey (NHANES) and the National Longitudinal Study of Adolescent Health (Add Health) confirm the existence of marked STD disparities.^1,2

Completeness of Race/Ethnicity Data

To adjust for missing case report 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 any reporting bias.

Chlamydia – In 2007, 25.7% of reports on chlamydia cases were missing race or ethnicity (ranging by state from 0.0% to 55.5%) (Table A1).

Gonorrhea – In 2007, 20.3% of reports on gonorrhea cases were missing information on race or ethnicity (ranging by state from 0.0% to 40.2%).

Syphilis – In 2007, only 4.1% of reports on syphilis cases were missing information on race or ethnicity (ranging from 0.0% to 22.6% among states with 10 or more cases of P&S syphilis).

Observations

Chlamydia

All racial and ethnic groups except American Indian/Alaska Natives reported increases in chlamydia rates from 2006 to 2007 (Table 11B). From 2003 to 2007, chlamydia rates increased by 24.6% among blacks; 9.0% among American Indian/Alaska Natives; 10.5% among Hispanics; and 18.7% among whites. Over the same time period, rates decreased by 1.5% among Asian/Pacific Islanders.

Blacks – In 2007, approximately 48% of all chlamydia cases occurred among blacks (Table 11A). Overall, the rate of chlamydia among blacks in the United States was more than eight times that among whites. The rate of chlamydia among black women was more than seven times higher than the rate among white women (1,906.0 and 249.3 per 100,000 women, respectively) (Figure O, Table 11B). The chlamydia rate among black men was more than 11 times higher than that among white men (841.3 and 71.9 per 100,000 men, respectively).

American Indian/Alaska Natives – In 2007, the chlamydia rate among American Indian/Alaska Natives was 732.9 cases per 100,000 population, a decrease of 7.2% from the 2006 rate of 790.1. The chlamydia positivity rate among females aged 15-24 years screened in Indian Health Service (IHS) clinics ranged from 8.1% in HHS region V to 11.6% in region VIII (Figure P).

Asian/Pacific Islanders – In 2007, the chlamydia rate among Asian/Pacific Islanders was 139.5 cases per 100,000 population, a slight increase from the 2006 rate of 127.2.

Hispanics – In 2007, the chlamydia rate among Hispanics was 473.2 cases per 100,000 population, nearly three times higher than the rate among whites (162.3).

Gonorrhea

All racial and ethnic groups except blacks saw declines in gonorrhea rates from 2006 to 2007. In contrast, the gonorrhea rate among blacks increased by 1.8% from 2006 to 2007 (Table 21B and Figure 21)

Blacks – In 2007, approximately 70% of the total number of reported cases of gonorrhea occurred among blacks (Table 21A). In 2007, the rate of gonorrhea among blacks was 662.9 cases per 100,000 population. Overall, the rate of gonorrhea among blacks in the United States was 19 times greater than that among whites This disparity is unchanged from recent years (20 times higher in 2003) (Figure Q, Table 21B). This disparity was higher for black men (26.1 times higher) than for black women (14.9 times higher) (Figure R). The disparity in gonorrhea rates for blacks was higher in the Midwest and Northeast (27.2 and 24.8 times higher, respectively) than in the South or the West (15.6 and 12.4 times higher, respectively) (Figure S).

In 2007, gonorrhea rates were highest for blacks aged 15 to 19 and 20 to 24 years among all racial, ethnic, and age categories. Black women aged 15 to 19 years had a gonorrhea rate of 2,955.7 cases per 100,000 women. This rate was 14.7 times greater than the 2007 rate among white women of similar age (200.6). Black men in the 15- to 19-year-old age category had a 2007 gonorrhea rate of 1,537.8 cases per 100,000 men, which was 38.7 times higher than the rate among 15- to 19-year-old white men of 39.7 per 100,000 men. Among those aged 20 to 24 years, the gonorrhea rate among blacks was 16.5 times greater than that among whites (2,618.3 and 158.8 cases per 100,000 population, respectively) (Table 21B).

American Indian/Alaska Natives – In 2007 the gonorrhea rate among American Indian/Alaska Natives was 107.1 which was 3.1 times higher than the rate among whites. This disparity is similar to recent years (3.1 times higher in 2003) (Figure Q, Table 21B). This disparity was higher for American Indian/Alaska Native women (3.4 times higher) than for American Indian/Alaska Native men (2.6 times higher) (Figure R). The disparity in gonorrhea rates for American Indian/Alaska Natives was higher in the Northeast and the Midwest (3.9 and 3.3 times higher, respectively) than in the West or the South (2.9 and 2.6 times, respectively) (Figure S).

Asian/Pacific Islanders – In 2007 the gonorrhea rate among Asian/Pacific Islanders was 18.8 cases per 100,000 population which was lower than the rate among whites (Figure Q, Table 21B). This difference is greater for Asian/Pacific Islander women than for Asian/Pacific Islander men (Figure R). Rates among Asian/Pacific Islanders are consistently lower than among whites in all four regions of the U.S. (Figure S).

Hispanics – In 2007, the gonorrhea rate among Hispanics was 69.2 which was higher than the rate among whites. This disparity is similar to that in recent years (Figure Q, Table 21B). This disparity was higher for Hispanic men than for Hispanic women (Figure R). The disparity in gonorrhea rates for Hispanics was higher in the Northeast than in the West, the Midwest, or the South (Figure S).

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 36). Between 2003 and 2007, the rate of P&S syphilis increased among all racial and ethnic groups.

Blacks – Between 2006 and 2007, the rate of P&S syphilis among blacks increased 25.0% (from 11.2 to 14.0). In 2007, 46.0% of all cases of P&S syphilis reported to CDC were among blacks and 35.3% of all cases were among non-Hispanic whites (Table 33A). Compared to whites, the overall 2007 rate for blacks was 7.0 times higher. It was 5.9 times higher in 2006 (Table 33B). In 2007, the P&S rate among black men was more than 6.0 times higher than that among white men; the rate among black women was 14 times higher than that among white women. In some age groups, particularly 15-19 year old black men, disparities have increased markedly in recent years as rates of disease have increased (Figure V).

Recent trends in young black men are of particular concern given data indicating high HIV incidence in this population.⁵

American Indian/Alaska Natives – Between 2006 and 2007, the rate of P&S syphilis among American Indian/Alaska Natives increased 6.3% (from 3.2 to 3.4). In 2007, 0.7% of all cases of P&S syphilis reported to CDC were among American Indian/Alaska Natives (Table 33A).

Compared to whites, the 2007 rate for American Indian/Alaska Natives was 1.7 times higher (Table 33B).

Asian/Pacific Islanders – Between 2006 and 2007, the rate of P&S syphilis among Asian/Pacific Islanders remained unchanged (1.2 per 100,000 population). In 2007, 1.2% of all cases of P&S syphilis reported to CDC were among Asian/Pacific Islanders (Table 33A). The 2007 rate for Asian/Pacific Islanders was 0.6 times the rate for whites (Table 33B).

Hispanics – Between 2006 and 2007, the rate of P&S syphilis among Hispanics increased 22.9% (from 3.5 to 4.3). In 2007, 16.5% of all cases of P&S syphilis reported to CDC were among Hispanics (Table 33A). Compared to whites, the 2007 rate for Hispanics was 2.2 times higher (Table 33B).

Congenital Syphilis

In 2007, the rate of congenital syphilis (based on the mothers race/ethnicity) was 32.3 cases per 100,000 live births among blacks and 15.3 cases per 100,000 live births among Hispanics. These rates are 14 and 6.6 times higher, respectively, than the 2007 rate among whites (2.3 cases per 100,000 live births) (Figure W, 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.

⁵ Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system–United States, 2006. MMWR 2008;57:985–989.