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.
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 2004, 23.3% of reports on gonorrhea cases were missing information on race or ethnicity, and 29.3% 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.
Observations
Chlamydia
Although chlamydia in women is a widely distributed STD among all racial and ethnic groups, trends in positivity in women screened in HHS Region X show consistently higher chlamydia positivity among minorities (Figure
P).
In 2004, the rate of chlamydia among African-American females in the United States was more than 7 times higher than the rate among white females (1,722.3 and 226.6 per 100,000, respectively) (Table
11B). The chlamydia rate among African-American males was more than 11 times higher than that among white males (645.2 and 57.3 per 100,000 population, respectively).
Gonorrhea
In 2004, 69.6% of the total number of cases of gonorrhea reported to CDC
occurred among African-Americans (Table 21A). In 2004, the rate of gonorrhea
among African-Americans was 629.6 cases per 100,000 population, among American
Indian/Alaska Natives the rate was 117.7, and among Hispanics the rate was
71.3. These rates are 19, 4, and 2 times higher, respectively, than the rate
among whites in 2004 of 33.3 cases per 100,000 population. The rate of
gonorrhea among Asian/Pacific Islanders in 2004 was 21.4 cases per 100,000 population
(Figure 15, Table
21B).
From 2000 through 2004, gonorrhea rates among African-Americans declined by 19.1% (778.1 and 629.6 cases per 100,000 population, respectively). During the same period, gonorrhea rates increased by 19.8% among whites, 19.4% among American Indian/Alaska Natives, and 3.8% among Hispanics, and decreased by 19.9% among Asian/Pacific Islanders (Table
21B).
Gonorrhea rates in 2004 among African-American men were 26 times higher than among white men. Gonorrhea rates in 2004 among African-American women were 15 times higher than among white women (Figure
Q).
Gonorrhea rates in 2004 were highest for African-Americans aged 15-24 years among all racial, ethnic, and age categories. In 2004, African-American women aged 15-19 years had a gonorrhea rate of 2,790.5 cases per 100,000 females. This rate was 14 times greater than the 2004 rate among white females of similar age (201.7). African-American men in the 15- to 19-year-old age category had a 2004 gonorrhea rate of 1,390.1 cases per 100,000 males, which was 37 times higher than the rate among 15- to 19-year-old white males of 37.9 per 100,000. Among 20- to 24-year-olds in 2004, the gonorrhea rate among African-Americans was 17 times greater than that among whites (2,487.2 and 149.0 cases per 100,000 population, respectively) (Table
21B).
Although gonorrhea rates decreased for most age and race/ethnic groups during
the 1980s, they did not decrease for African-American adolescents during this
period; African-American 15- to 19-year-old females did not show a decrease
in rates until 1991 (Figure R). Decreases among 15- to 19-year old African-American
males did not begin until 1992 (Figure S). From 2000 to 2004, gonorrhea rates
among 15- to 19-year-old African-American females and males decreased 19.7%
and 25.5%, respectively.
Primary and Secondary Syphilis
The syphilis epidemic in the late 1980s occurred primarily among heterosexual, minority populations.1During the 1990s, the rate of primary and secondary (P&S) syphilis declined among all racial and ethnic groups (Figure
31). During 2000-2004, the rate continued to decline among African-Americans, but the overall rate of P&S syphilis and rates among non-Hispanic whites, Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives increased; increases in P&S syphilis occurred only among men and the most rapid rate of increase occurred among non-Hispanic white men during this time (Table
34B).
Between 2003 and 2004, the rates of primary and secondary syphilis increased 11% in white men, 17% in African-American men and increased slightly (2%) among African-American women (Table
34B). Rates continued to increase among Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives.
In 2004, 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
34A). The 2004 rate for African-Americans was 6 times greater than the rate among non-Hispanic whites (Table
34B).
In 2004, the incidence of P&S syphilis by sex among African-Americans
was highest among women aged 20-24 years (13.4 cases per 100,000 population)
and among men aged 25-29 (34.6 cases per 100,000 population) (Table
34B). In
2003, African-American men in the 35-39 age group had the highest rates.
Between 2003 and 2004, P&S syphilis rates for African-Americans in every age group increased. (Table
34B).
In 2004, 16% of all cases of P&S syphilis reported to CDC occurred among Hispanics (Table
34A). The rate of P&S syphilis among Hispanic men increased 12% (from 4.9 to 5.5 cases per 100,000 population) between 2003 and 2004. The rate among Hispanic women remained essentially unchanged (0.7 cases per 100,000 population). The rate among Hispanics in 2004 was 2 times greater than the rate among non-Hispanic whites.
The incidence of P&S syphilis among Hispanics was highest among women aged 20-24 years (1.9 cases per 100,000 population) and among men aged 35-39 years (14.0 cases per 100,000 population) in 2004 (Table
34B).
Congenital Syphilis
In 2004, the rate of congenital syphilis (based on the mother's race/ethnicity) was 26.7 cases per 100,000 live births among African-Americans and 16.2 cases per 100,000 live births among Hispanics. These rates are 16 and 10 times greater, respectively, than the 2004 rate among non-Hispanic whites (1.7 cases per 100,000 live births), respectively (Figure
W, Table 44).
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.
Racial
and Ethnic Minorities 1 
