Wednesday, November 14, 2007

Centers For Disease Control 2006 Report Shows Chlamydia, Gonorrhea, And Syphilis All On The Rise In The United States

The incidence of gonorrhea, which had declined sharply, has risen in the last two years in this country while the number of chlamydia and syphilis cases continue to rise, according to officials with the Centers for Disease Control (CDC). Media story from the New York Times.

The CDC released their findings in the form of a report entitled "Trends In Reportable Sexually Transmitted Diseases In the United States, 2006". Click HERE to view the HTML version, or click HERE to view the seven-page PDF version.

A grand total of about 19 million new cases of all kinds of sexually transmitted diseases occur in the United States each year, but only three of them, chlamydia, gonorrhea, and syphilis, are nationally reported. So even though genital herpes, papillomavirus and trichomonas infections account for the vast majority of STD cases, they are not centrally tracked because doctors are not required to report them nationally.

In 2006, 1,030,911 cases of chlamydia were reported, the highest ever recorded for any nationally reported disease in any year. Officials claim that because of underreporting, a more accurate estimate is 2.8 million new chlamydia cases annually. Chlamydia’s rise in incidence is due mainly to urging by the centers for annual testing of sexually active women under age 26 (see graphic above left). Current tests are more sensitive in detecting chlamydia than those used a few years ago. Most cases were among women who had no symptoms but could transmit the microbe. Alaska recorded 4,525 chlamydia cases in 2006, an average of 681.8 per 100,000 people, the highest rate in the nation.

The chlamydia microbe can cause pelvic inflammatory disease and resulting abdominal pain, ectopic pregnancy and infertility in women.

Gonorrhea is the second most prevalent of the three. From 1975 through 1997 the reported rate of gonorrhea dropped 74 percent, then plateaued. But in 2006, the number of cases surged to 358,366. The CDC estimates that at least twice that number actually occurred. Alaska recorded 630 gonorrhea cases in 2006, an average of 94.9 per 100,000 people, 22nd in the nation.

And even syphilis is on the rise. In the days before penicillin became available in World War II to cure syphilis, the number of reported syphilis cases peaked at 575,000, and that total included individuals who never could be treated and developed the late stages of the disease that cause brain and heart damage. The incidence of syphilis continued to steadily decline, bottoming out in 2000. But cases have risen each year since then to 9,756 cases in 2006. Most cases have involved gay men, who account for about 65 percent of cases (even though they comprise only 3 percent of the population), and to a lesser extent women. Also, a small number of cases have occurred among newborns. Alaska recorded 11 syphilis cases in 2006, an average of 1.7 per 100,000 people, 28th in the nation.

Different reasons account for the rise of each of the three reportable and curable diseases, and for each a different approach is needed to reduce its incidence, Dr. John M. Douglas Jr., head of the division of sexually transmitted diseases at the Centers for Disease Control and Prevention, told reporters by telephone.

There's also racial disparities. Non-whites are more susceptible than whites. In particular, the three reported sexually transmitted diseases affect African-Americans disproportionately. The black to white ratios are gonorrhea 18 to 1, syphilis 6 to 1 and chlamydia 8 to 1, Dr. Douglas said in an interview. The reasons for the disparities are not clear. Lack of access to health care may be one problem.

African-Americans account for 69 percent of all gonorrhea in this country. “The biggest increase in gonorrhea regionally has been in the South, and we do not have a ready explanation for that,” Dr. Douglas said.

The CDC report itself offers more extensive information about the racial disparities, including information about Alaska Natives, of interest to Alaskans. Here's the applicable excerpt from the report:

Racial Disparities Persist Across All Reportable STDs

Racial and ethnic minorities continue to be disproportionately affected by sexually transmitted diseases in the United States. These disparities may be, in part, because racial and ethnic minorities are more likely to seek care in public health clinics that report STDs more completely than private providers. However, this reporting bias does not fully explain these differences. Other contributing factors include limited access to quality health care, poverty, and higher prevalence of disease in these populations.

Data in CDC’s
2006 STD Surveillance Report show higher rates of all STDs among minority racial and ethnic populations when compared to whites, with the exception of Asians/Pacific Islanders.


In 2006, the rate of chlamydia among African Americans was more than eight times higher than the rate among whites (1275.0 vs. 153.1 per 100,000 population), with approximately 46 percent of all chlamydia cases reported among African Americans. Additionally, the rates among American Indians/Alaska Natives (797.3 per 100,000) and Hispanics (477.0 per 100,000), were five times and three times higher than whites, respectively. In 2006, chlamydia rates increased for all racial/ethnic groups, except for Asians/Pacific Islanders.


Racial disparities in gonorrhea rates are even greater and racial gaps in diagnosis of gonorrhea are more pronounced than any other disease. The gonorrhea rate among African Americans was 18 times greater than that for whites in 2006 (658.4 per 100,000 vs. 36.5 per 100,000). From 2005 to 2006, the gonorrhea rate among African Americans increased by 6.3 percent—the first increase since 1998. In 2006, African Americans accounted for 69 percent of reported cases of gonorrhea.

In that same year, American Indians/Alaska Natives had the second-highest gonorrhea rate (138.3 per 100,000), followed by Hispanics (77.4), whites (36.5), and Asians/Pacific Islanders (21.1). In 2006, there were increases in gonorrhea rates among all racial and ethnic groups, except Asians/Pacific Islanders.


Although racial gaps in syphilis rates are narrowing, disparities remain, with rates in 2006 approximately six times higher among blacks than among whites. This represents a substantial decline from 1999, when the rate among blacks was 29 times greater than among whites. It is important to note that this narrowing reflects both declining disease rates among African Americans as well as significant increases among white males in recent years.

Despite some progress, African Americans continue to remain disproportionately affected by syphilis with a rate of 11.3 cases per 100,000 population in 2006. This is more than three times the rate for Hispanics, who have the second highest rate (3.6 cases per 100,000) as well as American Indians/Alaska Natives (3.3 cases per 100,000).

In 2006, the P&S syphilis rate among blacks increased for the third consecutive year, following more than a decade of declines. Between 2005 and 2006, the rate among blacks increased 16.5 percent (from 9.7 to 11.3), with the largest increase among black males (15.5 to 18.3, an increase of 18.1 percent).

In 2006, the rate of P&S syphilis in black females was 16 times higher than in white females. In that same year, 43.2 percent of all reported P&S syphilis cases occurred among African Americans, while whites accounted for 38.4 percent. Syphilis rates increased for all races and ethnicities in 2006.

So, despite comprising only 12% of the national population, blacks accounted for 46% of the chlamydia cases, 69% of the gonorrhea cases, and 43% of the syphilis cases in 2006. Hell of a legacy, huh?

Some are trying, though. On June 5-6, 2007 in Atlanta, GA, a wide variety of experts met with CDC policymakers to exchange information and brainstorm solutions to the racial disparities in STDs within the black community. The results are documented in a 48-page PDF report entitled "Consultation to Address STD Disparities in African American Communities".

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