Sexually Transmitted Disease Surveillance 1995

Division of STD Prevention

September 1996

U.S. Department of Health and Human Services 
Public Health Service 
Centers for Disease Control and Prevention  
National Center for HIV, STD, and TB Prevention 
Division of STD Prevention 
Atlanta, Georgia 30333

Copyright Information 

All material contained in this report is in the public domain and may be
used and reprinted without special permission; citation to source, however,
is appreciated.

Suggested Citation

Division of STD Prevention. Sexually Transmitted Disease Surveillance,
1995. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1996.

Copies can be obtained from Information Technology and Services Office,
National Center for HIV, STD, and TB Prevention, Centers for Disease
Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia
30333 or by telephone at (404) 639-1819.

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                            STDs in the South

Public Health Impact

The southern region (Alabama, Arkansas, Delaware, Florida, Georgia,
Kentucky, Louisiana, Maryland, Mississippi, Oklahoma, North Carolina, South
Carolina, Tennessee, Texas, Virginia, West Virginia) has had higher rates
of primary and secondary (P&S) syphilis and gonorrhea than other regions of
the country. The reasons for regional differences in rates are not well
understood, but may include differences in racial and ethnic distribution
of the population, poverty, and availability and quality of health care
services. These racial and ethnic differentials in STD rates are
particularly disturbing in light of the fact that STDs facilitate HIV
transmission at least two to five fold. High HIV prevalence among
childbearing women living in the South may be due, in part, to the high
rates of these others STDs. Data from a randomized controlled trial of STD
treatment to prevent HIV infection suggest that as much as a 40% reduction
in HIV incidence might be achieved in areas with high STD rates (1).

Observations

--  The South has consistently had higher rates of both gonorrhea and P&S
    syphilis compared with other regions throughout the 1980's and 1990's
    (Figure_7, Figure_8, Figure_19, and Figure_21,
    Table_11 and Table_23).

--  In 1995, the 10 states with the highest rates of gonorrhea were all
    located in the South (Figure_7 and Table_10). Thirteen of the
    17 states with rates of P&S syphilis above the revised HP2000 objective
    of 4 per 100,000 population were located in the South (Figure_19
    and Figure_20; Table_22). All 8 states with rates of P&S
    syphilis that exceeded 12 cases per 100,000 population (or three times
    the revised HP2000 national objective) were located in the South
    (Figure_19 and Table_22).

--  In 1995, 492 (84%) of 588 counties with P&S syphilis rates above the
    revised HP2000 objective were located in the South (Figure_20 and
    Figure_N).

--  Between 1994 and 1995, P&S syphilis rates increased in 244 (54%) of 449
    counties in the South that had 1995 rates greater than 4 cases per
    100,000 population (Figure_O).

--  Rates of P&S syphilis in African-Americans by region show that rates in
    this group, while decreasing, are high regardless of region
    (Figure_P).

Figure_N.  South -- Primary and secondary syphilis case rates by county, 
               1995
Figure_O.  South -- Increases and decreases in cases of primary and
               secondary syphilis in 1995 compared with 1994 cases, by
               county
Figure_P.  Primary and secondary syphilis -- Rates in African-Americans
               by region: 1981-1995

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(1) Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, Mayaud
    P, Changalucha J, Nicoll A, ka-Gina G, Newell J, Mugeye K, Mabey D,
    Hayes R. Impact of improved treatment of sexually transmitted diseases
    on HIV infection in rural Tanzania: randomised controlled trial. Lancet
    1995;346:530-6.

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