Sexually Transmitted Disease Surveillance 1994

Division of STD Prevention

September 1995

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 (proposed)
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,
1994. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1995.

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

Both the 1993 and 1994 reports are now available electronically on CDC
WONDER. For information about registering for CDC WONDER, please contact
CDC's Information Resource Management Office at (404) 332-4569.

                            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.

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).

 --  In 1994, the nine states with the highest rates of gonorrhea were
     located in the South (Figure_7 and Table_10). Ten of the
     twelve states with rates of P&S syphilis above the HP2000 objective of
     10 per 100,000 population were located in the South (Figure_19 and
     Figure_20; Table_22). All five states with rates of P&S
     syphilis that exceeded 20 cases per 100,000 population (or twice the
     HP2000 national objective) were located in the South (Figure_19
     and Table_22). 

 --  In 1994, 364 (92%) of 396 counties with P&S syphilis rates above the
     HP2000 objective were located in the South (Figure_20 and
     Figure_L).

 --  Between 1993 and 1994, P&S syphilis rates increased in 198 (54%) of
     364 counties in the South that had 1994 rates greater than 10 cases
     per 100,000 population (Figure_M).

 --  Much of the difference in rates between the South and other regions of
     the country is due to the differences in distribution of the
     population by race and ethnicity. As stated above, gonorrhea and
     syphilis are largely focused in minority populations and these groups
     are disproportionately located in southern states. When gonorrhea
     rates were adjusted for the race and ethnic composition of the
     population, states in the South no longer had the highest rates, and
     states with the highest rates were located in the Midwest
     (Figure_N). When P&S syphilis rates were adjusted for race and
     ethnicity, the differences between the South and other regions,
     especially the Midwest, were greatly diminished (Figure_O).
     However, many states in the South continued to have high rates.

 --  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_L. Primary and secondary syphilis case rates by county, 1994    
Figure_M. South - Increases and decreases in cases of primary and
              secondary syphilis in 1994 compared with 1993 cases, by
              county    
Figure_N. Gonorrhea - Rates by state, adjusted for race and ethnic
              distribution of the population: United States, 1994    
Figure_O. Primary and secondary syphilis - Rates by state, adjusted for
              race and ethnic distribution of the population: United
              States, 1994    
Figure_P. Primary and secondary syphilis - Rates in African-Americans
              by region: 1981-1994    

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