Sexually Transmitted Disease Surveillance 1996

Division of STD Prevention September 1997

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,
1996. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1997.

Copies can be obtained from the Office of Communications, National Center
for HIV, STD, and TB Prevention, Centers for Disease Control and
Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

The reports for 1993 through 1996 are available electronically on CDC
WONDER. For information about registering for CDC WONDER, please contact
CDC's Epidemiology Program Office at (888) 496-8347. These reports are also
available from the Internet via the CDC home page address
http://wonder.cdc.gov/wonder/data/Reports.html. 


National Overview of Sexually Transmitted Diseases, 1996

The logo on the cover of Sexually Transmitted Disease Surveillance, 1996 is
a reminder of the multifaceted, national dimensions of the morbidity,
mortality, and costs that result from sexually transmitted diseases (STDs)
in the United States. It highlights the central role of STD prevention in
improving women's and infants' health and in promoting HIV prevention.
Organized collaboration among interested, committed public and private
organizations is the key to reducing STDs and their related health burdens
in our population. As noted in the recent report of the Institute of
Medicine, The Hidden Epidemic: Confronting Sexually Transmitted Diseases
(1), surveillance is a key component of our efforts to prevent and control
these diseases.

This overview summarizes national surveillance data on the three diseases
for which we have federally-funded control programs: chlamydia, gonorrhea,
and syphilis. Several observations for 1996 are worthy of note.

In 1996, the reported number of cases of genital Chlamydia trachomatis
infections was 490,080, a rate of 194.5 per 100,000 persons. This rate
exceeds that of all other notifiable infectious diseases in the United
States. In 1996, the overall reported rate for women (321.5 per 100,000)
was more than five times that in men (60.4). This difference in reported
cases is attributable to screening strategies that focus on women because
the severe sequelae of chlamydia infections accrue principally to women,
and because these infections are asymptomatic in the majority of cases
among women.

Using local, state, and federal resources, chlamydia prevention programs
for screening of asymptomatic women have been established throughout the
country. In 1996, state-specific chlamydia test positivity among women aged
15-24 years who were screened at selected family planning clinics ranged
from 2.5% to 10.9%. These screening programs have consistently shown that
the highest rates of chlamydial infection in women are in adolescents. In
addition, examination of chlamydial screening results for rural and urban
disadvantaged women aged 16-24 years entering the U.S. Job Corps shows that
chlamydia is highly prevalent in these economically disadvantaged young
women, with state-specific rates in 1996 ranging from 1.7% to 17.9%.

In parts of the United States where large-scale chlamydia programs have
been instituted, prevalence of disease has steadily declined. During
1988-1996, among 15- to 44-year-old women participating in the screening
programs in Health and Human Services (HHS) Region X family planning
clinics, the rate of chlamydia test positivity declined 61% (from 9.3% to
3.6%). During 1994-1996, among women under 45 years of age in Region III,
positivity declined 28% (from 4.7% to 3.4%), and in Region VIII, positivity
declined 21% (from 3.9% to 3.1%). See the Appendix for definition of HHS
regions.

Data on gonorrhea for 1996 show that the annual decreases that have been
evident since the national gonorrhea control program began in the mid-1970s
are continuing. The 1996 gonorrhea rate of 124.0 is the lowest rate since
national reporting began but is above the revised Healthy People 2000
(HP2000) objective of 100. The average annual decreases in gonorrhea over
the last 10 years have been about 25 cases per 100,000 persons per year.
The decrease in reported cases between 1995 (149.4 per 100,000) and 1996
was 25.4 cases per 100,000.

With respect to gender, the 1996 gonorrhea rate decreased from the 1995
rate by 19.0% in males (128.5), and by 14.8% in females (119.5). In
general, age-specific rates decreased for both sexes. Relative to 1995,
decreases in the age-specific rates ranged from approximately 10% to 27% in
males and about 1% to 19% in females. Decreases were greatest in the
youngest age group: 10- to 14-year-olds (males:26.6%; females:19.1%).
Because men with gonorrhea are usually symptomatic and seek medical care,
trends in males are a good measure of disease incidence. Trends in women
are largely determined by screening practices. As for chlamydia, rates of
gonorrhea in women are particularly high in adolescents, with the highest
rates in 15- to 19-year-olds. 

With regard to antimicrobial resistance, a growing number of Neisseria
gonorrhoeae isolates tested through the Gonococcal Isolate Surveillance
Project have demonstrated decreased susceptibility to ciprofloxacin, one of
the currently recommended treatments for gonorrhea. However in 1996,
resistance to ciprofloxacin was rare (0.04%).

The 11,387 cases of primary and secondary (P&S) syphilis reported in 1996
were the fewest cases reported in the United States since 1959. The P&S
syphilis rate of 4.3 per 100,000 persons is approaching the HP2000
objective of 4 per 100,000. Syphilis continues to be reported only in
specific areas of the country. In 1996, the percentage of U.S. counties
that did not report any syphilis cases increased to 73% compared to 69% of
the counties in 1995. In 1996, P&S syphilis rates exceeded 4 per 100,000 in
482 counties (15% of total counties). These counties accounted for 84% of
all reported P&S syphilis cases. Most notably, 89% (429 of 482) of these
counties were in the South. In addition, 12 of the 18 states or outlying
areas with P&S syphilis rates greater than 4 per 100,000 were located in
the South. These data suggest that comprehensive syphilis prevention
efforts focused in the South may markedly reduce the number of U.S.
syphilis cases by the end of the decade.

When STD statistics were examined by race or ethnicity, very wide
discrepancies continue between racial or ethnic groups. For example,
gonorrhea rates in black adolescents (15-19 years of age) are almost 25
times greater than the rate in white adolescents. The rate of P&S syphilis
in blacks is nearly 50 times that in whites; P&S syphilis in Hispanics is
about 3 times that in whites. Congenital syphilis has decreased nationally
in recent years. However, in 1996, of the 1,160 reported cases with known
race or ethnicity of the mother, blacks and Hispanics accounted for 90% of
all reported cases, while accounting for only 23% of the female population.
Race and ethnicity in the United States serve as risk markers that
correlate with other, more fundamental determinants of health status such
as socioeconomic status, access to good quality medical care, and efforts
to receive good quality medical care. Reporting biases also undoubtedly
play a role in race differentials, while not explaining them completely.

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(1) Institute of Medicine. The Hidden Epidemic: Confronting Sexually
    Transmitted Diseases, Committee on Prevention and Control of Sexually
    Transmitted Diseases, National Academy Press, Washington, D.C., 1997. 

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