Sexually Transmitted Disease Surveillance 1993
Division of STD/HIV Prevention December 1994 U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Center for Prevention Services Division of STD/HIV Prevention Surveillance and Information Systems Branch 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/HIV Prevention. Sexually Transmitted Disease Surveillance, 1993. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, December 1994. Copies can be obtained from Information Services, National Center for Prevention Services, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333. National Profile The National Profile section contains figures showing trends and distribution of sexually transmitted diseases (STDs) by age, gender, race/ethnicity, and location for the United States. When possible, the figures have been selected to show progress toward the specific year 2000 goals for the nation published in Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Chlamydia Infections due to Chlamydia trachomatis are among the most prevalent of all sexually transmitted diseases. In women these infections often result in serious reproductive tract complications, such as pelvic inflammatory disease, infertility, and ectopic pregnancy. In addition, infected pregnant women can infect their babies during delivery. However, surveillance of chlamydial infection is incomplete in many areas of the country. A combination of factors limit the documentation of the incidence and prevalence of genital chlamydial infection: enforcement of public health laws requiring that health care providers and laboratories report cases to local health authorities; large numbers of asymptomatic persons who can be identified only through screening; limited resources to support screening activities; and incompletely developed information management infrastructures for collecting, maintaining, and analyzing morbidity data. Thus, for most areas, the number of reported chlamydia cases reported to CDC by state health departments reflects the degree of local interest in chlamydia as a public health problem and initial attempts to resolve reporting limitations rather than true disease burden or trends. In 1993, 46 states reported chlamydial infections to CDC (Table_3). -- From 1984 through 1992 reported rates of chlamydia increased dramatically, from 3.2 cases per 100,000 population to 178.3 (Figure_1); in 1993, the rate decreased slightly to 167.9. Trends continue to primarily reflect increased screening, recognition of asymptomatic infection (mainly in women), and improved reporting capacity rather than true trends in disease incidence. -- Rates of chlamydia were highest in the West and the Midwest, where substantial resources have been committed for organized screening programs (e.g., in family planning clinics) (Figure_2 and Figure_3). In the areas where these screening programs are in place, chlamydia rates far exceed gonorrhea rates. -- Between 1992 and 1993 rates of chlamydia in large cities with >200,000 population decreased slightly from 290.2 cases per 100,000 population to 272.3 (Figure_4, Table_6). -- Reported rates of chlamydia for women far exceed those for men (Figure_5, Table_4, Table_5, Table_7, and Table_8). This is mainly due to increased detection of asymptomatic infection in women through screening. The low rates in men suggest that many of the sex partners of women with chlamydia are not diagnosed or reported. -- Additional information on chlamydia screening programs in women and chlamydia in adolescents and minorities can be found in the Special Focus Profiles section. Figure_1. Chlamydia - Reported rates: United States, 1984 1993 Figure_2. Chlamydia - Rates by state: United States, 1993 Figure_3. Chlamydia - Rates by region: United States, 1984-1993 Figure_4. Chlamydia - Rates in U.S. cities of >200,000 population, 1984-1993 Figure_5. Chlamydia - Rates by gender: United States, 1984-1993 Gonorrhea -- In 1993, 439,673 cases of gonorrhea were reported. The rate of gonorrhea has continued to decline, from 196.7 cases per 100,000 population in 1992 to 172.4 in 1993 (Table_1 and Figure_6). -- In 1993, the gonorrhea rates for 38 states were below the Healthy People 2000 (HP 2000) national objective of 225 cases per 100,000 population (Figure_7 and Table_10). -- Gonorrhea rates declined in all regions during 1993 (Figure_8). Although the overall gonorrhea rate for large cities (with >200,000 population) continued to decline in 1993 (Figure_9), 39 (61%) of 64 large cities had rates exceeding the HP 2000 objective (Table_14). -- Gonorrhea rates for both men and women continued to decline in 1993 and were below the HP 2000 objective (Figure_10; Table_12, Table_13, Table_16, and Table_17). -- Gonorrhea rates for all racial and ethnic groups other than non-Hispanic blacks were below the HP 2000 objective (Figure_11 and Table_9B). The gonorrhea rate for blacks decreased from 1,404.8 cases per 100,000 population in 1992 to 1,215.2 in 1993 and is now below the HP 2000 sub-objective of 1,300 cases per 100,000 population for this special target group (Table_9B). -- The gonorrhea rate for 15- to 19-year-old adolescents decreased from 869.6 cases per 100,000 population in 1992 to 742.1 in 1993 and is now below the HP 2000 sub-objective of 750 cases per 100,000 population for this special target population (Table_9B). -- Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. Overall, 30.4% of GISP isolates in 1993 were resistant to penicillin, tetracycline, or both (Figure_14). Between 1991 and 1993, the percentage of gonorrhea isolates from sentinel STD clinics participating in the Gonococcal Isolate Surveillance Project (GISP), which were penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates, declined from 13.1% to 9.6% (Figure_15). Although no GISP isolates have yet demonstrated clinically significant resistance to the antimicrobial agents currently recommended for therapy (1), some isolates have begun to demonstrate decreased levels of susceptibility to some of these agents (2). -- Additional information about gonorrhea in racial and ethnic minorities and adolescents can be found in the Special Focus Profiles section. (1) CDC. 1993 Sexually transmitted diseases treatment guidelines MMWR 1993;42(No. RR-14):56-66. (2) CDC. Decreased susceptibility of Neisseria gonorrhoeae to fluoroquinolones--Ohio and Hawaii, 1992-1994. MMWR 1994;43:325-7. Figure_6. Gonorrhea - Reported rates: United States, 1970-1993 and the year 2000 objective Figure_7. Gonorrhea - Rates by state: United States, 1993 Figure_8. Gonorrhea - Rates by region: United States, 1981-1993 and the year 2000 objective Figure_9. Gonorrhea - Rates in U.S. cities of >200,000 population, 1981-1993 and the year 2000 objective Figure_10. Gonorrhea - Rates by gender: United States, 1981 1993 and the year 2000 objective Figure_11. Gonorrhea - Rates by race and ethnicity: United States, 1981 1993 and the year 2000 objective Figure_12. Gonorrhea - Age- and gender-specific rates: United States, 1993 Figure_13. Gonococcal Isolate Surveillance Project (GISP) - Location of participating clinics and regional laboratories: United States, 1993 Figure_14. Gonococcal Isolate Surveillance Project (GISP) - Percentage distribution of antimicrobial resistance in gonorrhea isolates, 1993 Figure_15. Gonococcal Isolate Surveillance Project (GISP) - Trends in plasmid-mediated resistance, 1988-1993 Figure_16. Gonococcal Isolate Surveillance Project (GISP) - Trends in chromosomally mediated resistance, 1988-1993 Syphilis -- Between 1992 and 1993, the incidence of primary and secondary (P&S) syphilis in the United States declined from 13.3 to 10.4 cases per 100,000 population (Figure_18 and Table_1). -- In 1993, P&S syphilis rates were below the Healthy People 2000 (HP 2000) national objective of 10 cases per 100,000 population in 36 states (Figure_19 and Table_22). -- In 1993, 2,006 (64%) of 3,116 counties in the United States reported no cases of P&S syphilis. Of 1,110 counties reporting at least one case of P&S syphilis, 649 (58%) counties reported rates of 10 cases or less per 100,000 population (Figure_20). The rates of P&S syphilis were above the HP 2000 objective in 461 counties. These counties accounted for 81% of all reported P&S syphilis cases. -- In 1993, the rates of P&S syphilis declined in all regions of the U.S., indicating the epidemic of syphilis that began in the mid-1980's has subsided. However, the rate of 18.8 cases per 100,000 population in the South remained well above the HP 2000 objective (Figure_21). -- The overall rate of P&S syphilis in large cities (>200,000 population) declined from 24.5 cases per 100,000 population in 1992 to 17.8 in 1993 (Figure_22 and Table_27). However, rates exceeded the HP 2000 objective in 36 (56%) of 64 of the large cities in the United States and outlying areas for which data were available (Table_26). -- Since 1990, the rates of P&S syphilis have declined for all racial and ethnic groups (Figure_24 and Table_21B). However, the 1993 rate for non-Hispanic blacks of 76.5 cases per 100,000 population was more than 60 times greater than the rate for non-Hispanic whites (Figure_24 and Table_21B). -- Between 1992 and 1993, the overall rate of congenital syphilis decreased from 94.7 to 79.0 cases per 100,000 live births (Figure_27, Table_34). During this period, rates increased in nine states (Alabama, Louisiana, Michigan, Mississippi, Missouri, New Jersey, Ohio, South Carolina, and Tennessee) reporting more than 10 cases in 1993 (Table_35). -- In 1993, fourteen states (Florida, Georgia, Illinois, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, and Texas) had rates that exceeded the HP 2000 objective of 50 cases per 100,000 live births (Table_35). -- Additional information on syphilis and congenital syphilis can be found in the Special Focus Profiles section. Figure_17. Syphilis - Reported cases by stage of illness: United States, 1941-1993 Figure_18. Primary and secondary syphilis - Reported rates: United States, 1970-1993 and the year 2000 objective Figure_19. Primary and secondary syphilis - Rates by state: United States, 1993 Figure_20. Primary and secondary syphilis - Counties with rates above and counties with rates below the year 2000 objective: United States, 1993 Figure_21. Primary and secondary syphilis - Rates by region: United States, 1981-1993 and the year 2000 objective Figure_22. Primary and secondary syphilis - Rates in U.S. cities of >200,000 population, 1981-1993 and the year 2000 objective Figure_23. Primary and secondary syphilis - Rates by gender: United States, 1981-1993 and the year 2000 objective Figure_24. Primary and secondary syphilis - Rates by race and ethnicity: United States, 1981-1993 and the year 2000 objective Figure_25. Primary and secondary syphilis - Age- and gender-specific rates: United States: 1993 Figure_26. Congenital syphilis - Reported cases in infants <1 year of age and rates of primary and secondary syphilis among women: United States, 1970-1993 Figure_27. Congenital syphilis - Rates in infants <1 year of age: United States, 1981-1993 Other Sexually Transmitted Diseases -- Hospitalizations for acute and chronic pelvic inflammatory disease (PID) have continued to declined since the early 1980's (Figure_28). However, initial visits to physicians' offices for PID have remained relatively constant (Figure_29). -- Since 1987, reported cases of chancroid have declined steadily (Table_1 and Figure_31). -- Comprehensive surveillance data for non-specific urethritis, viral STDs, and vaginitis are not available. Current data are limited to estimates of trends in physicians' office practices provided by the National Disease and Therapeutic Index. These data suggest that these diseases affect large numbers of persons each year (Figure_30, Figure_32, Figure_33 and Figure_34). Figure_28. Pelvic inflammatory disease - Hospitalizations of women 15-44 years of age: United States, 1980-1992 Figure_29. Pelvic inflammatory disease - Initial visits to physicians' offices by women 15-44 years of age: United States, 1980- 1993 Figure_30. Nonspecific urethritis - Initial visits to physicians' offices by men: United States, 1966-1993 Figure_31. Chancroid - Reported cases: United States, 1981-1993 Figure_32. Human papillomavirus (genital warts) - Initial visits to physicians' offices: United States, 1966-1993 Figure_33. Genital herpes simplex virus infections - Initial visits to physicians' offices: United States, 1966-1993 Figure_34. Trichomonal and other vaginal infections - Initial visits to physicians' offices: United States, 1966-1993
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