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. 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 1993, nine of the ten states with the highest rates of gonorrhea were located in the South (Figure_7 and Table_10). Nine of the ten states with the highest rates of P&S syphilis were also located in the South (Figure_19 and Figure_20; Table_22). Seven of the eight states with rates of P&S syphilis that exceeded 20 cases per 100,000 population (or twice the Healthy People 2000 [HP 2000] national objective) were located in the South (Figure_19 and Table_22). -- In 1993, 424 (92%) of 461 counties with P&S syphilis rates above the HP 2000 objective were located in the South (Figure_R). -- Between 1992 and 1993, P&S syphilis rates increased in 212 (50%) of 424 counties in the South that had 1993 rates greater than 10 cases per 100,000 population (Figure_S). -- 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 are adjusted for race and ethnic composition of the population, states in the South no longer have the highest rates, and states with the highest rates are located in the Midwest (Figure_T). When P&S syphilis rates are adjusted for race and ethnicity, the differences between the South and other regions, especially the Midwest, are greatly diminished (Figure_U). However, many states in the South continue to have high rates. -- Rates of P&S syphilis in African-Americans by region show that the epidemic of the 1980's was largely an epidemic within this group regardless of region (Figure_V). Figure_R. Primary and secondary syphilis case rates by county, 1993 Figure_S. South - Increases and decreases in cases of primary and secondary syphilis in 1993 compared with 1992 cases, by county Figure_T. Gonorrhea - Rates by state, adjusted for race and ethnic distribution of the population: United States, 1993 Figure_U. Primary and secondary syphilis - Rates by state, adjusted for race and ethnic distribution of the population: United States, 1981-1993 Figure_V. Primary and secondary syphilis - Rates in African-Americans by region: 1981-1993
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