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.

The reports for 1993 through 1995 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. These
reports are also available from the Internet via the CDC home page address
http://www.cdc.gov.


Centers for Disease Control and Prevention
David Satcher, M.D., Ph.D.
Director

National Center for  HIV, STD, and TB Prevention
Helene D. Gayle, M.D., M.P.H.
Director

Division of STD Prevention
Judith N. Wasserheit, M.D., M.P.H.
Director
 

Preface

Sexually Transmitted Disease Surveillance, 1995 presents statistics and
trends of sexually transmitted diseases (STDs) in the United States through
1995. It is intended as a reference document for program managers, health
planners, researchers, investigators, policy makers, and others who are
concerned with the public health implications of these diseases.

The STD surveillance systems operated by state and local STD control
programs are the sources of most of the information in this publication.
These systems are an integral part of program management at all levels of
STD prevention and control in the United States. The role of these
surveillance systems is to provide program managers with the disease burden
and trend information necessary for problem definition, priority setting,
resource allocation, and program evaluation.

Sexually Transmitted Disease Surveillance, 1995 is an annual publication,
and figures and tables in this edition supersede those in earlier
publications of these data.

Sexually Transmitted Disease Surveillance, 1995 consists of four parts. The
National Profile contains figures that provide an overview of the STD
situation in the United States. The accompanying text identifies major
findings and trends for selected STDs. The Special Focus Profiles contain
figures and text describing STDs in selected subgroups and populations that
are a focus of national and state prevention efforts. The Detailed Tables
provide statistical information about STDs at the state, city, and national
levels. The Appendix provides information about the sources and limitations
of the data used to produce this report.

Selected figures and tables in this document include a reference point that
is used to monitor progress toward some of the Healthy People 2000 (HP2000)
national health status objectives for STDs (1). The original HP2000 health
status objectives were developed in 1989 and revised in 1995. The revisions
are used as reference points in this edition of Sexually Transmitted
Disease Surveillance, 1995. 

Any comments and suggestions that would improve the usefulness of future
publications are appreciated and should be sent to Director, Division of
STD Prevention, National Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02,
Atlanta, Georgia, 30333.


(1) Department of Health and Human Services. Healthy People 2000: Midcourse
    Review and 1995 Revisions. U.S. Department of Health and Human
    Services, Public Health Service. U.S. Government Printing Office,
    Washington, D.C., 1995.


                             Acknowledgments

Publication of this report would not have been possible without the
contributions of the State and Territorial Health Departments and the
Sexually Transmitted Disease Control Programs, who provided morbidity data to
the Centers for Disease Control and Prevention.

This report was prepared by the following staff members of the Division of
STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for
Disease Control and Prevention:  Susan Bradley, Sharon Clanton, Martha R.
Cowart, Darlene Davis, Kathleen B. Dry, Melinda L. Flock, Kimberly K. Fox,
Samuel L. Groseclose, Alesia Jester-Harvey, William C. Levine, Debra Mosure,
Russ Roegner, Karen L. Southwick, Margaret B. VanNorden, and Diane M. Vitro.

Dedication

We dedicate this volume to our  colleague and friend, Martha R. Cowart. After
30 years of government service, Mrs. Cowart is retiring. She has been an
integral member of the team producing this report. We wish her the best in
the years ahead.

                     Geographic Divisions of the United States

Figure_GEO.   Geographic Divisions of the United States


        National Overview of Sexually Transmitted Diseases, 1995

The logo on the cover of Sexually Transmitted Disease Surveillance, 1995,
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, collaborative efforts among interested, committed public and
private organizations are the keys to reducing STDs and their related
health burdens in our population. Several observations for 1995 are worthy
of note. 

States have recognized the programmatic importance of collecting and
sharing reliable information on efforts to reduce the number of genital
Chlamydia trachomatis infections in the population. In 1994, through the
efforts of the Council of State and Territorial Epidemiologists (CSTE),
chlamydia became a nationally notifiable condition. The development of
improved state and federal data bases will ultimately result in better
planning, priority setting, and evaluation of chlamydia control efforts. In
1995, the reported number of cases of chlamydial infection (477,638)
exceeded the reported number of cases of gonorrhea (392,848) in the United
States. This occurred amid growth in chlamydia control programs nationwide,
together with continuing commitments to sustain gonorrhea prevention
programs that began in the 1970s. In 1995, for every chlamydia case
detected and reported in males, almost 6 cases were detected in females.
This discrepancy is attributable to screening strategies that focus on
women because they are asymptomatic in the majority of cases. Male sex
partners of infected women may be treated prophylactically for chlamydia
without a diagnostic laboratory test, but current surveillance systems are
limited in their ability to document the treatment of male partners. Using
local, state, and federal resources, chlamydia prevention programs
targeting asymptomatic women have been established throughout the country.
Chlamydia positivity rates from these screening and treatment programs
illustrate the widespread distribution of chlamydial infection throughout
the United States. Large-scale screening projects in Public Health Service
Region X (Alaska, Idaho, Oregon, and Washington) and elsewhere 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 among these
economically disadvantaged young women, and geographically widespread.
Monitoring chlamydia positivity rates in selected populations, in addition
to traditional morbidity surveillance, shouldallow us to better quantify
the reservoir of infection in both women and men.

Data on gonorrhea for 1995 suggest that the annual decreases that have been
evident since the mid-1970s are continuing. The 1995 gonorrhea rate of
149.5 is the lowest rate since the early 1960s but is above the revised
Healthy People 2000 (HP2000) objective of 100. The average annual decreases
in gonorrhea over the previous 10 years have been about 20 cases per
100,000 population per year. The decrease in reported cases between 1994
(165.1 per 100,000) and 1995 was 15.6 cases per 100,000.

With respect to gender, the 1995 gonorrhea rate decreased from the 1994
rate by 11.8% among males (158.6), and by 6.9% among females (140.3).
Decreases were greater among the youngest age groups: 10- to 14-year-olds
(males: 21.3%; females: 12.1%), and 15- to 19-year-olds (males: 15.5%;
females: 6.4%). Because men with gonorrhea are usually symptomatic and seek
medical care, trends among males are a good measure of disease incidence.
Trends in women are largely determined by screening practices. It is
possible that expansion of chlamydia screening programs for women
(especially for younger women) is having an indirect, beneficial effect on
gonorrhea detection and treatment, as well. As for chlamydia, rates of
gonorrhea in women are particularly high in adolescents, with the highest
rates being among 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 resistance to
ciprofloxacin remains rare (0.2%).

The 16,500 cases of primary and secondary (P&S) syphilis reported in 1995
were the fewest cases reported in the United States since 1960. The P&S
syphilis rate of 6.3 per 100,000 population is above the revised HP2000
objective of 4 per 100,000. Syphilis remains a problem only in selected
areas of the country. In 1995, 69% of U.S. counties did not report any
syphilis cases. A comparable percent (68%) of counties did not report any
syphilis cases in 1994. In 1995, P&S syphilis rates exceeded 4 per 100,000
in 588 counties (19% of total counties). These counties accounted for 89%
of all reported P&S syphilis cases. Most notably, 84% (492 of 588) of these
counties were located in the South. In addition, 13 of the 18 states/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 dramatically reduce the number of U.S. syphilis
cases by the end of the decade.

When we examine STD statistics by race/ethnicity, we continue to see very
wide discrepancies among racial/ethnic groups. For example, gonorrhea rates
among black adolescents (15-19 years of age) are more than 26 times greater
than the rate among white adolescents. The rate of P&S syphilis among
blacks is nearly 60 times that in whites; P&S syphilis among Hispanics is
about 4 times that in whites. Congenital syphilis has decreased nationally
in recent years. However, in 1995, of the 1,534 reported cases with known
race/ethnicity of the mother, blacks and Hispanics accounted for 91% of all
reported cases, while accounting for only 21% of the female population.
Although there are no known biologic reasons to explain why racial or
ethnic factors alone should alter STD risk, 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 quality health care, and health care seeking behavior. Reporting
biases may also play a role in race differentials. 

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