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 Minorities

Public Health Impact

Surveillance data show high rates of STDs for some minority groups when
compared with rates for whites.  There are no known biologic reasons to
explain why racial or ethnic factors alone should alter risk for STDs. 
Rather, race and ethnicity in the United States are risk markers that
correlate with other more fundamental determinants of health status such as
poverty, access to quality health care, health care seeking behavior,
illicit drug use, and living in communities with high prevalence of STDs. 
Acknowledging the disparity in STD rates by race/ethnicity is one of the
first steps in empowering affected communities to organize and focus on
this problem.

Surveillance data are based on cases of STDs reported to state and local
health departments (see Appendix).  In many areas, reporting from public
sources (e.g., STD clinics) is more complete than reporting from private
sources.  Since minorities may utilize public clinics more than whites,
differences in rates between minorities and whites may be biased toward
showing higher rates for minorities.  However, this bias is unlikely to
account for the very large differences in rates between minorities and
whites discussed below.  In areas where reporting from private sources is
known to be of high quality, the differences in rates between minorities
and whites persist (CDC, unpublished data).

Observations

     --   Although chlamydia is a widely distributed STD among all racial
          and ethnic groups, trends in positivity in women screened in
          three demonstration projects (Region X, San Francisco,
          California, and Columbus, Ohio) show higher rates among
          minorities (Figure_K, Figure_L, and Figure_M).

     --   In 1993, African-Americans accounted for about 81% of total
          reported cases of gonorrhea (Table_9A).  The overall
          gonorrhea rate in 1993 was 1,215.2 cases per 100,000 in blacks
          and 114.3 in Hispanics compared with 28.6 in non-Hispanic whites
          (Figure_11, Table_9B).

     --   Age-specific rates are very high in African-American adolescents
          and young adults.  In 1993, black 15- to 19-year-old women had a
          gonorrhea rate of 4,654.8 cases per 100,000 population and black
          men in this age group had a gonorrhea rate of 4,099.6.  These
          rates were more than 20-fold higher than those in white
          adolescents (Table_9B).

     --   Despite declines in gonorrhea rates for most age and race/ethnic
          groups during the 1980's, African-American adolescents did not
          show steady declining trends in rates until 1991 (black women)
          and 1992 (black men) (Figure_N and Figure_O). 

     --   The most recent epidemic of syphilis was largely an epidemic in
          heterosexual minority populations (1).  Since 1990, the rates of
          primary and secondary (P&S) syphilis have declined among all
          racial and ethnic groups.  However, rates among African-Americans
          and Hispanics continued to be higher than for non-Hispanic
          whites.  In 1993, African-Americans accounted for about 86% of
          all reported cases of P&S syphilis (Table_21A).  Although the
          rate among African-Americans declined from 96.9 cases per 100,000
          population in 1992 to 76.5 in 1993, the latter rate remained more
          than 60-fold greater than the non-Hispanic white rate of 1.2. 
          The 1993 rate of P&S syphilis in Hispanics of 6.0 was 5-fold
          greater than for non-Hispanic whites (Figure_24 and
          Table_21B).

     --   In 1993, the rate of congenital syphilis in African-Americans was
          344.9 per 100,000 live births and 96.3 in Hispanics compared with
          6.1 in whites (Figure_P).

     --   Minorities are also at increased risk for the long term
          consequences of STDs as evidenced by differences in ectopic
          pregnancy rates (Figure_Q).

(1) Rolfs RT, Nakashima AK.  Epidemiology of primary and secondary syphilis
in the United States, 1981 through 1989.  JAMA 1990;264:1432-7. 

Figure_K. Chlamydia - Percent positivity among women tested in family
              planning clinics by race and ethnicity: Region X, 1988-1993 
Figure_L. Chlamydia - Percent positivity among women tested in 16
              sentinel clinics by race and ethnicity: San Francisco,
              California, 1988-1993
Figure_M. Chlamydia - Percent positivity among women tested in primary
              care settings by race group: Columbus, Ohio, 1988-1993    
Figure_N. Gonorrhea - Reported rates for 15- to 19-year-old females by
              race and ethnicity: United States, 1981-1993    
Figure_O. Gonorrhea - Reported rates for 15- to 19-year-old males by
              race and ethnicity: United States, 1981-1993    
Figure_P. Congenital syphilis - Rates for infants <1 year of age by
              race and ethnicity: United States, 1991-1993    
Figure_Q. Ectopic pregnancy - Rates by race and year group: United
              States, 1970-1989    

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