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    

---