Sexually Transmitted Disease Surveillance 1994
Division of STD Prevention September 1995 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 (proposed) 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, 1994. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1995. Copies can be obtained from Information Technology and Services Office, National Center for HIV, STD, and TB Prevention (proposed), Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333 or by telephone at (404) 639-1819. Both the 1993 and 1994 reports 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. 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. Where relevant, the figures illustrate progress toward 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. While surveillance of chlamydial infections is improving, it remains incomplete in many areas of the country. A combination of factors limit the documentation of the incidence and prevalence of genital chlamydial infection: variable compliance with public health laws and regulations that require health care providers and laboratories to 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 1994, 448,984 chlamydial infections were reported to CDC from 47 states (Table_3). This is the first year that reported cases of chlamydia exceeded reported cases of gonorrhea (418,068 gonorrhea cases in 1994, Table_1). -- From 1984 through 1994 reported rates of chlamydia increased dramatically, from 3.2 cases per 100,000 population to 188.4 (Figure_1). 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. -- As in previous years, 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 1993 and 1994 rates of chlamydia reported from large cities (>200,000 population) increased 17% from 280.7 cases per 100,000 population to 328.4 (Figure_4, Table_6). -- Reported rates of chlamydia for women (265.3 per 100,000 population) exceed those for men (46.2 per 100,000 population) (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. In addition, men diagnosed as having non-gonococcal urethritis are treated but frequently not tested. A large proportion of these men are infected with chlamydia, but they are not detected by surveillance systems based on laboratory reporting of positive chlamydia tests. -- Additional information on chlamydia screening programs in women and chlamydia in adolescents and minority populations can be found in the Special Focus Profiles section. Figure_1. Chlamydia - Reported rates: United States, 1984-1994 Figure_2. Chlamydia - Rates by state: United States, 1994 Figure_3. Chlamydia - Rates by region: United States, 1984-1994 Figure_4. Chlamydia - Rates in U.S. cities of >200,000 population, 1984-1994 Figure_5. Chlamydia - Rates by gender: United States, 1984-1994 Gonorrhea -- In 1994, 418,068 cases of gonorrhea were reported. The rate of gonorrhea has continued its overall decline since 1975. Between 1993 and 1994 the rate decreased from 173.8 cases per 100,000 population in 1993 to 168.4 (Table_1 and Figure_6). However, the state of Georgia did not report in 1994. In previous years, Georgia has reported among the highest rates of gonorrhea; thus, exclusion of Georgia lowered the overall rate for the nation in 1994 (see Appendix). -- In 1994, 37 states reported gonorrhea rates below the Healthy People 2000 (HP2000) national objective of 225 cases per 100,000 population (Figure_7 and Table_10). However, gonorrhea rates increased between 1993 and 1994 in 21 of 35 states reporting more than 1,000 cases in 1994. This trend was decidedly different from recent years of steep declines in most states (Table_11) (1). -- The decrease in gonorrhea rates slowed in 1994 for the West, Northeast, and South. The rate increased for the Midwest from 176.0 cases per 100,000 population in 1993 to 181.4 in 1994. (Figure_8). -- Although the overall gonorrhea rate for large cities (with >200,000 population) continued to decline in 1994 (Figure_9), 39 (62%) of 63 large cities (excluding Atlanta, see Appendix) had rates exceeding the HP2000 objective (Table_14). The same number of large cities had rates exceeding the HP2000 objective in 1993. -- The gonorrhea rate for men continued to decline in 1994, but increased in women from 147.1 per 100,000 population to 153.7. Rates for both men and women remained below the HP2000 objective (Figure_10; Table_12, Table_13, Table_16, and Table_17). -- In 1994, gonorrhea rates increased slightly for all racial and ethnic groups except Hispanics (Figure_11 and Table_9B). However, rates for all racial and ethnic groups except non-Hispanic blacks remained below the HP2000 objective (Figure_11 and Table_9B). The gonorrhea rate for blacks increased from 1,215.2 cases per 100,000 population in 1993 to 1,219.3 in 1994, but remained below the HP2000 sub-objective of 1,300 cases per 100,000 population for the second year in a row in this special target group (Table_9B). -- Between 1993 and 1994, the gonorrhea rate for 15- to 19-year-old adolescents increased nearly 3% from 742.1 cases per 100,000 population to 763.4 and exceeded the HP2000 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, 30.5% of isolates collected in 1994 by the Gonococcal Isolate Surveillance Project (GISP) were resistant to penicillin, tetracycline, or both (Figure_14). Between 1991 and 1994, the percentage of GISP isolates that were penicillinase- producing Neisseria gonorrhoeae (PPNG), declined from 13.1% to 7.8% (Figure_15). In contrast, isolates with chromosomally mediated resistance increased from 13.9% in 1990 to 16.2% in 1994 (Table_18). Although no GISP isolates have yet demonstrated clinically significant resistance to the antimicrobial agents currently recommended for therapy (2), some isolates have begun to demonstrate decreased levels of susceptibility to some of these agents (3). -- Additional information about gonorrhea in racial and ethnic minority populations and adolescents can be found in the Special Focus Profiles section. (1) CDC. Increasing incidence of gonorrhea -- Minnesota, 1994. MMWR 1995;44:282-6. (2) CDC. 1993 Sexually transmitted diseases treatment guidelines MMWR 1993;42(No. RR-14):56-66. (3) 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, 1970-1994 and the year 2000 objective Figure_7. Gonorrhea - Rates by state: United States, 1994 Figure_8. Gonorrhea - Rates by region: United States, 1981-1994 and the year 2000 objective Figure_9. Gonorrhea - Rates in U.S. cities of >200,000 population, 1981-1994 and the year 2000 objective Figure_10. Gonorrhea - Rates by gender: United States, 1981-1994 and the year 2000 objective Figure_11. Gonorrhea - Rates by race and ethnicity: United States, 1981-1994 and the year 2000 objective Figure_12. Gonorrhea - Age- and gender-specific rates: United States, 1994 Figure_13. Gonococcal Isolate Surveillance Project (GISP) - Location of participating clinics and regional laboratories: United States, 1994 Figure_14. Gonococcal Isolate Surveillance Project (GISP) - Percentage distribution of antimicrobial resistance in gonorrhea isolates, 1994 Figure_15. Gonococcal Isolate Surveillance Project (GISP) - Trends in plasmid-mediated resistance, 1988-1994 Figure_16. Gonococcal Isolate Surveillance Project (GISP) - Trends in chromosomally mediated resistance, 1988-1994 Syphilis -- In 1994, 20,627 cases of primary and secondary (P&S) syphilis were reported to CDC. This is the fewest cases reported since 1977. Between 1993 and 1994, the incidence of primary and secondary syphilis in the United States declined from 10.4 to 8.1 cases per 100,000 population (Figure_18 and Table_1). -- In 1994, P&S syphilis rates were below the Healthy People 2000 (HP2000) national objective of 10 cases per 100,000 population in 38 states (Figure_19 and Table_22). Ten states reported no or fewer than 5 cases of P&S syphilis in 1994. -- In 1994, 2,105 (68%) of 3,116 counties in the United States reported no cases of P&S syphilis compared with 2,006 (64%) counties in 1993. Of 1,011 counties reporting at least one case of P&S syphilis in 1994, 615 (61%) counties reported rates of 10 cases or less per 100,000 population (Figure_20). The rates of P&S syphilis were above the HP2000 objective for 396 counties in 1994 compared with 461 counties in 1993. These counties (13% of the total counties in the United States) accounted for 77% of all reported P&S syphilis cases. -- In 1994, the rates of P&S syphilis continued to decline for all regions of the United States. However, the rate of 15.3 cases per 100,000 population in the South remained above the HP2000 objective (Figure_21). -- The overall rate of P&S syphilis in large cities (>200,000 population) declined from 17.8 cases per 100,000 population in 1993 to 12.7 in 1994 (Figure_22 and Table_27). However, rates exceeded the HP2000 objective in 30 (47%) of 64 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 1994 rate for non-Hispanic blacks of 59.5 cases per 100,000 population was 60 times greater than the rate for non-Hispanic whites (Figure_24 and Table_21B). -- Between 1993 and 1994, the overall rate of congenital syphilis decreased from 80.7 to 55.6 cases per 100,000 live births (Figure_27, Table_34). However, compared with 1993, increases were seen in 1994 in eight of the 28 states reporting more than five cases (Arkansas, Indiana, Iowa, Kentucky, New Jersey, Oklahoma, South Carolina, and Tennessee) (Table_35). -- In 1994, 11 states (Arkansas, Illinois, Louisiana, Mississippi, Missouri, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, and Texas) had congenital syphilis rates that exceeded the HP2000 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, 1941-1994 Figure_18. Primary and secondary syphilis - Reported rates: United States, 1970-1994 and the year 2000 objective Figure_19. Primary and secondary syphilis - Rates by state: United States, 1994 Figure_20. Primary and secondary syphilis - Counties with rates above and counties with rates below the year 2000 objective: United States, 1994 Figure_21. Primary and secondary syphilis - Rates by region: United States, 1981-1994 and the year 2000 objective Figure_22. Primary and secondary syphilis - Rates in U.S. cities of >200,000 population, 1981-1994 and the year 2000 objective Figure_23. Primary and secondary syphilis - Rates by gender: United States, 1981-1994 and the year 2000 objective Figure_24. Primary and secondary syphilis - Rates by race and ethnicity: United States, 1981-1994 and the year 2000 objective Figure_25. Primary and secondary syphilis - Age- and gender-specific rates: United States: 1994 Figure_26. Congenital syphilis - Reported cases in infants <1 year of age and rates of primary and secondary syphilis among women: United States, 1970-1994 Figure_27. Congenital syphilis - Rates in infants <1 year of age: United States, 1981-1994 Other Sexually Transmitted Diseases -- Hospitalizations for acute and chronic pelvic inflammatory disease (PID) have continued to decline 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, Figure_31). -- Comprehensive surveillance data for non-specific urethritis, viral STDs, and vaginitis are not available. Ongoing trend 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, 1980-1993 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, 1981-1994 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
This page last reviewed: Monday, February 01, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.