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.

                           STDs in Minorities

Public Health Impact

Surveillance data show high rates of STDs for some minority racial/ethnic
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 minority populations 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 federal
     Region X (Alaska, Idaho, Oregon, and Washington) show consistently
     higher rates among minorities (Figure_H).

 --  In 1994, African-Americans accounted for about 81% of total reported
     cases of gonorrhea (Table_9A). The overall gonorrhea rates in 1994
     were 1,219.3 cases per 100,000 for African-Americans and 84.5 for
     Hispanics compared with 30.1 for non-Hispanic whites (Figure_11,
     Table_9B). Compared with 1993, 1994 rates increased slightly for
     all race/ethnic groups except Hispanics.

 --  Age-specific rates are very high for African-American adolescents and
     young adults. In 1994, black 15- to 19-year-old women had a gonorrhea
     rate of 4,911.9 cases per 100,000 population, representing a 5.5%
     increase over the rate in 1993. Black men in this age group had a
     gonorrhea rate of 4,007.5, representing a 2.2% decrease over the rate
     in 1993. These rates were on average more than 28-fold higher than
     those in white adolescents 15- to 19-years-old (Table_9B). Among
     20- to 24-year-olds in 1994, the gonorrhea rate among blacks was 38
     times greater than that of whites (4,479.3 vs. 116.3, respectively)
     (Table_9B).

 --  Despite declines in gonorrhea rates for most age and race/ethnic
     groups during the 1980's, African-American adolescents did not show
     declining trends in rates until 1991 (black women) and 1992 (black
     men). Between 1993 and 1994 gonorrhea rates for black females 10- to
     24-years-old increased. Rates for black  males in this age group
     decreased (Table_9B and Figure_I and Figure_J). 

 --  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
     1994, African-Americans accounted for about 87% of all reported cases
     of P&S syphilis (Table_21A). Although the rate among African-
     Americans declined from 76.5 cases per 100,000 population in 1993 to
     59.5 in 1994, the latter rate remained about 60-fold greater than the
     non-Hispanic white rate of 1.0. The 1994 rate of P&S syphilis in
     Hispanics was 3.5 (Figure_24 and Table_21B).

 --  In 1994, the rate of congenital syphilis in African-Americans was
     202.1 per 100,000 live births and 66.9 in Hispanics compared with 4.2
     in whites (Figure_K). Compared with 1993 this represented a 43%
     decrease among blacks and a 39% decrease among Hispanics.

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

Figure_H. Chlamydia - Percent positivity among women tested in family
              planning clinics by race and ethnicity: Region X, 1988-1994 
Figure_I. Gonorrhea - Reported rates for 15- to 19-year-old females by
              race and ethnicity: United States, 1981-1994
Figure_J. Gonorrhea - Reported rates for 15- to 19-year-old males by
              race and ethnicity: United States, 1981-1994    
Figure_K. Congenital syphilis - Rates for infants <1 year of age by
              race and ethnicity: United States, 1991-1994    

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