Sexually Transmitted Disease Surveillance 1996

Division of STD Prevention September 1997

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,
1996. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1997.

Copies can be obtained from the Office of Communications, National Center
for HIV, STD, and TB Prevention, Centers for Disease Control and
Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

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STDs in the South

Public Health Impact

The southern region (Alabama, Arkansas, Delaware, District of Columbia,
Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North
Carolina, Oklahoma, 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. These racial and ethnic
differentials in STD rates are particularly disturbing in light of the fact
that STDs facilitate HIV transmission at least two to five fold. High HIV
prevalence among childbearing women living in the South may be due, in
part, to the high rates of these other STDs. Data from a randomized
controlled trial of STD treatment to prevent HIV infection suggest that as
much as a 40% reduction in HIV incidence might be achieved in areas with
high STD rates (1).

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_12, Figure_13, Figure_25, Figure_27,
    Table_14 and Table_26). In 1996, the South also had the highest
    rate of Chlamydia (Figure_3, Table_5) compared to the other
    regions.

--  In 1996, 6 of the 10 states with the highest chlamydia rates were in
    the South (Table_4). Similarly, the 10 states with the highest
    rates of gonorrhea were all located in the South (Figure_12,
    Table_13). Twelve of 16 states with rates of P&S syphilis above the
    HP2000 objective of 4 per 100,000 persons were located in the South
    (Figure_25 and Figure_26, Table_25). All 8 states with
    rates of P&S syphilis that exceeded 10 cases per 100,000 population (or
    2.5 times the HP2000 national objective) were located in the South
    (Figure_25, Table_25).

--  In 1996, 429 (89%) of 482 counties with P&S syphilis rates above the
    HP2000 objective were located in the South (Figure_26 and
    Figure_T).

--  Of the 429 counties in the South that had a 1996 P&S syphilis rate
    above 4.0 per 100,000 population, 188 (44%) had an increasing rate from
    1995 to 1996 (Figure_T and Figure_U).

Figure_T.   South -- Primary and secondary syphilis case rates by 
                county, 1996
Figure_U.   South -- Increases and decreases in cases of primary and 
                secondary syphilis in 1996 compared with 1995 cases, by
                county

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(1) Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, Mayaud
    P, Changalucha J, Nicoll A, ka-Gina G, Newell J, Mugeye K, Mabey D,
    Hayes R. Impact of improved treatment of sexually transmitted diseases
    on HIV infection in rural Tanzania: randomised controlled trial. Lancet
    1995;346:530-6.

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