Minorities disproportionately affected by STDs, with highest rates of chlamydia, gonorrhea among African-American women ages 15 to 19
Reported cases of chlamydia and gonorrhea in the United States exceeded 1.4 million in 2007, and reported new cases of syphilis continued to increase, according to an annual report by the Centers for Disease Control and Prevention.
The report, Sexually Transmitted Disease Surveillance, 2007, shows persistent racial disparities across these and other sexually transmitted diseases and a particularly heavy burden of chlamydia and gonorrhea among women.
But the increases in syphilis remain a serious threat to the health of gay and bisexual men, according to CDC officials.
Once on the verge of elimination, syphilis began re-emerging as a threat in 2001 and increased 15.2 percent between 2006 and 2007, officials said.
In 2007, men who have sex with men continued to account for the majority of primary and secondary syphilis cases, representing 65 percent of the 11,466 primary and secondary syphilis cases reported. Increased transmission among MSM is believed to be the primary driver of increased rates of syphilis overall in the United States, CDC officials said.
They said Syphilis among MSM is of particular concern because it can facilitate HIV transmission and lead to irreversible complications such as strokes, especially in those who already have HIV.
The CDC recommends that all MSM be tested for syphilis at least annually.
CDC officials also said that while primary and secondary syphilis continues to occur at substantially lower levels among women than men — 1.1 cases per 100,000 among females compared to 6.6 among males — syphilis rates have been increasing among women and infants in recent years, reversing years of decline in these populations.
Studies show that syphilis rates among women have increased since 2004, and the rate of congenital syphilis increased for the second consecutive year in 2007.
Because untreated syphilis can be transmitted from a pregnant woman to her infant and result in stillbirths, infant deaths or severe complications in children who survive, CDC recommends that all women be screened for syphilis during the early stages of pregnancy.
CDC officials said women continue to bear a disproportionate burden of the long-term health consequences of STDs.
This most recent report shows that in 2007, the chlamydia rate among women was three times that of men: 543.6 cases per 100,000 women, compared to 190 cases per 100,000 men.
The gonorrhea rate was also higher among women: 123.5 per 100,000 women, compared to 113.7 per 100,000 among men.
The report found that there were more than 1.1 million chlamydia cases reported in 2007, up from about 1 million in 2006, making it the largest number of cases ever reported to CDC for any condition.
Gonorrhea, the second most commonly reported infectious disease, had more than 350,000 cases reported in 2007. However, CDC officials said, it is estimated that more than half of all new infections with chlamydia and gonorrhea continue to go undiagnosed, underscoring the importance of increased screening.
The CDC recommends annual chlamydia screening for all sexually active women under 26 years old, and supports U.S. Preventive Services Task Force recommendations to screen high-risk, sexually active women for gonorrhea.
The 2007 STD surveillance report also indicates ongoing racial disparities in the three most common reportable STDs, with African-Americans bearing the greatest burden.
While representing 12 percent of the U.S. population, blacks had about 70 percent of reported gonorrhea cases and almost half of all chlamydia and syphilis cases — 48 percent and 46 percent respectively — in 2007, the report indicated.
Black women 15 to 19 years of age account for the highest rates of both chlamydia — 9,646.7 per 100,000 population — and gonorrhea — 2,955.7 per 100,000 population — of any group.
Studies have shown that one of the most important social determinants of sexual health is socioeconomic status, CDC officials said. Higher rates of poverty among blacks than whites, and socioeconomic barriers to quality healthcare and STD prevention and treatment services have been associated with higher prevalence and incidence of STDs among racial and ethnic minorities, they added.
CDC officials said expanded STD prevention efforts are "urgently needed," adding that the agency’s estimates indicate that almost 19 million new sexually transmitted infections occur each year, and almost half of those are among 15- to 24-year-olds.
In addition to the threat of infertility, increased risk of HIV acquisition, and other health risks, STDs also have a substantial economic impact, officials said, estimating that STDs cost the U.S. health care system as much as $15.3 billion annually.
Officials said the CDC supports a comprehensive approach to STD prevention through screening, treatment, and behavioral interventions, with a focus on reducing health disparities, especially those occurring among racial and ethnic groups.
The full report is available at http://www.cdc.gov/std/stats07/.
This article appeard in the Dallas Voice print edition January 23, 2009.