Sexually Transmitted Disease: U.S. Government Seeks Better Reporting

A three-state study in the United States discovered up to 36 percent of gonorrhea cases and up to 22 percent of chlamydia cases were not reported to public health officials, as required by state law. The CDC conducted the study with managed care companies in Colorado, Massachusetts and Minnesota during 1995-1999. The government wants to see improvements in the figures because better, faster reporting of STDs helps health departments quickly identify and control outbreaks.

Some doctors may be withholding case reports because of concerns about confidentiality and paperwork mix-ups, said analysts with the CDC. Doctors may also be busy treating patients, said Guoyo Tao, a CDC scientist. "They may not have time, or they may just forget," he added. The study found that health departments were notified of 78-98 percent of chlamydia cases and 64-80 percent of gonorrhea cases.

There were also wide variations in the amount of time it took for positive test results to get from the lab to public health officials. Some results took less than a week, while others took more than a year. The lag is important because "by monitoring these trends in disease, health departments can get a better sense of people that are most in need of STD services," the CDC's Dr. Kathleen Irwin said.

Most states have some type of law requiring the reporting of STDs, though there are variations. In Minnesota, for example, doctors and labs are required to report chlamydia, while Colorado requires reporting only by labs. Health officials were careful not to cast blame on labs, health plans or doctors. Some cases may get lost in the mail, they said, and others may have had typographical errors. Some doctors may simply be unaware that the law compels them to report the cases, Irwin said.

Health officials have little historical data to judge whether STD reporting is improving. A 1998 study of private clinicians in North Carolina found reporting of 70 percent for chlamydia and 55 percent for gonorrhea. The CDC study examined reporting through the health plans Kaiser Permanente, Health Plan of Colorado, Harvard Vanguard Medical Associates of Massachusetts and HealthPartners of Minnesota.

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