Sexually Transmitted Diseases in the United States, 2008
National Surveillance Data for Chlamydia, Gonorrhea and Syphilis
Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STD infections each year -- almost half of them among young people 15 to 24 years of age.1 The cost of STDs to the U.S. health care system is estimated to be as much as $15.9 billion annually.2
Because many cases of STDs go undiagnosed -- and some common viral infections, such as human papillomavirus and genital herpes, are not reported to CDC at all -- reported cases of chlamydia, gonorrhea, and syphilis are only a fraction of the true burden of STDs in the United States. This fact sheet summarizes 2008 national data on three reportable STDs -- chlamydia, gonorrhea, and syphilis -- that are published in CDC's report, Sexually Transmitted Disease Surveillance, 2008 (available here).
Chlamydia, Gonorrhea, and Syphilis
In 2008, there were more than 1.5 million total cases of chlamydia and gonorrhea reported to CDC -- making them the two most commonly reported infectious diseases in the United States. Adolescent girls and young women are especially hard hit by these two diseases. The largest number of reported cases of both chlamydia and gonorrhea in 2008 was among girls between 15 and 19 years of age, followed closely by young women 20 to 24 years of age. This likely reflects a combination of factors, including biological differences that place females at greater risk for STDs than males, as well as higher STD screening rates among young women.
Syphilis -- a disease once on the verge of elimination -- began re-emerging as a public health threat in 2001. This is primarily because of a resurgence of the disease among men who have sex (MSM), though cases among women have also been increasing in recent years.
STDs and Infertility
Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women. CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the United States each year to become infertile.3
Expanded access to STD prevention services, screening, and treatment is urgently needed to reduce the toll of STDs and protect the health of millions of Americans.
Racial minorities continue to face severe disparities across all three reportable STDs. While racial disparities persist overall, African-Americans, especially young African-American women, are the most heavily affected. Young African-American women face significantly higher rates of chlamydia and gonorrhea than any other group, while the highest rates of syphilis are among African-American men.
Chlamydia remains the most commonly reported infectious disease in the United States. There were more than 1.2 million cases of chlamydia (1,210,523) reported to CDC in 2008, an increase from the 1.1 million cases reported in 2007. The national rate of chlamydia in 2008 was 401.3 cases per 100,000 population, an increase of 9.2 percent from 2007 (367.5).
Increases in chlamydia cases and rates are most likely the result of continued expansion of screening, use of more sensitive tests, and more complete national reporting systems, but may also reflect a true increase in disease burden nationally. Still, CDC research indicates that the majority of chlamydia cases go undiagnosed and unreported and that there are an estimated 2.8 million cases in the United States each year.1
Populations Most Affected
Women, especially young and minority women, are hardest hit by chlamydia. In 2008, girls 15 to 19 years of age had the highest numbers of reported cases (342,875) and rates of chlamydia (3,275.8 per 100,000 females), followed closely by young women 20 to 24 years of age (323,696 cases; 3,179.9 cases per 100,000 females). Studies also show that women are most severely affected by the long-term health consequences of untreated chlamydia, including infertility.
In recent years, following the expanded availability of less invasive urine testing for chlamydia, men are getting tested with increased frequency, resulting in an increase of 45 percent in the chlamydia rate among men between 2004 and 2008. While the overall rate of reported chlamydia among men is lower than among women, CDC estimates that the actual overall prevalence of chlamydia is similar among men and women.8
There were 336,742 reported cases of gonorrhea in 2008, a slight decline from 2007 (355,991 cases) -- making gonorrhea the second most commonly reported infectious disease in the United States. In 2008, the national gonorrhea rate was 111.6 cases per 100,000 population, a small decrease of 5.4 percent from 2007 (118.0).
Following a 74 percent decline in the rate of reported gonorrhea from 1975 through 1997, overall gonorrhea rates have remained relatively stable for the past decade, though the disease persists at too high a level. Like chlamydia, gonorrhea is substantially under-diagnosed and under-reported, and CDC estimates that there are approximately twice as many new gonorrhea infections each year as are reported.1
Populations Most Affected
For the eighth consecutive year, gonorrhea rates among women and men were similar. In 2008, the gonorrhea rate among women was 119.4 cases per 100,000 population, compared to 103.0 among men. Gonorrhea rates in 2008 continued to be highest among adolescent girls and young women. In 2008, girls 15 to 19 years of age and young women 20 to 24 years of age had the highest rates of gonorrhea (636.8 and 608.6 cases per 100,000 females, respectively).
In 2008, there were 13,500 reported cases of primary and secondary (P&S) syphilis -- the most infectious stages of the disease -- the highest number of cases since 1995 and an increase over 2007 (11,466 cases).
Although on the verge of elimination less than a decade ago, syphilis re-emerged as a public health threat in 2001 and rates have steadily increased since then. In 2008, the national P&S syphilis rate was 4.5 cases per 100,000 population, an 18 percent increase from 2007 (3.8).
Populations Most Affected
The majority of reported syphilis cases in the United States continues to be among men who have sex with men (MSM). In 2008, data from the District of Columbia and the 44 states that track the gender of sex partners of those infected with syphilis showed that 63 percent of P&S syphilis cases were among MSM, compared to only 4 percent of cases in 2000. This is of particular concern, since MSM are also most heavily affected by HIV, and syphilis infection can facilitate HIV transmission.7
While P&S syphilis rates remain substantially lower among women than men, rates among women have increased each year since 2004, following more than a decade of declines. In 2008, the syphilis rate among women increased 36 percent from the previous year (1.1 cases per 100,000 females in 2007 vs. 1.5 in 2008).
Rates of congenital syphilis (transmission from mother to infant) remained stable between 2007 and 2008, following two years of increases. There were 431 reported cases of congenital syphilis in 2008 (10.1 cases per 100,000 live births).
Data from 2008 indicate persistent racial disparities in STD rates, with African-Americans bearing an especially heavy burden.
In 2008, Hispanics also experienced significant disparities across all reportable STDs.
American Indian/Alaska Natives
In 2008, American Indian/Alaska Natives were also disproportionately affected by STDs.
Reported racial disparities may exist, in part, because racial and ethnic minorities are more likely to seek care in public health clinics that report STDs to CDC more completely than private providers. However, this reporting bias does not fully explain these differences. Socioeconomic barriers to quality healthcare and STD prevention and treatment services have also likely contributed to higher STD rates among racial and ethnic minorities. Ensuring that minority communities have access to STD prevention, screening, treatment, and partner services needed to improve health is critical to addressing these disparities.
To reduce the toll of STDs and protect the health of millions of Americans, it is critical that public health officials maximize the use of all available tools. CDC supports a comprehensive approach to STD prevention that includes screening, treatment of infected partners, and behavioral interventions -- with a focus on reducing racial disparities.
Screening is one of the most effective, yet underutilized, tools to identify and treat those who are infected and to help prevent the further spread of STDs.
Treatment of STDs is essential, both to prevent serious health consequences for those who are infected and to reduce the further spread of disease. When detected early, treatment is relatively simple. For example, chlamydia and gonorrhea can each be treated with a few pills.
The most reliable ways to avoid infection with an STD are to abstain from sex (i.e., oral, vaginal, or anal sex) or to be in a long-term, mutually monogamous relationship with an uninfected partner. Consistent and correct use of the male latex condom reduces the risk of STD and HIV infection. Expanded access to proven behavioral interventions to reduce the risk of contracting STDs, particularly those tailored for adolescents, MSM, and African-Americans at greatest risk, is an important component of the nation's response. Individual-level and small-group prevention programs have been shown to produce behavioral changes that either reduce risk of exposure to STDs or increase health-seeking behaviors, such as physician visits and requesting STD screening. Some of these programs are specifically tailored to those who experience the greatest disparities in sexual health. For example, the SiHLE and WiLLOW interventions (www.cdc.gov/hiv/topics/research/prs/best-evidence-intervention.htm) have been found effective in reducing STD infections among African-Americans by reducing STD and HIV risk behaviors and promoting healthy relationships.
Addressing Racial Disparities
It is critical to reduce the severe racial disparities in STD rates, especially for African-Americans. This will require increased awareness among affected communities of the importance of this problem, as well as a strong public health response to ensure that minority communities have access to prevention, screening, treatment, and partner services. Expanded access to care would be an important contributor to addressing this problem.
It will also require intensified efforts at all levels -- federal, state and local -- to mitigate the impact of poverty and other social determinants that help contribute to these disparities. More research is needed to understand and respond to factors contributing to racial disparities, including poverty, access to care, and stigma.
CDC's Approach to STD Prevention
CDC is working with public health partners on a number of fronts to reduce the national STD burden. To make further progress against chlamydia, CDC, the Partnership for Prevention, and eight other national organizations established the National Chlamydia Coalition (www.prevent.org/ncc). The Coalition, whose membership now exceeds 40 national organizations, recently developed an implementation guide for health care providers to increase chlamydia screening among sexually active adolescents and young adults.
CDC is also continuing its efforts to eliminate syphilis as a health threat in the United States. CDC's Syphilis Elimination Plan outlines a comprehensive approach to syphilis control that is needed at all levels of government to reverse recent national trends in syphilis infection rates. The plan includes action steps to evaluate and improve new strategies to combat the syphilis epidemic among MSM in the hardest-hit U.S. cities, such as online strategies for notifying sexual partners and education campaigns.
CDC also closely tracks STDs to help ensure that prevention resources are targeted to the populations in greatest need, and provides funds to state health departments to support local STD prevention efforts. In 2009, 74 percent of CDC's funding for the Division of STD Prevention went directly to state health departments for disease surveillance, prevention, program development and implementation, and other resources. As part of this effort, CDC provided almost $28 million to health departments in 2009 to prevent infertility in young women through expanded screening and treatment. CDC also assigned employees to work within state and local health departments on a broad range of disease control and prevention efforts, including direct service provision, program management, and on-site technical assistance. CDC also funds state and local health departments and community organizations to implement prevention programs to reduce risk behavior and increase STD and HIV testing among populations at greatest risk.
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.
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