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STD rates increasing in the United States
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The most common sexually transmitted diseases currently documented in the United States – chlamydia, gonorrhea and syphilis – are steadily on the rise, according to a recent report from the CDC, titled Sexually Transmitted Disease Surveillance 2006.
“This report serves as a reminder that STDs pose an ongoing, serious health threat to millions of Americans,” Hillard Weinstock, MD, medical epidemiologist at the CDC, told Infectious Disease News.
“We are seeing increases across the board for chlamydia, gonorrhea and syphilis, and we continue to see the highest rates among the younger population in regards to chlamydia and gonorrhea. Much of this is biologically driven because the cells where gonorrhea and chlamydia live are in the area of the cervix where younger women are more prone to becoming infected. But there are undoubtedly behavioral risk factors as well,” Weinstock said.
The CDC report further indicated the highest rates of all STDs occur among women, men who have sex with men and among minority populations (with the exception of the Asian/Pacific Islander population).
Chlamydia
Among all reported STDs in the United States, chlamydia is currently the most common STD, with 1,030,911 cases reported in 2006. By factoring in the number of unreported cases, the CDC suggested this number may be closer to 2.8 million cases per year.
An average of 329.4 cases per 100,000 people was documented for 2005, which then increased to 347.8 cases in 2006.
According to the CDC, this increase likely reflects the continued expansion of screening efforts and an increased use of more sensitive diagnostic tests; but it may also be a reflection of an actual rise of infections.
Women aged 15 to 19 had the highest chlamydia rate in 2006, followed by females aged 20 to 24 (2,862.7 vs. 2,797).
The report further indicated that in 2006 young women were most affected by chlamydia compared with young men (515.8 cases per 100,000 population in women vs. 173 cases per 100,000 population among men).
Because chlamydia is the most common bacterial STD among young women in the United States, the CDC currently recommends that all sexually active women aged younger than 26 and women aged older than 26 with new or multiple sex partners should be screened annually. But according to the CDC, many sexually active young women are not being tested for chlamydia; this may reflect a lack of awareness among some providers and limited resources for screening.
“Clearly we can reduce the incidence of these diseases and what is key for chlamydia is expanded screening, particularly in young women,” Weinstock said.
Gonorrhea
Gonorrhea is the second most common STD in the United States with a total of 358,366 cases reported in 2006 (120.9 cases per 100,000 people).
For the first time in eight years, gonorrhea rates increased in the southern part of the United States from 141.8 per 100,000 people in 2005 to 159.2 per 100,000 people in 2006. An increase was also found in the western part of the United States from 2005 to 2006 (80.5 to 82.8 per 100,000 people) and a 31.8% increase from 2002 to 2006. However, there was a 21.2% decrease from 2002 to 2006 in the northeast.
More recently, drug resistance to the fluoroquinolones has become a concern in the prevention and treatment of gonorrhea. The highest resistance has been found among MSM, which increased from 29% in 2005 to 39% in 2006.
Because of this, the CDC no longer recommends the use of this class of antibiotics for the treatment of gonorrhea in the United States and currently recommends cephalosporins for the treatment of gonorrhea.
“Not only is testing important with gonorrhea, but as time passes we have seen increasing resistance to the antibiotics used so it is very important for physicians to be aware of the latest guidelines for the treatment and the control of this infection,” Weinstock said.
According to the CDC, increased monitoring for emerging resistance and accelerated research into new treatments are needed to continue the nation’s progress in controlling this STD.
Syphilis
For the sixth year in a row, the rates of syphilis have increased. From 2005 to 2006 the rates of syphilis rose by 13.8%, with the highest increase among men (11.8%).
“There are increases across the board with syphilis as well, but we are seeing more of an increase among men who have sex with men. Syphilis generally occurs in a slightly older aged population,” Weinstock said.
The rate of syphilis among men increased by 54% between 2002 and 2006, which has driven overall syphilis rates for the nation. For 2006 alone, 64% of all syphilis cases in the United States were among MSM based on data from 30 areas.
There was also a slight increase found in the rates of congenital syphilis from 2005 to 2006 (8.2 to 8.5 per 100,000 live births).
According to the CDC, while it is too early to determine if this increase among newborns is a trend, increases in congenital syphilis have historically followed increases among women. Although the total syphilis rate is lower among the female population, an 11.1% increase was documented from 2005 to 2006, which has been largely driven by increases among black females (an increase of 11.4% from 2005 to 2006).
According to the CDC, although the data represented in this report may be useful in examining the overall trends among populations at risk, many STD cases may never be reported and many cases will continue to go undiagnosed and untreated.
“We continue to advocate that all sexually active women aged younger than 26 years be screened annually for chlamydia, and this is something that physicians and all providers should know and practice. This is certainly something that women can ask [to be screened] for themselves on a regular basis,” Weinstock said. – by Jennifer Southall
For more information:
- www.cdc.gov
- Trends in reportable sexually transmitted diseases in the United States, 2006. CDC; 2007.