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CDC reports record high chlamydia rate in US
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Annual surveillance data from the CDC revealed large increases in nationally notifiable STD rates within the United States, with a record number of chlamydia cases reported in 2014.
These diseases continue to affect women and young people more than any other demographic, although infection rates appear to be increasing among men who have sex with men as well, according to the Sexually Transmitted Disease Surveillance 2014 report.
Jonathan Mermin
“America’s worsening STD epidemic is a clear call for better diagnosis, treatment and prevention,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, said in a press release. “STDs affect people in all walks of life, particularly young women and men, but these data suggest an increasing burden among gay and bisexual men.”
Surveillance information was collected from state and local STD case reports submitted to the CDC by public and private sources. These data indicate 1,441,789 cases of chlamydia were reported last year to the CDC, which translates to an incidence rate of 456.1 cases per 100,000 population. This is a 2.8% increase over 2013, according to CDC, and the highest annual rate of chlamydia infection ever reported in the U.S. Although this change was largely driven by a 6.8% rate increase among men, women continued to account for the majority of all detected chlamydia infections and likely reflects the larger portion of women who receive screening compared with men, the researchers wrote.
There were 19,999 cases of primary and secondary syphilis, representing a 15.1% annual infection rate increase to 6.3 cases per 100,000 population. Men accounted for 91% of all syphilis infections, although large rate increases were seen among both men and women. Case increases were seen in every region of the country and among all age groups, but the disease continues to affect a disproportionately large number of blacks, according to the researchers.
A total of 350,062 reported gonorrhea cases resulted in a 5.1% rate increase to 110.7 cases per 100,000 population. Incidence was highest among men and blacks, and the largest incidence rate increases from 2013-2014 were seen among men and American Indian/Alaskan Natives. Antimicrobial resistance among gonorrhea cases remains a concern, the researchers wrote, with the percentage of isolates with reduced azithromycin susceptibility rising to 2.5% in 2014.
Collectively, this is the first time reported cases of chlamydia, syphilis and gonorrhea have increased since 2006, the CDC said. The majority of all cases were reported to private physician offices and health maintenance organizations, as opposed to STD clinics. Many transmissions occurred in younger people, with more than half of reported gonorrhea cases and nearly two-thirds of chlamydia cases reported among persons aged 15 to 24 years. According to the CDC, these findings support previous data suggesting that half of the estimated 20 million notifiable and non-notifiable STDs diagnosed annually occur among this age group.
Gail Bolan
“The consequences of STDs are especially severe for young people,” Gail Bolan, MD, director of the CDC’s Division of STD Prevention, said in the release. “Because chlamydia and gonorrhea often have no symptoms, many infections go undiagnosed, and this can lead to lifelong repercussions for a woman’s reproductive health, including pelvic inflammatory disease and infertility.”
Of additional concern is the incidence of STDs among MSM. According to the report, MSM accounted for 83% of male syphilis cases in which the sex of an individual’s partners was reported, and 51% of MSM diagnosed with syphilis were coinfected with HIV. Although syphilis is the only nationally notifiable STD in which sex partner information is reported, data collected through the STD Surveillance Network among MSM tested at participating clinics imply the prevalence of gonorrhea and chlamydia to be 19.2% and 14.9%, respectively. The CDC wrote that this sentinel surveillance system data — along with high-risk behaviors often associated with MSM — suggest chlamydia and gonorrhea infections also may be of significant concern among this population. – by Dave Muoio
Reference:
CDC. Sexually Transmitted Diseases Surveillance 2014. www.cdc.gov/std/stats14/surv-2014-print.pdf. Accessed: November 17, 2015.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
The increasing rates of chlamydial infections in MSM bear watching. Concern has been raised that this may in part reflect increasing condomless sex linked to HIV viral suppression by antiretroviral therapy and the use of PrEP. Better education in the MSM community and more active STD screening are clearly needed.
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