Disproportionate Impact on Racial Minorities Persists

Adolescent girls ages 15–19 years had the largest reported number of chlamydia and gonorrhea cases (409,531) when compared to any other age group, followed closely by women ages 20-24, according to an annual report on sexually transmitted diseases (STDs) released today by the Centers for Disease Control and Prevention.  The report finds that more than 1.5 million cases of chlamydia and gonorrhea were reported in 2008. 

The report – Sexually Transmitted Disease Surveillance, 2008, which tracks reported cases of chlamydia, gonorrhea and syphilis in the United States – also showed that African-Americans continue to be more disproportionately affected by STDs than any other racial or ethnic group. 

While adolescent males have a similar prevalence of STDs, biological differences place females at greater risk for STDs than males.  Additionally, the health consequences are more severe among females than males for chlamydia and gonorrhea – the two most commonly reported infectious diseases in the United States.  These diseases may have no symptoms and often go undetected.  CDC estimates that half of new gonorrhea cases and more than half of new chlamydia cases remain undiagnosed and unreported.  Left untreated, it is estimated that 10-20 percent of chlamydia or gonorrhea infections in women can result in pelvic inflammatory disease, which can lead to long-term complications, such as chronic pelvic pain, ectopic pregnancy (a potentially life-threatening form of pregnancy where implantation of the fertilized egg occurs outside the uterus) and infertility.  Untreated STDs are estimated to cause at least 24,000 women to become infertile each year in the United States. 

“When you take into account the severe health consequences of STDs and the millions of Americans infected every year, it is clear that much more work needs to be done to prevent unintended long-term health issues,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “We know adolescent girls and minorities are most impacted by STDs.  So it is up to us as a nation, to reach out to them and ensure we are providing the necessary prevention, testing and treatment services.  Taking these critical steps now could help reduce the number of couples who may not be able have children in the future because of a previously undiagnosed, yet treatable, STD.” 

In the United States overall, about 1.2 million cases of chlamydia were reported in 2008; almost 337,000 cases of gonorrhea were reported in the same year.

Disproportionate Impact on Racial Minorities – Especially Among Young African-American Women

Racial minorities continue to face severe disparities in all reportable STDs, but African-Americans are the group most impacted.  Gonorrhea rates among African-Americans are higher than any other racial or ethnic group and 20 times higher than that of whites.  Blacks represent 12 percent of the U.S. population, but accounted for about 71 percent of reported gonorrhea cases and almost half of all chlamydia and syphilis cases (48 percent and 49 percent, respectively) in 2008.  

Among women, black women 15 to 19 years of age had the highest rates of chlamydia and gonorrhea (10,513 per 100,000 and 2,934 per 100,000, respectively), followed by black women ages 20 to 24 (9,373 per 100,000 and 2,770 per 100,000, respectively). 

“We cannot ignore the glaring racial disparities in rates of STDs, particularly when we consider the hard truth that gonorrhea rates among African-Americans are 20 times those of whites,” said John M. Douglas, Jr., M.D., director of CDC’s Division of STD Prevention. “Research has shown that socioeconomic barriers to quality health care and higher overall prevalence of STDs within minority communities contribute to this pervasive threat.  It is imperative that we improve access to effective STD prevention and treatment services in local communities for those who need them most.” 

Increasing Threat of Syphilis

Syphilis, once on the verge of elimination, began re-emerging as a threat in 2001.  In 2008, 13,500 cases of primary and secondary syphilis cases were reported, an almost 18 percent increase from 2007.  The majority of these syphilis cases (63 percent) continues to be among men who have sex with men (MSM).  Increased syphilis transmission among MSM is believed to be the primary driver of syphilis rate increases nationally.  For MSM, syphilis infection is of particular concern because it can facilitate HIV transmission and lead to irreversible complications such as strokes, especially in those who are HIV-infected.   

While occurring at substantially lower levels among women than men, syphilis rates have been increasing among women since 2004.  In 2008, the syphilis rate among women increased 36 percent from the previous year (1.1 cases per 100,000 women in 2007 vs. 1.5 in 2008).  By comparison, rates among men increased 15 percent from the previous year (6.6 cases per 100,000 men in 2007 vs. 7.6 in 2008).  Untreated syphilis can be transmitted from pregnant women to infants and can result in stillbirths, infant deaths, or severe complications in children who survive. 

Intensified Efforts Needed to Reduce Toll of STDs

To reduce the toll of STDs and protect the health of millions of Americans, expanded education and prevention efforts, including increased screening, are urgently needed.  Chlamydia, gonorrhea and syphilis cases represent only a fraction of the true STD burden in the United States.  CDC estimates that a total of almost 19 million new sexually transmitted infections occur each year, almost half of which are among 15- to 24-year-olds.  In addition, CDC estimates that STDs cost the U.S. health care system as much as $15.9 billion annually.

Since treatment of STDs is essential to prevent long-term health consequences, early testing and diagnosis are crucial.  STD screening remains one of the most effective yet underutilized tools to protect heath and prevent the further spread of these diseases.  Recent data show that less than half of sexually active women under 26 are screened for chlamydia – the most commonly reported infectious disease.  CDC recommends annual chlamydia screening for sexually active women younger than 26 years of age, and supports U.S. Preventive Services Task Force recommendations to screen high-risk, sexually active women for gonorrhea.  CDC also recommends that all sexually active MSM be tested for syphilis, chlamydia, gonorrhea and HIV at least annually. 

The full report is available at www.cdc.gov/std/stats. 

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DEPARTMENT OF HEALTH AND HUMAN SERVICES