National Overview of Sexually Transmitted Diseases (STDs), 2010

All Americans should have the opportunity to make choices that lead to health and wellness. Working together, interested, committed public and private organizations, communities, and individuals can take action to prevent sexually transmitted diseases (STDs) and their related health burdens. In addition to federal, state, and local public support for STD prevention, local community leaders can promote STD prevention education. Health providers can assess their patients’ risks and talk to them about testing. Parents can better educate their children about STDs and sexual health. Individuals can use condoms consistently and correctly, and openly discuss ways to protect their health with partners and providers. As noted in the Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases,¹ surveillance is a key component of all our efforts to prevent and control these diseases.

This overview summarizes national surveillance data for 2010 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis. Several observations for 2010 are worthy of note.

Chlamydia

In 2010, a total of 1,307,893 cases of sexually transmitted Chlamydia trachomatis infection were reported to the Centers for Disease Control and Prevention (CDC) (Table 1). This is the largest number of cases ever reported to CDC for any condition. This case count corresponds to a rate of 426.0 cases per 100,000 population, an increase of 5.1% compared with the rate in 2009. Rates of reported chlamydial infections among women have been increasing annually since the late 1980s, when public programs for screening and treatment of women were first established to avert pelvic inflammatory disease (PID) and related complications.

The continued increase in chlamydia case reports in 2010 most likely represents a continued increase in screening for this usually asymptomatic infection, expanded use of more sensitive tests, and more complete national reporting, but it also may reflect a true increase in morbidity.

In 2010, the overall rate of chlamydial infection in the United States among women (610.6 cases per 100,000 females) was over two and a half times the rate among men (233.7 cases per 100,000 males), reflecting the large number of women screened for this disease (Tables 4 and 5). However, with the increased availability of urine testing, men are increasingly being tested for chlamydial infection. During 2006–2010, the chlamydia rate in men increased 36.4%, compared with a 19.5% increase in women during this period. Rates also varied among different racial and ethnic minority populations. For example, in 2010, the chlamydia rate in blacks was over eight times the rate in whites.

Data from multiple sources on the prevalence of chlamydial infection in defined populations have been useful in monitoring disease burden and guiding chlamydia screening programs.

In 2010, the median state-specific chlamydia test positivity was 8.0% (range: 3.8% to 13.7%) among women aged 15–24 years who were screened at selected family planning clinics in all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands (Figures 10 and 11).

At selected prenatal clinics in 16 states, Puerto Rico, and the Virgin Islands, the median state-specific chlamydia positivity was 7.2% (range: 2.7% to 21.2%) (Figure B).

The prevalence of infection was greater among economically disadvantaged women aged 16–24 years who entered the National Job Training Program (NJTP) in 2010 in 44 states, the District of Columbia, and Puerto Rico. The median state-specific prevalence was 11.4% (range: 5.2% to 21.3%) (Figure K). Among men entering the program in 2010 in 48 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.2% (range: 1.8% to 12.7%) (Figure L).

Among adolescent females entering selected juvenile corrections facilities, the median facility-specific chlamydia positivity was 14.5% (range: 4.0% to 26.5%). Among adolescent males entering selected juvenile corrections facilities, the median facility-specific chlamydia positivity was 6.5% (range: 0.5% to 13.8%).

Gonorrhea

Following a 74% decline in the rate of reported gonorrhea during 1975–1996, overall gonorrhea rates plateaued for 10 years; it decreased during 2006–2009 to the lowest rate since national reporting began and then increased 2.8% between 2009 and 2010. In 2010, a total of 309,341 cases of gonorrhea were reported in the United States, which corresponds to a rate of 100.8 cases per 100,000 population (Figure 14, Table 1).

In 2010, as in previous years, the South had the highest gonorrhea rate among the four regions of the country (Table 14). Rates in the South and Midwest remained higher than rates in the Northeast and West. During 2009–2010 rates increased in the Northeast, South, and West, but decreased in the Midwest (Figure 16).

During 1997–2006, gonorrhea rates in men and women were similar. Since 2002, the rates in women have been slightly higher than rates in men (Figure 15). In 2010, the gonorrhea rate in women was 106.5 cases per 100,000 population compared with a rate of 94.1 in men (Figure 15). As with chlamydia, gonorrhea rates in women were highest among those aged 15–24 years. In men, they were highest among those aged 20–24 years (Figure 19). In 2010, the gonorrhea rate in blacks was 18.7 times the rate in whites. As with chlamydia, data on gonorrhea prevalence in defined populations were available from several sources in 2010. These data showed a continuing high burden of disease in some adolescents and young adults in parts of the United States.

Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. With increased resistance to the fluoroquinolones now endemic in the United States, the cephalosporins remain the only class of antibiotics recommended for the treatment of gonorrhea. Continued monitoring of susceptibility patterns to these antibiotics is critical. No isolates with decreased susceptibility to ceftriaxone were seen in 2010 in CDC’s sentinel surveillance system, the Gonococcal Isolate Surveillance Project (GISP). In 2010, 9 isolates with decreased susceptibility to cefixime were reported, 7 from the West, and 8 in men who have sex with men (MSM). The percentage of isolates with elevated mean inhibitory concentrations (MICs) to cefixime increased during 2009–2010, particularly among isolates from the West and from MSM.

Syphilis

The rate of primary and secondary (P&S) syphilis reported in the United States decreased during the 1990s, and in 2000, it was the lowest since reporting began in 1941. The low rate of syphilis and the concentration of most syphilis cases in a small number of geographic areas led to the development of the National Plan to Eliminate Syphilis from the United States, which was announced by the Surgeon General in 1999 and updated in 2006.² The overall rate of P&S syphilis in the United States declined 89.7% during 1990–2000, then increased each year from 2001 through 2009. In 2010, the overall rate decreased for the first time in 10 years. The rate decreased 21% in women but increased slightly, 1.3%, in men. In 2010, a total of 13,774 cases of P&S syphilis were reported to CDC. After 14 years of decline, the number of reported cases of congenital syphilis reached an historic low of 339 cases in 2005. The number of cases increased from 2006–2008 but has since decreased with 377 cases reported in 2010, a 15% decrease since 2008.

Although wide disparities exist in the rates of STDs among racial and ethnic groups, these disparities have decreased for syphilis over the past 10 years. In 2010, the P&S syphilis rate among blacks was eight times the rate among whites, which is substantially lower than the disparity observed in 1999, when the rate among blacks was 24 times higher than the rate among whites.

During 2006–2010, however, syphilis rates increased 75% among black men aged 15–19 years and 134% among those aged 20–24 years. The 2010 rate among black men aged 15–19 years was 25 times the rate for white men of that age. Among black women aged 15–19 years, rates increased 46% during 2006–2010 and 59% among those aged 20–24 years. In 2010, rates for black women aged 15–19 years were 38 times the rate for white women of the same age.

Although efforts to eliminate syphilis have focused on racial and ethnic minority populations, the syphilis rates among all MSM have increased since 2001, especially among young MSM.^3,4 While some decreases were observed this year, syphilis rates remain disproportionately high among black men and women. These findings highlight the importance of continually reassessing and refining surveillance, prevention, and control strategies to eliminate syphilis.

1 Eng TR, Butler WT, editors; Institute of Medicine (US). The hidden epidemic: confronting sexually transmitted diseases. Washington (DC): National Academy Press; 1997. p 43.

2 Centers for Disease Control and Prevention. The national plan to eliminate syphilis from the United States. Atlanta: U.S. Department of Health and Human Services; 2006.

3 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 states. Ann Intern Med. 2011;155 (3);145-151.

4 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends in primary and secondary syphilis among men who have sex with men in the United States. Am J Pub Health. 2007;97(6):1076-1083.