# 25 {#section .Chapter-# .unnumbered}

# Sexually Transmitted Diseases

#### Bacterial STD Illness and Disability

25-1 Chlamydia

25-1a Females aged 15 to 24 years attending family planning clinics

25-1b Females aged 15 to 24 years attending STD clinics

25-1c Males aged 15 to 24 years attending STD clinics

25-2 Gonorrhea

25-3 Primary and secondary syphilis

#### Viral STD Illness and Disability

25-4 Genital herpes

25-5 Human papillomavirus infection

#### STD Complications Affecting Females

25-6 Pelvic inflammatory disease (PID)

25-7 Fertility problems

25-8 Heterosexually transmitted HIV infection in women

#### STD Complications Affecting the Fetus and Newborn

25-9 Congenital syphilis

25-10 Neonatal STDs

#### Personal Behaviors

25-11 Responsible adolescent sexual behavior

25-12 Responsible sexual behavior messages on television

#### Community Protection Infrastructure

25-13 Hepatitis B vaccine services in STD clinics

25-14 Screening in youth detention facilities and jails

25-15 Contracts to treat nonplan partners of STD patients

#### Personal Health Services

25-16 Annual screening for genital chlamydia

25-17 Screening of pregnant women

25-18 Compliance with recognized STD treatment standards

25-19 Provider referral services for sex partners

### Bacterial STD Illness and Disability

25-1. Reduce the proportion of adolescents and young adults with
*Chlamydia trachomatis* infections.

  ---------------------- ------------------------------------------------
  25-1a. Females aged 15 
  to 24 years attending  
  family planning        
  clinics.               

  **National Data        STD Surveillance System (STDSS), CDC, NCHSTP.
  Source**               

  **State Data Sources** State and local Health Department STD Control
                         Programs and Regional Infertility Prevention
                         Programs.

  **Healthy People 2000  Adapted from 19.2 (Sexually Transmitted
  Objective**            Diseases).

  **Measure**            Percent.

  **Baseline**           5.0 (1997).

  **Numerator**          Number of positive tests among women aged 15 to
                         24 years who attended family planning clinics in
                         the past 12 months.

  **Denominator**        Number tests administered (unsatisfactory tests,
                         indeterminate or inconclusive results, or
                         inadequate specimens are excluded) among women
                         aged 15 to 24 years who attended family planning
                         clinics in the past 12 months.

  **Population           U.S. civilian population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for *Chlamydia trachomatis* is
                         provided by CDC.**^1^**

                         Data are collected from Regional Infertility
                         Prevention Program laboratory reports.

                         This measure tracks only tests that are specific
                         for *Chlamydia trachomatis* infection. The
                         number of positive cases is based on test
                         results from persons routinely screened. Routine
                         screening is defined by each clinic. In some
                         clinics, all patients are universally screened.
                         In others, routine screening is done selectively
                         based on clinical findings or behavioral risk
                         factors.

                         A minimum of 500 valid test results by gender
                         and subpopulation is recommended to derive
                         reliable estimates for this measure. Some
                         clinics may not collect all U.S. Census-defined
                         race and/or ethnicity data categories.

                         Data for this measure are also included in the
                         annual STD Surveillance Report.**^2^**

                         This measure is a modification of Healthy People
                         2000 objective 19.2, which tracked percent
                         positivity in women under age 25 years who
                         attended family planning clinics. This measure
                         tracks percent positivity among women aged 15 to
                         24 years who attended family planning clinics.

                         See Part C for a description of STDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  25-1b. Females aged 15 
  to 24 years attending  
  STD clinics.           

  **National Data        STD Surveillance System (STDSS), CDC, NCHSTP.
  Source**               

  **State Data Sources** State and local Health Department STD Control
                         Programs and Regional Infertility Prevention
                         Programs.

  **Healthy People 2000  Adapted from 19.2 (Sexually Transmitted
  Objective**            Diseases).

  **Measure**            Percent.

  **Baseline**           12.2 (1997).

  **Numerator**          Number of positive tests among women aged 15 to
                         24 years who attended STD clinics in the past 12
                         months.

  **Denominator**        Number of tests administered (unsatisfactory
                         tests, indeterminate or inconclusive results, or
                         inadequate specimens are excluded) to women aged
                         15 to 24 years who attended STD clinics in the
                         past 12 months.

  **Population           U.S. civilian population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for *Chlamydia trachomatis* is
                         provided by CDC.**^1^**

                         Data are collected from Regional Infertility
                         Prevention Program laboratory reports.

                         This measure tracks only tests that are specific
                         for *Chlamydia trachomatis* infection. The
                         number of positive cases is based on test
                         results from persons routinely screened. Routine
                         screening is defined by each clinic. In some
                         clinics, all patients are universally screened.
                         In others, routine screening is done selectively
                         based on clinical findings or behavioral risk
                         factors.

                         A minimum of 500 valid test results by gender
                         and subpopulation is recommended to derive
                         reliable estimates for this measure. Some
                         clinics may not collect all U.S. Census-defined
                         race and/or ethnicity data categories.

                         Data for this measure are also included in the
                         annual STD Surveillance Report.**^2^**

                         This measure is a modification of Healthy People
                         2000 objective 19.2, which tracked percent
                         positivity in women under age 25 years who
                         attended family planning clinics. This measure
                         expands upon the Healthy People 2000 measure and
                         tracks percent positivity among women aged 15 to
                         24 years who attended STD clinics.

                         See Part C for a description of STDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 25-1c. Males aged   |                                                |
| 15 to 24 years      |                                                |
| attending STD       |                                                |
| clinics.            |                                                |
+---------------------+------------------------------------------------+
| ######              | STD Surveillance System (STDSS), CDC, NCHSTP.  |
| National Data Sourc |                                                |
| e {#national-data-s |                                                |
| ource .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | State and local Health Department STD Control  |
| Source**            | Programs.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 19.2 (Sexually Transmitted        |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 15.7 (1997).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of positive tests among men aged 15 to  |
|                     | 24 years who attended STD clinics in the past  |
|                     | 12 months.                                     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number tests administered (unsatisfactory      |
|                     | tests, indeterminate or inconclusive results,  |
|                     | or inadequate specimens are excluded) among    |
|                     | men aged 15 to 24 years who attended STD       |
|                     | clinics in the past 12 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for *Chlamydia trachomatis*  |
|                     | is provided by CDC.**^1^**                     |
+---------------------+------------------------------------------------+
|                     | Data are collected from Regional Infertility   |
|                     | Prevention Program laboratory reports.         |
+---------------------+------------------------------------------------+
|                     | This measure tracks only tests that are        |
|                     | specific for *Chlamydia trachomatis*           |
|                     | infection. The number of positive cases is     |
|                     | based on test results from persons routinely   |
|                     | screened. Routine screening is defined by each |
|                     | clinic. In some clinics, all patients are      |
|                     | universally screened. In others, routine       |
|                     | screening is done selectively based on         |
|                     | clinical findings or behavioral risk factors.  |
+---------------------+------------------------------------------------+
|                     | A minimum of 500 valid test results by gender  |
|                     | and subpopulation is recommended to derive     |
|                     | reliable estimates for this measure. Some      |
|                     | clinics may not collect all U.S.               |
|                     | Census-defined race and/or ethnicity data      |
|                     | categories.                                    |
+---------------------+------------------------------------------------+
|                     | Data for this measure are also included in the |
|                     | annual STD Surveillance Report.**^2^**         |
+---------------------+------------------------------------------------+
|                     | This measure is a modification of Healthy      |
|                     | People 2000 objective 19.2, which tracked      |
|                     | percent positivity in women under age 25 years |
|                     | who attended family planning clinics. This     |
|                     | measure expands the Healthy People 2000        |
|                     | measure and tracks percent positivity among    |
|                     | men aged 15 to 24 years who attended STD       |
|                     | clinics.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of STDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  25-2. Reduce           
  gonorrhea.             

  **National Data        STD Surveillance System (STDSS), CDC, NCHSTP.
  Source**               

  **State Data Source**  State and local Health Department STD Control
                         Programs.

  **Healthy People 2000  19.1 (Sexually Transmitted Diseases).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           123 (1997).

  **Numerator**          Number of new reported cases of gonorrhea in the
                         past 12 months.

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Report of Civilian Cases of Primary and
  Obtain the National    Secondary Syphilis, Gonorrhea, and Chlamydia by
  Data**                 Reporting Source, Sex, Race/Ethnicity, and
                         Group, Form 73.2638, Rev. 01/96.

  **Expected             Annual.
  Periodicity**          

  **Comments**           In most instances, if age or race/ethnicity was
                         not specified, cases were allocated according to
                         the distribution of cases for which these
                         variables were specified. In 1998, New Jersey
                         and Idaho did not report race/ethnicity for most
                         cases and were excluded.

                         Data for this measure are also included in the
                         annual STD Surveillance Report.**^2^**

                         See Part C for a description of STDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 25-3. Eliminate     |                                                |
| sustained domestic  |                                                |
| transmission of     |                                                |
| primary and         |                                                |
| secondary syphilis. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | STD Surveillance System (STDSS), CDC, NCHSTP.  |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | State and local Health Department STD Control  |
| Source**            | Programs.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 19.3 (Sexually Transmitted Diseases).          |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 3.2 (1997).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of new reported cases of primary and    |
|                     | secondary syphilis in the past 12 months.      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Questi       | CDC Report of Civilian Cases of Primary and    |
| ons Used To Obtain  | Secondary Syphilis, Gonorrhea, and Chlamydia   |
| the National Data { | by Reporting Source, Sex, Race/Ethnicity, and  |
| #questions-used-to- | Group, Form 73.2638, Rev. 01/96.               |
| obtain-the-national |                                                |
| -data .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data are collected using Form 2638 from CDC.   |
|                     | In most instances, if age or race/ethnicity    |
|                     | was not specified, cases were allocated        |
|                     | according to the distribution of cases for     |
|                     | which these variables were specified.          |
+---------------------+------------------------------------------------+
|                     | Data for this measure are also included in the |
|                     | annual STD Surveillance Report.**^2^**         |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of STDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

### Viral STD Illness and Disability

  ---------------------- ------------------------------------------------
  25-4. Reduce the       
  proportion of adults   
  with genital herpes    
  infection.             

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 19.5 (Sexually Transmitted
  Objective**            Diseases).

  **Measure**            Percent.

  **Baseline**           17 (1988--94).

  **Numerator**          Number of adults aged 20 to 29 years with a
                         positive result from a herpes simplex virus,
                         type 2 (HSV-2) laboratory test.

  **Denominator**        Number of adults aged 20 to 29 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual beginning with 1999 data.
  Periodicity**          

  **Comments**           A case definition for genital herpes is provided
                         by CDC.**^1^**

                         This measure is a modification of Healthy People
                         2000 objective 19.5, which tracked the number of
                         first-time visits to physicians' offices for
                         genital herpes, as measured by the National
                         Disease and Therapeutic Index, IMS America, Ltd.
                         This measure tracks the proportion of persons
                         aged 20 to 29 years with a positive laboratory
                         test result for herpes simplex virus, type 2, as
                         measured by NHANES.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  25-5. (Developmental)  
  Reduce the proportion  
  of persons with human  
  papillomavirus (HPV)   
  infection.             

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         National Health and Nutrition Examination Survey
                         (NHANES), CDC, NCHS. A reduction in the number
                         of HPV cases will minimize the prevalence of
                         subtypes 16 and 18 and other subtypes associated
                         with cervical cancer in persons aged 15 to 44
                         years.

                         This objective is modified from Healthy People
                         2000 objective 19.5, which tracked the number of
                         first-time consultations for genital warts.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### STD Complications Affecting Females

+---------------------+------------------------------------------------+
| 25-6. Reduce the    |                                                |
| proportion of       |                                                |
| females who have    |                                                |
| ever required       |                                                |
| treatment for       |                                                |
| pelvic inflammatory |                                                |
| disease (PID).      |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Survey of Family Growth (NSFG), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 19.6 (Sexually Transmitted        |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 8 (1995).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of females aged 15 to 44 years who      |
|                     | reported ever requiring treatment for PID.     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of females aged 15 to 44 years.         |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1995 National Survey of Family        |
| Obtain the National | Growth:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever been treated for an          |
|                     |     infection in your fallopian tubes, womb,   |
|                     |     or ovaries, also called a pelvic           |
|                     |     infection, pelvic inflammatory disease, or |
|                     |     P.I.D.?                                    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | There are no reliable national surveillance    |
|                     | systems that measure women requiring treatment |
|                     | for PID. This measure, based on data from      |
|                     | NSFG, is used as a proxy for this objective.   |
+---------------------+------------------------------------------------+
|                     | PID is a subjective diagnosis made by          |
|                     | physicians. Laparoscopy is required for a      |
|                     | definitive diagnosis of PID. The data from the |
|                     | NSFG are self-reported and therefore may not   |
|                     | be accurate, particularly due to the unknown   |
|                     | prevalence of asymptomatic or subclinical PID. |
+---------------------+------------------------------------------------+
|                     | This measure is a modification of Healthy      |
|                     | People 2000 objective 19.6, which tracked the  |
|                     | number of hospitalizations due to PID, as      |
|                     | measured by the National Hospital Discharge    |
|                     | Survey (NHDS), CDC, NCHS. This measure tracks  |
|                     | the number of women aged 15 to 44 years who    |
|                     | report ever requiring treatment for PID.       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NSFG and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 25-7. Reduce the    |                                                |
| proportion of       |                                                |
| childless females   |                                                |
| with fertility      |                                                |
| problems who have   |                                                |
| had a sexually      |                                                |
| transmitted disease |                                                |
| or who have         |                                                |
| required treatment  |                                                |
| for pelvic          |                                                |
| inflammatory        |                                                |
| disease (PID).      |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Survey of Family Growth (NSFG), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 27 (1995).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of childless females aged 15 to 44      |
|                     | years with fertility problems who report       |
|                     | history of STD or PID.                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of females aged 15 to 44 years who are  |
|                     | childless and have fertility problems.         |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1995 National Survey of Family        |
| Obtain the National | Growth:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Has a doctor or other medical care         |
|                     |     provider ever told you that you had:       |
|                     |                                                |
|                     |     genital warts?\                            |
|                     |     gonorrhea?\                                |
|                     |     syphilis?\                                 |
|                     |     genital herpes?                            |
+---------------------+------------------------------------------------+
|                     | -   Have you ever been treated for an          |
|                     |     infection in your fallopian tubes, womb,   |
|                     |     or ovaries, also called a pelvic           |
|                     |     infection, pelvic inflammatory disease, or |
|                     |     P.I.D.?                                    |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | \[Following a series of questions to ALL       |
|                     | respondents that address pregnancy,            |
|                     | contraceptive use and periods of no sexual     |
|                     | activity:\]                                    |
|                     |                                                |
|                     | -   Have you ever had [both]{.underline} your  |
|                     |     tubes tied, cut, or removed? This          |
|                     |     procedure is often called a tubal          |
|                     |     ligation.                                  |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had a hysterectomy, that is, |
|                     |     surgery to [remove]{.underline} your       |
|                     |     uterus?                                    |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had [both]{.underline} your  |
|                     |     ovaries removed?                           |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had any [other]{.underline}  |
|                     |     operation that makes it impossible for you |
|                     |     to have another baby?                      |
+---------------------+------------------------------------------------+
|                     | -   As far as you know, are you completely     |
|                     |     sterile from this operation, that is, does |
|                     |     it make it impossible for you to have a    |
|                     |     baby in the future?                        |
+---------------------+------------------------------------------------+
|                     | -   Has ([name of                              |
|                     |     husband/partner]{.underline}) ever had a   |
|                     |     vasectomy or any other operation that      |
|                     |     would make it impossible to father a baby  |
|                     |     in the future?                             |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
|                     | \[Nonsurgically sterile respondents are those  |
|                     | who have not reported any operations for       |
|                     | themselves, or if they are married or          |
|                     | cohabiting, for their husbands/partners.\]     |
|                     |                                                |
|                     | \[For respondents who are nonsurgically        |
|                     | sterile:\]                                     |
|                     |                                                |
|                     | -   Some women are not                         |
|                     |     [physically]{.underline} able to have      |
|                     |     children. As far as you know, is it        |
|                     |     physically possible for you, yourself, to  |
|                     |     have a baby?                               |
+=====================+================================================+
|                     | -   What about ([name of                       |
|                     |     husband/partner]{.underline})? As far as   |
|                     |     you know, is it [physically]{.underline}   |
|                     |     impossible for him to father a baby in the |
|                     |     future?                                    |
+---------------------+------------------------------------------------+
|                     | \[If it is physically possible:\]              |
|                     |                                                |
|                     | -   Some women are [physicall]{.underline}y    |
|                     |     able to have a baby, but have              |
|                     |     [difficulty]{.underline} getting pregnant  |
|                     |     or carrying a baby to term. As far as you  |
|                     |     know, would you, yourself, have any        |
|                     |     difficulty getting pregnant or carrying a  |
|                     |     baby to term?                              |
+---------------------+------------------------------------------------+
|                     | -   As far as you know, does ([name of male    |
|                     |     partner]{.underline}) have any difficulty  |
|                     |     fathering a baby?                          |
+---------------------+------------------------------------------------+
|                     | -   At any time has a medical doctor ever      |
|                     |     advised you to [never]{.underline} become  |
|                     |     pregnant (again)?                          |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Women are classified as childless if they have |
|                     | not given birth to a child [and]{.underline}   |
|                     | have not had a sterilizing operation.          |
+---------------------+------------------------------------------------+
|                     | Fertility problems refer to the standard       |
|                     | medical definitions of infertility (have not   |
|                     | used contraception and have not become         |
|                     | pregnant for 12 months or more) or impaired    |
|                     | fecundity (women reporting no sterilizing      |
|                     | operation and are classified as those who find |
|                     | it difficult or impossible to get pregnant or  |
|                     | carry a baby to term).                         |
+---------------------+------------------------------------------------+
|                     | Respondents are considered to have fertility   |
|                     | problems if they report that neither they      |
|                     | [or]{.underline} their husband/partner has had |
|                     | a sterilizing operation [or]{.underline} any   |
|                     | one of the following:                          |
+---------------------+------------------------------------------------+
|                     | \(1\) she and her husband/partner are          |
|                     | nonsurgically sterile and it is physically     |
|                     | impossible for her to get pregnant or carry a  |
|                     | baby to term or for her husband to father a    |
|                     | baby.                                          |
+---------------------+------------------------------------------------+
|                     | \(2\) it is physically difficult for her to    |
|                     | get pregnant or carry a baby to term or for    |
|                     | her husband/partner to father a baby.          |
+---------------------+------------------------------------------------+
|                     | \(3\) she has been advised by a doctor (for    |
|                     | health reasons) not to become pregnant.        |
+---------------------+------------------------------------------------+
|                     | \(4\) she and her husband/partner have         |
|                     | reported sexual activity without contraception |
|                     | for at least 12 consecutive months and have    |
|                     | had no pregnancies in that time period.        |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NSFG and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  25-8. (Developmental)  
  Reduce HIV infections  
  in adolescent and      
  young adult females    
  aged 13 to 24 years    
  that are associated    
  with heterosexual      
  contact.               

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         HIV/AIDS Surveillance System, CDC, NCHSTP.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### STD Complications Affecting the Fetus and Newborn

  ---------------------- ------------------------------------------------
  25-9. Reduce           
  congenital syphilis.   

  **National Data        STD Surveillance System (STDSS), CDC, NCHSTP;
  Sources**              National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **State Data Sources** State and local Health Department STD Control
                         Programs; State and Local Vital Statistics.

  **Healthy People 2000  19.4 (Sexually Transmitted Diseases).
  Objective**            

  **Measure**            Rate per 100,000 live births.

  **Baseline**           27 (1997).

  **Numerator**          Number of new reported cases of congenital
                         syphilis in the past 12 months.

  **Denominator**        Number of live births.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Congenital Syphilis (CS) Case Investigation
  Obtain the National    and Report, Form 73.126, Rev. 09/91.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Less than 5 percent of cases have missing
                         race/ethnicity data and were excluded from the
                         baseline estimate.

                         Data for this measure are also included in the
                         annual STD Surveillance Report.**^2^**

                         See Part C for a description of STDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  25-10. (Developmental) 
  Reduce neonatal        
  consequences from      
  maternal sexually      
  transmitted diseases,  
  including chlamydial   
  pneumonia, gonococcal  
  and chlamydial         
  opthalmia neonatorum,  
  laryngeal              
  papillomatosis (from   
  human papillomavirus   
  infection), neonatal   
  herpes, and preterm    
  birth and low birth    
  weight associated with 
  bacterial vaginosis.   

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the STD
                         Surveillance System (STDSS), CDC, NCHSTP.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Personal Behaviors

+---------------------+------------------------------------------------+
| 25-11. Increase the |                                                |
| proportion of       |                                                |
| adolescents who     |                                                |
| abstain from sexual |                                                |
| intercourse or use  |                                                |
| condoms if          |                                                |
| currently sexually  |                                                |
| active.             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 5.5 and 5.6 (Family Planning)     |
| 2000 Objective**    | (also 18.15 and 19.16).                        |
+---------------------+------------------------------------------------+
| **Leading Health    | Responsible Sexual Behavior.                   |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 85 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | report that they have never had sexual         |
|                     | intercourse; or who have had sexual            |
|                     | intercourse, but not in the past 3 months; or  |
|                     | who have had sexual intercourse in the past 3  |
|                     | months but used a condom at last sexual        |
|                     | intercourse.                                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12.     |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Surveillance |
| Obtain the National | System:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had sexual intercourse?      |
+---------------------+------------------------------------------------+
|                     | -   During the past three months, with how     |
|                     |     many people have you had sexual            |
|                     |     intercourse?                               |
|                     |                                                |
|                     |     I have never had sexual intercourse\       |
|                     |     I have had sexual intercourse, but not in  |
|                     |     the past 3 months\                         |
|                     |     1 person\                                  |
|                     |     2 people\                                  |
|                     |     3 people\                                  |
|                     |     4 people\                                  |
|                     |     5 people\                                  |
|                     |     6 or more people                           |
+---------------------+------------------------------------------------+
|                     | -   The last time you had sexual intercourse,  |
|                     |     did you or your partner use a condom?      |
|                     |                                                |
|                     |     I have never had sexual intercourse\       |
|                     |     yes\                                       |
|                     |     no                                         |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This measure is a modification of Healthy      |
|                     | People 2000 objectives 5.5 and 5.6, which      |
|                     | tracked the proportion of sexually active      |
|                     | in-school adolescents in grades 9 through 12   |
|                     | that abstained from sexual intercourse in the  |
|                     | past 3 months and used contraception at most   |
|                     | recent intercourse, respectively. This measure |
|                     | tracks the proportion of adolescents in grades |
|                     | 9 through 12 who have never had sexual         |
|                     | intercourse; [or]{.underline} who have had     |
|                     | sexual intercourse, but not in the past 3      |
|                     | months; [or]{.underline} have had sexual       |
|                     | intercourse in the past 3 months but used a    |
|                     | condom at last sexual intercourse.             |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Responsible Sexual Behavior Leading  |
|                     | Health Indicator. See Appendix H for a         |
|                     | complete listing.                              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  25-12. (Developmental) 
  Increase the number of 
  positive messages      
  related to responsible 
  sexual behavior during 
  weekday and nightly    
  prime-time television  
  programming.           

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is CDC,
                         NCHSTP.

                         Responsible sexual behavior includes abstinence,
                         delaying sexual intercourse, or using condoms.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Community Protection Infrastructure

+---------------------+------------------------------------------------+
| 25-13. Increase the |                                                |
| proportion of       |                                                |
| Tribal, State, and  |                                                |
| local sexually      |                                                |
| transmitted disease |                                                |
| programs that       |                                                |
| routinely offer     |                                                |
| hepatitis B         |                                                |
| vaccines to all STD |                                                |
| clients.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Survey of STD Programs, National Coalition of  |
| Source**            | STD Directors (NCSD).                          |
+---------------------+------------------------------------------------+
| **State Data        | Survey of STD Programs, National Coalition of  |
| Source**            | STD Directors (NCSD).                          |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 5 (1998).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of State and local STD clinics that     |
|                     | reported all clients are eligible to receive   |
|                     | the hepatitis B vaccine.                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of STD programs (free-standing          |
|                     | facilities with the capacity to diagnose and   |
|                     | treat STDs).                                   |
+---------------------+------------------------------------------------+
| **Questions Used to | From the 1998 Survey of STD Programs:          |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Who is eligible for the hepatitis B        |
|                     |     vaccine in STD clinics?                    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This measure tracks the proportion of programs |
|                     | that offer hepatitis B vaccines to clients in  |
|                     | accordance with CDC guidelines.**^3^**         |
+---------------------+------------------------------------------------+
|                     | The numerator is the number of facilities that |
|                     | report "hepatitis vaccines are offered to all  |
|                     | clients" to the question listed above.         |
+---------------------+------------------------------------------------+
|                     | The Survey of STD Programs is a national       |
|                     | convenience sample of free-standing facilities |
|                     | with the capacity to diagnose and treat STDs.  |
+---------------------+------------------------------------------------+
|                     | Data for Tribes are developmental. The         |
|                     | proposed national data source is the Indian    |
|                     | Health Service (IHS).                          |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  25-14. (Developmental) 
  Increase the           
  proportion of youth    
  detention facilities   
  and adult city or      
  county jails that      
  screen for common      
  bacterial sexually     
  transmitted diseases   
  within 24 hours of     
  admission and treat    
  STDs (when necessary)  
  before persons are     
  released.              

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the Annual
                         Survey of Correctional Facilities, CDC, NCHSTP
                         and National Institute of Justice; U.S.
                         Department of Justice, U.S. Bureau of Justice
                         Statistics.

                         See Appendix A for focus area contact
                         information.

  25-15. (Developmental) 
  Increase the           
  proportion of all      
  local health           
  departments that have  
  contracts with managed 
  care providers for the 
  treatment of nonplan   
  partners of patients   
  with bacterial         
  sexually transmitted   
  diseases (gonorrhea,   
  syphilis, and          
  chlamydia).            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the Survey
                         of STD Programs, National Coalition of STD
                         Directors (NCSD).

                         This objective is modified from Healthy People
                         2000 objective 19.15, which tracked partner
                         notification of exposure to sexually transmitted
                         by patients with bacterial STDs using the STDSS.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Personal Health Services

  ---------------------- ------------------------------------------------
  25-16. (Developmental) 
  Increase the           
  proportion of sexually 
  active females aged 25 
  years and under who    
  are screened annually  
  for genital chlamydia  
  infections.            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data sources are the
                         Office on Population Affairs (OPA) data reported
                         in Family Planning Annual Report and the STD
                         Surveillance System (STDSS), CDC, NCHSTP.

                         Primary health care centers include: family
                         planning clinics, community health centers,
                         university health services, Department of
                         Defense health clinics for active duty military,
                         and managed care plans.

                         See Appendix A for focus area contact
                         information.

  25-17. (Developmental) 
  Increase the           
  proportion of pregnant 
  females screened for   
  sexually transmitted   
  diseases (including    
  HIV infection and      
  bacterial vaginosis)   
  during prenatal health 
  care visits, according 
  to recognized          
  standards.             

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed measure is the percent of pregnant
                         females screened for STDs in community health
                         centers, and the proposed data sources are the
                         Department of Defense health clinics for active
                         duty military and managed care plans data from
                         the STD Surveillance System (STDSS), CDC,
                         NCHSTP.

                         Recognized standards are the most recent edition
                         of the *Guide to Clinical Preventive
                         Services*.**^4^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  25-18. Increase the    
  proportion of primary  
  care providers who     
  treat patients with    
  sexually transmitted   
  diseases and who       
  manage cases according 
  to recognized          
  standards.             

  **Comments**           An operational definition was not specified at
                         the time of publication.

                         The national data source for the 1998 baseline
                         is the National Disease and Therapeutic Index
                         (NDTI), IMS America. The proposed tracking
                         source is the National Ambulatory Medical Care
                         Survey (NAMCS), CDC, NCHS.

                         This objective is modified from Healthy People
                         2000 objective 19.13, which tracked correct
                         management of sexually transmitted disease cases
                         by primary care providers using the NDTI.

                         See Part C for a description of NAMCS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  25-19. (Developmental) 
  Increase the           
  proportion of sexually 
  transmitted disease    
  clinic patients who    
  are being treated for  
  bacterial STDs         
  (chlamydia, gonorrhea, 
  and syphilis) and who  
  are offered provider   
  referral services for  
  their sex partners.    

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is STD
                         Surveillance System (STDSS), CDC, NCHSTP.

                         Provider referral (previously called contact
                         tracing) is the process whereby health
                         department personnel directly and confidentially
                         notify the sexual partners of infected
                         individuals of their exposure to a sexually
                         transmitted disease for the purposes of
                         education, counseling, and referral to health
                         care services.

                         This objective is modified from Healthy People
                         2000 objective 19.15, which tracked partner
                         notification of exposure to sexually transmitted
                         diseases by patients with bacterial STDs using
                         STDSS.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

## References

1\. Centers for Disease Control and Prevention (CDC). Case definitions
for infectious conditions under public health surveillance. *Morbidity
and Mortality Weekly Report* 46 (RR-10): 1997.

2\. CDC, Division of STD Prevention. *Sexually Transmitted Disease
Surveillance, 1997.* Atlanta, GA: U.S. Department of Health and Human
Services (HHS), Public Health Service, CDC, 1998.

3\. CDC. Hepatitis B virus: A comprehensive strategy for eliminating
transmission in the United States through universal childhood
vaccination: Recommendations of the Advisory Committee on Immunization
Practices (ACIP). *Morbidity and Mortality Weekly Report*
40(RR-13):1-20, 1991.

4\. U.S. Preventive Services Task Force. *Guide to Clinical Preventive
Services.* 2nd ed. Washington, DC: HHS, 1995.