# Presentation: 725999

## STD in the U.S 2003:  an Update on National Epidemiology and Considerations for National STD Control

- John M. Douglas
- Director
- Division of STD Prevention
- Centers for Disease Control

## STDs in the United States

- More than 65 million people are currently living with an incurable sexually transmitted disease.
- An additional 18 million people become infected with one or more STDs each year.
- There is no single STD epidemic, but rather multiple epidemics.  Many diseases are difficult to track.

## Preliminary Estimates of the Burden of STD in the US—2000

**STD****	****	****	**** ****	****	****Incidence**
- Chlamydia				2.8 million
- Gonorrhea				718,000
- Syphilis				37,000
- Hepatitis B				81,000
- HIV					30,000
- Trichomoniasis			7.4 million
- HSV-2					1.6 million
- HPV					6.2 million
- TOTAL				18.86 million
-         (Weinstock et al. in preparation)

## Chlamydia — Rates by sex: United States, 1984–2002

## Gonorrhea — Rates by sex: United States, 1981–2002 and the Healthy People 2010 objective

## Gonorrhea — Rates by race and ethnicity: United States, 1981–2002 and the Healthy People 2010 objective

## Gonococcal Isolate Surveillance Project (GISP)  — Percent of gonorrhea cases that occurred among MSM, 1988-2002

## Pelvic inflammatory disease — Hospitalizations of women 15-44 years of age: United States, 1980–2001

- Note: The relative standard error for the estimates of the overall total number of PID cases range from 6% to 15%.
- SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)

## Pelvic inflammatory disease — Initial visits to physicians’ offices by women 15-44 years of age: United States, 1980–2001

- SOURCE: National Disease and Therapeutic Index (IMS America, Ltd.)

## Primary and secondary syphilis rates by sexin the United States, 1981–2002*

**Rate (per 100,000 men/women)**

- *Preliminary data

## Primary and secondary syphilis: Male-to-female rate ratios, 1981–2002

- *Preliminary data

- Male:female rate ratio

- 0

- 1

- 2

- 3

- 4

- 1982

- 1984

- 1986

- 1988

- 1990

- 1992

- 1994

- 1996

- 1998

- 2000

- 2002*

**Notes:**
Shows just how steep is the increase in the ratio of M:F rates.   Above M:F ratio in the early 1980’s 

## Primary and secondary syphilis — Rates by county: United States, 2002

- Note: The Healthy People 2010 objective for P&S syphilis is 0.2 case per 100,000 population.

## Progress on Syphilis Elimination  (1997-2002)

**1997**

**1998**

**2000**

**2001**

**2002**

**% Change**
**1997-2002**

**1999**

| P&S Syphilis Cases |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
|      Total | 8,556 | 7,007 | 6,617 | 5,979 | 6,130 | 6,862 | -20 |
|      Women | 3,895 | 3,096 | 2,777 | 2,445 | 1,967 | 1,594 | -59 |
|           White | 453 | 400 | 428 | 385 | 249 | 217 | -52 |
|           Black | 3,255 | 2,524 | 2,163 | 1,864 | 1,527 | 1,195 | -63 |
|           Hispanic | 145 | 138 | 139 | 162 | 146 | 147 | +1 |
| Congenital Syphilis Cases | 1,078 | 840 | 575 | 554 | 497 | 412 | -62 |
| Black:White P&S Syphilis Rate Ratio | 44:1 | 34:1 | 30:1 | 24:1 | 16:1 | 8:1 | -82 |

## Modeling Exercise:  Estimate of primary and secondary syphilis cases occurring among Men Who Have Sex with men (MSM) – United States, 1998-2002

| 1998 | 7,007 | 3,909 | 3,096 | 1.26 | 0 | 7,007 |
| --- | --- | --- | --- | --- | --- | --- |
| 1999 | 6,617 | 3,35 | 2,777 | 1.38 | 333 | 6,279 |
| 2000 | 5,979 | 3,532 | 2,445 | 1.44 | 442 | 5,535 |
| 2001 | 6,103 | 4,134 | 1,967 | 2.10 | 1,654 | 4,447 |
| 2002 | 6,862 | 5,267 | 1,594 | 3.30 | 3,256 | 3,605 |

**Year**

**Total**
**Cases**

**Cases **
**Among**
**men**

**Cases **
**Among**
**women**

**Male:Female**
**Case ratio**

**Cases**
**Among**
**MSM**

**Total Cases**
**Minus cases**
**Among MSM**

## Genital herpes  — Initial visits to physicians’ offices: United States, 1966–2002

- SOURCE: National Disease and Therapeutic Index (IMS America, Ltd.)

## HSV-2 Seroprevalence in NHANES By Age Group

## HPV Sentinel Surveillance: Preliminary Results (10/03)

| Clinic Type | Number Tested | Prevalence (%) HR-HPV |
| --- | --- | --- |
| STD | 298 | 25.5 |
| HIV | 115 | 40.9 |
| FP | 483 | 29.2 |
| PC | 365 | 21.6 |
| total | 1261 | 27.2 |

## Chlamydia Screening Coverage for 15-19 Year Old Women by U.S. Census Region*, 2000

| Overall | 60% | 55%-66% |
| --- | --- | --- |
| Midwest | 70% | 63%-77% |
| South | 61% | 55%-66% |
| West | 54% | 48%-60% |
| Northeast | 49% | 44%-54% |

_**% Coverage**_

_**90% Credibility Interval**_

- * Estimates exclude 4 states with >100% coverage

## HEDIS Chlamydia Screening Rates:  1999 through 2001

- 0%

- 10%

- 20%

- 30%

- 40%

- 50%

- % Screened

- 15-19 yrs.

- 20-25 yrs.

- Sexually Active Women

## % of MSM Syphilis Cases Reporting Meeting Partners through the INTERNET by Region

**% of MSM Syphilis Cases Reporting Meeting Partners through the **_**INTERNET**_** by Region**

- 7/2003 **Provisional** Data - CA DHS STD Control Branch

**San Francisco**

**Rest of California**

**Los Angeles**