Sexually

Transmitted

Disease

Surveillance

2006

Division of STD Prevention

November 2007

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of STD Prevention

Atlanta, Georgia 30333

Centers for Disease Control and

Prevention........................................Julie Louise Gerberding, M.D., M.P.H.

Director

Coordinating Center for

Infectious Diseases ...............................................Mitchell L. Cohen, M.D.

Director

National Center for HIV/AIDS, Viral Hepatitis, STD,

and TB Prevention..........................................Kevin Fenton, M.D., Ph.D.

Director

Division of STD Prevention ............................John M. Douglas, Jr., M.D.

Director

Epidemiology and Surveillance

Branch ...............................................Stuart M. Berman, M.D., Sc.M.

Chief

Surveillance and Special Studies

Team ......................................Hillard S. Weinstock, M.D., M.P.H.

Lead

Statistics and Data Management

Branch ....................................Samuel L. Groseclose, D.V.M., M.P.H.

Chief

Rose Horsley

Team Lead

iii
Copyright Information

All material contained in this report is in the public domain and may be used and reprinted

without special permission; citation to source, however, is appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance,

2006. Atlanta, GA: U.S. Department of Health and Human Services, November 2007.

Copies can be obtained from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E–07,

Atlanta, Georgia 30333. Printed copies and the on-line version of this report can be obtained

at the following web site: http://www.cdc.gov/std/

Selected STD Surveillance and Prevention References and Websites

Supplemental STD Surveillance Reports – 2006

• 2006 Chlamydia Prevalence Monitoring Project: http://www.cdc.gov/std/chlamydia2006/

• 2006 Gonococcal Isolate Surveillance Project: http://www.cdc.gov/std/GISP2006/

• 2006 Syphilis Surveillance Project: http://www.cdc.gov/std/Syphilis2006/

STD Surveillance Reports 1993 – 2006

• http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm

STD Data on Wonder

• http://wonder.cdc.gov/std.html

STD Fact Sheets

• http://www.cdc.gov/std/healthcomm/fact_sheets.htm

STD Treatment Guidelines

• http://www.cdc.gov/STD/treatment/

STD Program Evaluation Guidelines

http://www.cdc.gov/std/program/pupestd.htm

STD Program Operation Guidelines

• http://www.cdc.gov/std/program/default.htm

Recommendations for Public Health Surveillance of Syphilis in the United States

• http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a7.htm

Behavioral Surveillance

• YouthRiskBehaviorSurveillanceSystem:http://www.cdc.gov/HealthyYouth/yrbs/index.htm

• National Survey of Family Growth: Advance Data 362. Sexual Behavior and Selected Health

Measures: Men and Women 15-44 Years of Age, United States, 2002. 56 pp. (PHS)

2003-1250: http://www.cdc.gov/nchs/products/pubs/pubd/ad/361-370/ad362.htm

iv
v

Foreword

“STDs are hidden epidemics of enormous

health and economic consequence in the

United States. They are hidden because

many Americans are reluctant to address

sexual health issues in an open way and

because of the biologic and social

characteristics of these diseases. All

Americans have an interest in STD

prevention because all communities are

impacted by STDs and all individuals

directly or indirectly pay for the costs of

these diseases. STDs are public health

problems that lack easy solutions because

they are rooted in human behavior and

fundamental societal problems. Indeed,

there are many obstacles to effective

prevention efforts. The first hurdle will be to

confront the reluctance of American society

to openly confront issues surrounding

sexuality and STDs. Despite the barriers,

there are existing individual- and

community-based interventions that are

effective and can be implemented

immediately. That is why a multifaceted

approach is necessary to both the

individual and community levels.

To successfully prevent STDs, many

stakeholders need to redefine their

mission, refocus their efforts, modify

how they deliver services, and accept

new responsibilities. In this process,

strong leadership, innovative thinking,

partnerships, and adequate resources

will be required. The additional

investment required to effectively

prevent STDs may be considerable, but

it is negligible when compared with the

likely return on the investment. The

process of preventing STDs must be a

collaborative one. No one agency,

organization, or sector can effectively do

it alone; all members of the community

must do their part. A successful national

initiative to confront and prevent STDs

requires widespread public awareness

and participation and bold national

leadership from the highest levels.”1

1Concluding statement from the Institute of

Medicine’s Summary Report, The Hidden

Epidemic: Confronting Sexually Transmitted

Diseases, National Academy Press,

Washington, DC, 1997, p.43.
Preface

Sexually Transmitted Disease Surveillance,

2006 presents statistics and trends for

sexually transmitted diseases (STDs) in the

United States through 2006. This annual

publication is intended as a reference

document for policy makers, program

managers, health planners, researchers,

and others who are concerned with the

public health implications of these diseases.

The figures and tables in this edition

supersede those in earlier

publications of these data.

The surveillance information in this report

is based on the following sources of data:

(1) case reports from state and local STD

programs; (2) the Regional Infertility

Prevention Projects, the National Job

Training Program, the Corrections STD

Prevalence Monitoring Project, and the

Men Who Have Sex With Men (MSM)

Prevalence Monitoring Project; (3) the

Gonococcal Isolate Surveillance Project

(GISP); and (4) national surveys

implemented by federal and private

organizations.

The STD surveillance systems operated by

state and local STD control programs,

which provide the case report data for

chlamydia, gonorrhea, syphilis, and

chancroid are the data sources of many of

the figures and most of the statistical tables

in this publication. These systems are an

integral part of program management at all

levels of STD prevention and control in the

United States. Because of incomplete

diagnosis and reporting, the number of

STD cases reported to CDC is less than the

actual number of cases occurring in the

United States population. Case report data

for other STDs are not available because

they are not nationally notifiable diseases.

Sexually Transmitted Disease Surveillance,

2006 consists of four parts. The National

Profile contains figures that provide an

overview of STD morbidity in the United

States. The accompanying text identifies

major findings and trends for selected

STDs. The Special Focus Profiles

contain figures and text describing STDs in

selected subgroups and populations that

are a focus of national and state

prevention efforts. The Detailed Tables

provide statistical information about STDs

at the county, metropolitan statistical area

(MSA), regional, state, and national levels.

The Appendix includes information on

interpreting the STD surveillance data

used to produce this report, Healthy

People 2010 STD objectives, Government

Performance and Results Act (GPRA)

goals, and STD surveillance case

definitions.

Selected figures and tables in this document

identify goals that reflect progress towards

some of the Healthy People 2010

(HP2010) national health status objectives

for STDs.1 Appendix Table A3 displays

progress made towards the HP2010 targets

for STDs. These targets are used as

reference points throughout this edition of

Sexually Transmitted Disease Surveillance

2006.

vi
Any comments and suggestions that

would improve the usefulness of future

publications are appreciated and should

be sent to Director, Division of STD

Prevention, National Center for

HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention, Centers for Disease Control

and Prevention, 1600 Clifton Road,

Mailstop E-02, Atlanta, Georgia, 30333.

vii

1 U.S. Department of Health and Human Services.

Healthy People 2010. 2nd ed. With Understanding

and Improving Health and Objectives for Improving

Health. 2 vols. Washington, DC: U.S. Government

Printing Office, November 2000.
Acknowledgments

Publication of this report would not have been possible without the contributions of the

State and Territorial Health Departments and the Sexually Transmitted Disease Control

Programs and the Regional Infertility Prevention Projects, which provided surveillance

data to the Centers for Disease Control and Prevention.

This report was prepared by the following staff and contractors of the Division of STD

Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for

Disease Control and Prevention:

Office of the Director

Keith Davis

John Douglas

Melinda Flock

Suzanne Haecker

Amy Pulver

Epidemiology and Surveillance Branch

John Beltrami

Stuart Berman

Deblina Datta

Riduan Joesoef

Katrina Kramer

Kristen Mahle

Lori Newman

Catherine Lindsey Satterwhite

Hillard Weinstock

Eileen Yee

Statistics and Data Management Branch

Susan Bradley

Jim Braxton

Sharon Clanton

Darlene Davis

Miatta Dennis

Molly Dowling

LaZetta Grier

Samuel Groseclose

Alesia Harvey

Donna Helms

Rose Horsley

Kathleen Hutchins

Rob Nelson

Maya Sternberg

Akbar Zaidi

viii
ix

Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Figures in the National Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Figures in the Special Focus Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Tables in the National Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv

Geographic Divisions of the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

National Overview of Sexually Transmitted Diseases, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

National Profile

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Other Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Special Focus Profiles

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

STDs in Women and Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

STDs in Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

STDs in Racial and Ethnic Minorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

STDs in Men Who Have Sex with Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

STDs in Persons Entering Corrections Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Tables

National Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Selected STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Appendix

Interpreting STD Surveillance Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values

for selected demographic variables by state, 2006 . . . . . . . . . . . . . . . . . . . . . 152

Table A2. Reported cases of sexually transmitted disease by sex and reporting source:

United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 154

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

STD Surveillance Case Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Figures in the National Profile

Chlamydia

Figure 1. Chlamydia — Rates: Total and by sex: United States, 1987–2006. . . . . . . . . . 11

Figure 2. Chlamydia — Rates by region: United States, 1997–2006 . . . . . . . . . . . . . . . . 11

Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2006 . . . . . . . 12

Figure 4. Chlamydia — Rates by county: United States, 2006 . . . . . . . . . . . . . . . . . . . . 12

Figure 5. Chlamydia — Cases by reporting source and sex: United States,

1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Figure 6. Chlamydia — Rates by race/ethnicity: United States, 1997–2006 . . . . . . . . . . 13

Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2006 . . . . . . . . . . . . 14

Figure 8. Chlamydia — Median state-specific positivity among 15- to 24-year-old

women tested in family planning clinics: United States, 1997–2006 . . . . . . . . . 14

Figure 9. Chlamydia — Positivity among 15- to 24-year-old women tested in family

planning clinics by state: United States and outlying areas, 2006 . . . . . . . . . . . 15

Figure 10. Chlamydia — Trends in positivity among 15- to 24-year-old women

tested in family planning clinics by HHS region, 2002–2006 . . . . . . . . . . . . . . 15

Gonorrhea

Figure 11. Gonorrhea — Rates: United States, 1941–2006 and the Healthy

People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure 12. Gonorrhea — Rates: Total and by sex: United States, 1987–2006 and the

Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure 13. Gonorrhea — Rates by region: United States 1997–2006 and the

Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Figure 14. Gonorrhea — Rates by state: United States and outlying areas, 2006 . . . . . . . 25

Figure 15. Gonorrhea — Rates by county: United States, 2006 . . . . . . . . . . . . . . . . . . . . 26

Figure 16. Gonorrhea — Cases by reporting source and sex: United States,

1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Figure 17. Gonorrhea — Rates by race/ethnicity: United States, 1997–2006 . . . . . . . . . . 27

Figure 18. Gonorrhea — Age- and sex-specific rates: United States, 2006 . . . . . . . . . . . . 27

Figure 19. Gonorrhea — Age-specific rates among women 15 to 44 years of age:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Figure 20. Gonorrhea — Age-specific rates among men 15 to 44 years of age:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Figure 21. Gonorrhea — Positivity among 15- to 24-year-old women tested in

family planning clinics by state: United States and outlying areas, 2006. . . . . . 29

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Location of participating

clinics and regional laboratories: United States, 2006. . . . . . . . . . . . . . . . . . . . 29

Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and

tetracycline resistance among GISP isolates, 2006 . . . . . . . . . . . . . . . . . . . . . . 30

Figure 24. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance or intermediate resistance to

ciprofloxacin, 1990–2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Figure 25. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,

2001–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

x
Syphilis

Figure 26. Syphilis — Reported cases by stage of infection: United States,

1941–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Figure 27. Primary and secondary syphilis — Rates: Total and by sex: United States,

1987–2006 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 37

Figure 28. Primary and secondary syphilis — Rates by region: United States,

1997–2006

and the Healthy People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Figure 29. Primary and secondary syphilis — Rates by state: United States and

outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Figure 30. Primary and secondary syphilis — Rates by county: United States, 2006. . . . . 39

Figure 31. Primary and secondary syphilis — Cases by reporting source and sex:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Figure 32. Primary and secondary syphilis — Rates by race/ethnicity: United States,

1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Figure 33. Primary and secondary syphilis — Male-to-female rate ratios: United States,

1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Figure 34. Primary and secondary syphilis — Age- and sex-specific rates:

United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Figure 35. Primary and secondary syphilis — Age-specific rates among women

15 to 44 years of age: United States, 1997–2006. . . . . . . . . . . . . . . . . . . . . . . 41

Figure 36. Primary and secondary syphilis — Age-specific rates among men

15 to 44 years of age: United States, 1997–2006. . . . . . . . . . . . . . . . . . . . . . . 42

Figure 37. Congenital syphilis (CS) — Reported cases for infants < 1 year of age

and rates of primary and secondary syphilis among women:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Figure 38. Congenital syphilis — Rates for infants < 1 year of age: United States,

1997–2006 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 43

Other Sexually Transmitted Diseases

Figure 39. Chancroid — Reported cases: United States, 1981–2006. . . . . . . . . . . . . . . . . 47

Figure 40. Genital herpes — Initial visits to physicians’ offices: United States,

1966–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Figure 41. Genital warts — Initial visits to physicians’ offices: United States,

1966–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Figure 42. Trichomoniasis and other vaginal infections in women — Initial visits to

physicians’ offices: United States, 1966–2006 . . . . . . . . . . . . . . . . . . . . . . . . . 48

Figure 43. Prevalence of high-risk and low-risk human papillomavirus types

among females aged 14-59 years, 2003-2004 . . . . . . . . . . . . . . . . . . . . . . . . . 49

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia — Rates among women by state: United States and

outlying areas, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

xi
Figure B. Gonorrhea — Rates among women by state: United States and

outlying areas, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Figure C. Primary and secondary syphilis — Rates among women by state:

United States and outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Figure D. Congenital syphilis — Rates for infants < 1 year of age by state:

United States and outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2006 . . . . . . . . . . . . . . . . . . 59

Figure F. Gonorrhea — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2006 . . . . . . . . . . . . . . . . . . 59

Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age:

United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years

of age: United States, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women

15 to 44 years of age: United States, 1997–2006. . . . . . . . . . . . . . . . . . . . . . . 61

STDs in Adolescents and Young Adults

Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women

tested in family planning clinics by HHS region, 2002–2006 . . . . . . . . . . . . . . 66

Figure K. Chlamydia — Prevalence among 16- to 24-year-old women entering

the National Job Training Program by state of residence: United States

and outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Figure L. Chlamydia — Prevalence among 16- to 24-year-old men entering

the National Job Training Program by state of residence: United States

and outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Figure M. Gonorrhea — Prevalence among 16- to 24-year-old women entering

the National Job Training Program by state of residence: United States

and outlying areas, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Figure N. Gonorrhea — Prevalence among 16- to 24-year-old men entering

the National Job Training Program by state of residence: United States

and outlying areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia — Rates by race/ethnicity and sex: United States, 2006 . . . . . . . . . 72

Figure P. Gonorrhea — Rates by race/ethnicity and sex: United States, 2006 . . . . . . . . . 72

Figure Q. Gonorrhea — Rates among 15- to 19-year-old females by race/ethnicity:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Figure R. Gonorrhea — Rates among 15- to 19-year-old males by race/ethnicity:

United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Figure S. Primary and secondary syphilis — Rates by race/ethnicity and sex:

United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Figure T. Primary and secondary syphilis — Rates among 15- to 19-year-old

females by race/ethnicity: United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . 74

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old

males by race/ethnicity: United States, 1997–2006. . . . . . . . . . . . . . . . . . . . . . 75

Figure V. Congenital syphilis — Rates among infants < 1 year of age by mother’s

race/ethnicity: United States, 1997–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

xii
STDs in Men Who Have Sex with Men

Figure W. MSM Prevalence Monitoring Project — Number of gonorrhea tests

and number of positive tests in men who have sex with men, STD clinics,

1999–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity

among men who have sex with men, STD clinics, 1999–2006. . . . . . . . . . . . . 82

Figure Y. MSM Prevalence Monitoring Project — City-specific median number

of HIV tests and positivity among men who have sex with men,

STD clinics, 1999–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Figure Z. Gonococcal Isolate Surveillance Project (GISP) — Percent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex

with men attending STD clinics, 1988–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Figure AA. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates obtained from men who have sex with men

attending STD clinics, 2003–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

STDs in Persons Entering Corrections Facilities

Figure BB. Chlamydia — Positivity by age, juvenile corrections facilities, 2006 . . . . . . . . . 88

Figure CC. Chlamydia — Positivity by age, adult corrections facilities, 2006 . . . . . . . . . . . 88

Figure DD. Gonorrhea — Positivity by age, juvenile corrections facilities, 2006 . . . . . . . . . 89

Figure EE. Gonorrhea — Positivity by age, adult corrections facilities, 2006 . . . . . . . . . . . 89

Table AA. Chlamydia — Positivity among men and women in juvenile corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Table BB. Chlamydia — Positivity among men and women in adult corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Table CC. Gonorrhea — Positivity among men and women in juvenile corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Table DD. Gonorrhea — Positivity among men and women in adult corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Table EE. Syphilis— Positivity among men and women in juvenile corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Table FF. Syphilis— Positivity among men and women in adult corrections

facilities, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

xiii
Tables in the National Profile

National Summary

Table 1. Cases of sexually transmitted diseases reported by state health

departments and rates per 100,000 population: United States,

1941–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Chlamydia

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates:

United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Table 3. Chlamydia — Reported cases and rates by state/area and region listed

in alphabetical order: United States and outlying areas, 2002–2006 . . . . . . . . 98

Table 4. Chlamydia — Women – Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying areas,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Table 5. Chlamydia — Men – Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying

areas, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Table 6. Chlamydia — Counties and independent cities ranked by number

of reported cases: United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Table 7. Chlamydia — Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Table 8. Chlamydia — Women – Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Table 9. Chlamydia — Men – Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Table 10. Chlamydia — Reported cases and rates per 100,000 population by

age group and sex: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . 105

Table 11A. Chlamydia — Reported cases by race/ethnicity, age group and sex:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Table 11B. Chlamydia — Rates per 100,000 population by race/ethnicity,

age group and sex: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . 107

Gonorrhea

Table 12. Gonorrhea — Reported cases and rates by state/area, ranked by rates:

United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Table 13. Gonorrhea — Reported cases and rates by state/area and region listed

in alphabetical order: United States and outlying areas, 2002–2006 . . . . . . . 109

Table 14. Gonorrhea — Women – Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying areas,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Table 15. Gonorrhea — Men – Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying areas,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Table 16. Gonorrhea — Counties and independent cities ranked by number

of reported cases: United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

xiv
Table 17. Gonorrhea — Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Table 18. Gonorrhea — Women – Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Table 19. Gonorrhea — Men – Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Table 20. Gonorrhea — Reported cases and rates per 100,000 population

by age group and sex: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . 116

Table 21A. Gonorrhea — Reported cases by race/ethnicity, age group and sex:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Table 21B. Gonorrhea — Rates per 100,000 population by race/ethnicity,

age group and sex: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . 119

Syphilis

Table 22. All stages of syphilis — Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying areas,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Table 23. All stages of syphilis — Reported cases and rates in selected

metropolitan statistical areas†

(MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Table 24. Primary and secondary syphilis — Reported cases and rates by state,

ranked by rates: United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Table 25. Primary and secondary syphilis — Reported cases and rates by

state/area and region listed in alphabetical order: United States and

outlying areas, 2002–2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Table 26. Primary and secondary syphilis — Women – Reported cases and

rates by state/area and region listed in alphabetical order: United States

and outlying areas, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Table 27. Primary and secondary syphilis — Men – Reported cases and rates

by state/area and region listed in alphabetical order: United States

and outlying areas, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Table 28. Primary and secondary syphilis — Counties and independent cities

ranked by number of reported cases: United States, 2006 . . . . . . . . . . . . . . . 126

Table 29. Primary and secondary syphilis — Reported cases and rates in

selected metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Table 30. Primary and secondary syphilis — Women – Reported cases and

rates in selected metropolitan statistical areas (MSAs) listed in

alphabetical order: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . 128

Table 31. Primary and secondary syphilis — Men – Reported cases and rates

in selected metropolitan statistical areas (MSAs) listed in alphabetical

order: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Table 32. Primary and secondary syphilis — Reported cases and rates per 100,000

population by age group and sex: United States, 2002–2006. . . . . . . . . . . . . 130

Table 33A. Primary and secondary syphilis — Reported cases by race/ethnicity,

age group and sex: United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . 132

Table 33B. Primary and secondary syphilis — Rates per 100,000 population by

race/ethnicity, age group and sex: United States, 2002–2006. . . . . . . . . . . . . 133

xv
Table 34. Early latent syphilis — Reported cases and rates by state/area and

region listed in alphabetical order: United States and outlying areas,

2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Table 35. Early latent syphilis — Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Table 36. Late and late latent syphilis — Reported cases and rates by state/area

and region listed in alphabetical order: United States and outlying

areas, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Table 37. Late and late latent syphilis — Reported cases and rates in selected

metropolitan statistical areas (MSAs) listed in alphabetical order:

United States, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Table 38. Congenital syphilis — Reported cases and rates in infants < 1 year of

age by state, ranked by rates: United States, 2006 . . . . . . . . . . . . . . . . . . . . . 138

Table 39. Congenital syphilis — Reported cases and rates in infants < 1 year of

age by state/area and region listed in alphabetical order: United States

and outlying areas, 2002–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Table 40. Congenital syphilis — Reported cases and rates in infants < 1 year of

age by race/ethnicity of mother: United States, 2002–2006 . . . . . . . . . . . . . . 140

Chancroid

Table 41. Chancroid — Reported cases and rates by state/area listed in

alphabetical order: United States and outlying areas, 2002–2006 . . . . . . . . . 141

Selected STDs

Table 42. Selected STDs and complications — Initial visits to physicians' offices,

National Disease and Therapeutic Index: United States, 1966–2006 . . . . . . . 142

Interpreting STD Surveillance Data

Table A1. Selected STDs — Percentage of unknown, missing, or invalid

values for selected variables by state and by nationally notifiable

STD, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Table A2. Reported cases of sexually transmitted disease reporting source and

by sex: United States, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 154

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

xvi
xvii

West Midwest Northeast

South

Geographic Divisions of the United States

West Midwest South Northeast

Alaska Illinois Alabama Connecticut

Arizona Indiana Arkansas Maine

California Iowa Delaware Massachusetts

Colorado Kansas District of Columbia New Hampshire

Hawaii Michigan Florida New Jersey

Idaho Minnesota Georgia New York

Montana Missouri Kentucky Pennsylvania

Nevada Nebraska Louisiana Rhode Island

New Mexico North Dakota Maryland Vermont

Oregon Ohio Mississippi

Utah South Dakota North Carolina

Washington Wisconsin Oklahoma

Wyoming South Carolina

Tennessee

Texas

Virginia

West Virginia

National Overview of Sexually

Transmitted Diseases, 2006

The logo on the cover of Sexually

Transmitted Disease Surveillance, 2006 is a

reminder of the multifaceted, national

dimensions of the morbidity, mortality, and

costs that result from sexually transmitted

diseases (STDs) in the United States. It

highlights the central role of STD

prevention in improving health among

women and infants and in promoting HIV

prevention. Organized collaboration among

interested, committed public and private

organizations and communities is the key to

reducing STDs and their related health

burdens. As noted in the report of the

Institute of Medicine, The Hidden

Epidemic: Confronting Sexually

Transmitted Diseases,

1 surveillance is a key

component of our efforts to prevent and

control these diseases.

This overview summarizes national

surveillance data on the three notifiable

diseases for which there are

federally-funded control programs:

chlamydia, gonorrhea, and syphilis. Several

observations for 2006 are worthy of note.

Chlamydia

In 2006, 1,030,911 cases of genital

Chlamydia trachomatis infection were

reported to CDC (Table 1). This case count

corresponds to a rate of 347.8 cases per

100,000 population, an increase of 5.6%

compared with the rate in 2005. 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 and related

complications. The continued increase in

chlamydia case reports in 2006 most likely

represents a continued increase in screening

for this infection, more sensitive tests, and

more complete national reporting, but it

may also reflect a true increase in

morbidity.

In 2006, the overall rate of chlamydial

infection in the United States among

women (515.8 cases per 100,000 females)

was almost three times the rate among men

(173.0 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.2 From 2002 through

2006, the chlamydia rate in men increased

by 36% (compared with a 16% increase in

women over this period).

Data from multiple sources on prevalence

of chlamydial infection in defined

populations have been useful in monitoring

disease burden and guiding chlamydia

screening programs.

In 2006, the median state-specific

chlamydia test positivity among women 15

to 24 years of age who were screened at

selected family planning clinics in all states,

the District of Columbia, Puerto Rico, and

the Virgin Islands was 6.7% (range 2.8% to

16.9%) (Figures 8 and 9).

At selected prenatal clinics in 23 states,

Puerto Rico, and the Virgin Islands the

STD Surveillance 2006 Overview 1
median state-specific chlamydia prevalence

was 8.1% (range 3.5% to 16.7%) (Figure E).

The prevalence of infection is greater

among economically-disadvantaged

women 16 to 24 years of age who entered

the National Job Training Program in 2006

from 40 states, the District of Columbia,

and Puerto Rico. The median state-specific

prevalence was 13.1% (range 4.9% to

20.0%) (Figure K). Among men entering

the program in 2006 from 48 states, the

District of Columbia, and Puerto Rico the

median state-specific chlamydia prevalence

was 7.9% (range 1.8% to 12.4%) (Figure L).

The prevalence is even greater among

adolescent women entering 57 juvenile

detention centers; the median chlamydia

positivity by facility was 14.2% (range 2.8%

to 29.4%) (Table AA).

Among adolescent men entering 83

juvenile detention centers, the median

chlamydia positivity was 5.3% by facility

(range 0.5% to 46.7%) (Table AA).

Although these data on prevalence are not

entirely comparable because of differences

in the populations screened, in the

performance characteristics of the screening

tests, and variations in screening criteria,

they provide important information on the

continuing high burden of disease in the

United States.

Gonorrhea

Following a 74% decline in the rate of

reported gonorrhea from 1975 to 1997,

overall gonorrhea rates appeared to

plateau. In 2006, 358,366 cases of

gonorrhea were reported in the United

States, corresponding to a rate of 120.9 per

100,000 population, an increase of 5.5%

percent since 2005 and an increase for the

second consecutive year. (Figure 11 and

Table 1). This rate considerably exceeds the

Healthy People 2010 (HP2010) target of 19

cases per 100,000 population.

As in previous years, in 2006 the South had

the highest gonorrhea rate among the four

regions of the country (Table 12). Although

the gonorrhea rate in the South declined

for many years, in 2006, it rose by 12%

from 2005 to a rate of 159.2 cases per

100,000 population. The rate in the West

continued to increase slightly in 2006 while

rates in the Northeast declined and the rate

in the Midwest showed little change.

For the fifth consecutive year, the

gonorrhea rate in women in 2006 was

higher (124.3 per 100,000 population) than

the rate among men (116.8 per 100,000

population) (Figure 12). As with chlamydia,

gonorrhea rates in women 15 to 24 years

of age are particularly high. In men, they

are highest among men 20 to 29 years of

age (Figure 18). In 2006, the gonorrhea

rate among African American men was 25

times higher than among white men; the

gonorrhea rate for African American

women was 14 times higher than that for

white women.

In 2006, data on gonorrhea prevalence in

defined populations were available from

several sources. These data showed a

continuing high burden of disease in

adolescents and young adults in some parts

of the United States.

For 16- to 24-year-old women entering the

National Job Training Program in 36 states,

the District of Columbia and Puerto Rico in

2006, the median state-specific gonorrhea

prevalence was 2.4% (range 0.0% to

7.1%).

Among men entering the program from 20

states, the median state-specific gonorrhea

prevalence was 3.6% (range 0.0% to

6.2%).

Among women entering juvenile

corrections facilities the median gonorrhea

positivity was 3.8% (range 0.0% to 12.2%);

the median gonorrhea positivity for men

entering juvenile corrections facilities was

0.9% (range 0.0% to 4.5%).

2 Overview STD Surveillance 2006
Among women entering adult corrections

facilities, the median gonorrhea positivity

was 4.1% (range 0.0% to 10.9%). In men,

the median gonorrhea positivity was 2.3%

(range 0.0% to 18.3%) in adult corrections

facilities.

Among men who have sex with men

(MSM) attending eight STD clinics, the

median clinic urethral gonorrhea positivity

was 10% (range 8% to 13%).

In the Gonococcal Isolate Surveillance

Project (GISP), a sentinel surveillance

project located in 28 STD clinics

throughout the United States, the

proportion of isolates among MSM that

were resistant to ciprofloxacin increased in

2006 to 39%. The overall proportion of

resistant isolates among heterosexuals

doubled from 3.8% in 2005 to 7% in 2006.

As a result of the high prevalence of

quinolone resistant N. gonorrhoeae among

MSM and heterosexuals, CDC revised the

2006 STD Treatment Guidelines.

Fluoroquinolones are no longer

recommended for the treatment of

gonorrhea and associated conditions such

as pelvic inflammatory disease.3

Syphilis

The rate of primary and secondary (P&S)

syphilis reported in the United States

decreased during the 1990s and in 2000

was the lowest since reporting began in

1941. The low rate of syphilis and the

concentration of the majority of 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

2006.4 The rate of P&S syphilis in the

United States declined by 89.7% from 1990

through 2000. However, the rate of P&S

syphilis has increased each year since 2001,

mostly in men, but also in women for the

past two years. In 2006, 9,756 cases of

P&S syphilis cases were reported to CDC,

corresponding to a rate of 3.3 cases per

100,000 population, a 13.8% increase from

2005. Since 2001, the rate of P&S syphilis

has increased 57%. After 14 years of

decline, the rate of congenital syphilis

increased in 2006 to 8.5 cases per 100,000

live births from 8.2 in 2005. There were

349 cases of congenital syphilis reported.

Although wide disparities exist in the rates

of STDs among racial and ethnic groups,

there has been a reduction in these

differences for syphilis over the past seven

years. The P&S syphilis rate for 2006

among African Americans was 5.9 times

the rate among whites, reflecting a

substantial decline from 1999, when the

rate among African Americans was 29

times greater than that among whites (Table

33B). While this has reflected decreasing

rates among African Americans, it also

reflects increases among white men during

the past five years. In 2006, increases were

observed among both African-American

men (18.3 cases per 100,000 population,

up from 15.5 in 2005) and AfricanAmerican women (4.9 cases per 100,000

population, up from 4.4 in 2005). An

increase was also observed among white

men (3.5 cases per 100,000 population),

up from 3.3 in 2005, while the rate in white

women remained the same (0.3 per

100,000 population).

While syphilis elimination efforts have

successfully focused on heterosexual

minority populations at risk for syphilis,

increases in syphilis among MSM since

2001 and more recent increases among

women and African Americans highlight the

importance of continually reassessing and

refining surveillance, prevention, and

control strategies.

STD Surveillance 2006 Overview 3
4 Overview STD Surveillance 2006

1 Institute of Medicine. The Hidden Epidemic:

Confronting Sexually Transmitted Diseases,

Committee on Prevention and Control of

Sexually Transmitted Diseases, National

Academy Press, Washington, DC, 1997.

2 Centers for Disease Control and Prevention.

Male chlamydia screening consultation, Atlanta,

Georgia, May 28-29, 2006, Meeting Report,

May 22, 2007. Available at:

http://www.cdc.gov/std/chlamydia/ChlamydiaSc

reening-males.pdf. Accessed October 16, 2007.

3 Centers for Disease Control and Prevention.

Update to CDC’s Sexually Transmitted Diseases

Treatment Guidelines, 2006: Fluoroquinolones

No Longer Recommended for Treatment of

Gonococcal Infections. MMWR,

2007;56:332-336.

4 Division of STD Prevention. The National Plan

to Eliminate Syphilis from the United States.

National Center for HIV, STD, and TB

Prevention, Centers for Disease Control and

Prevention, 2006.
NATIONAL PROFILE
NATIONAL PROFILE
National Profile

The National Profile section contains

figures showing trends and the distribution

of nationally reportable sexually transmitted

diseases (chlamydia, gonorrhea, syphilis and

chancroid) by age, sex, race/ethnicity, and

location for the United States. Where relevant,

the figures illustrate progress towards specific

Healthy People 2010 targets* for the nation.1

STD Surveillance 2006 National Profile National Profile 5

* See the Appendix for a listing of the Healthy

People 2010 objectives for the diseases

addressed in this report.

1 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

Chlamydia

Background

Chlamydia trachomatis infections are the

most commonly-reported notifiable disease

in the United States. They are among the

most prevalent of all STDs and, since 1994,

have comprised the largest proportion of all

STDs reported to CDC (Table 1). Recent

studies also demonstrate the high

prevalence of chlamydial infections in the

general U.S. population. From 1999 to

2002, chlamydia prevalence among

participants (aged 14-39 years) in the

National Health and Nutrition Examination

Survey was 2.2%.1 Among young adults

(18-26 years of age) participating in the

National Longitudinal Study of Adolescent

Health from 2001 to 2002, chlamydia

prevalence was 4.2%.2

In women, chlamydial infections, which are

usually asymptomatic, may result in pelvic

inflammatory disease (PID), which is a

major cause of infertility, ectopic pregnancy,

and chronic pelvic pain. Data from a

randomized controlled trial of chlamydia

screening in a managed care setting

suggested that screening programs can lead

to a reduction in the incidence of PID by as

much as 60%.3 As with other inflammatory

STDs, chlamydial infection can facilitate the

transmission of HIV infection. In addition,

pregnant women infected with chlamydia

can pass the infection to their infants during

delivery, potentially resulting in neonatal

ophthalmia and pneumonia. Due to the

large burden of disease and risks associated

with infection, CDC recommends screening

all sexually active women younger than 26

years of age for chlamydia annually.4

The increase in reported chlamydial

infections during the last 10 years reflects

the expansion of chlamydia screening

activities, use of increasingly sensitive

diagnostic tests, an increased emphasis on

case reporting from providers and

laboratories, improvements in the

information systems for reporting, and,

possibly, true increases in disease.

However, many women who are at risk are

still not being tested, reflecting, in part, lack

of awareness among some health care

providers and limited resources available to

support screening. Chlamydia screening

and reporting are likely to continue to

expand further in response to the

Healthcare Effectiveness Data and

Information Set (HEDIS) measure for

chlamydia screening of sexually active

women 15 through 25 years of age who

receive medical care through commercial or

Medicaid managed care organizations.5

To better monitor trends in disease burden

in defined populations during the

expansion of chlamydia screening activities,

data on chlamydia positivity among

persons screened in a variety of settings are

used. In most instances, test positivity

serves as a reasonable approximation of

prevalence.6

Chlamydia - United States

In 2000, for the first time, all 50 states and

the District of Columbia had regulations

requiring the reporting of chlamydia cases.

In 2006, 1,030,911 chlamydial infections

were reported to CDC from 50 states and

the District of Columbia (Table 1). This is

the first time reported cases of chlamydia

STD Surveillance 2006 National Profile Chlamydia 7
have exceeded 1 million. This case count

corresponds to a rate of 347.8 cases per

100,000 population, an increase of 5.6%

compared with the rate of 329.4 in 2005.

The reported number of chlamydial

infections was almost three times the

number of reported cases of gonorrhea

(358,366 gonorrhea cases were reported in

2006) (Table 1).

From 1987 through 2006, the rate of

reported chlamydial infection increased

from 50.8 to 347.8 cases per 100,000

population (Figure 1, Table 1).

Chlamydia by Region

For the years 1997-2001, chlamydia rates

in the southern region of the United States

were slightly higher than in any other

region of the country (Figure 2, Table 3).

For the years 2002-2006, overall rates were

comparable in the Midwest, West, and

South. Rates have consistently remained

lowest in the Northeast. In 2006, rates

increased in the South, West, and

Northeast (363.3, 357.9, 299.0 cases per

100,000 population, respectively) and

remained the same in the Midwest (352.4

cases).

Chlamydia by State

In 2006, chlamydia rates per 100,000

population by state ranged from 152.4

cases in New Hampshire to 681.8 cases in

Alaska (Figure 3, Table 2). Thirty states, the

District of Columbia, and Guam had

chlamydia case rates higher than 300 cases

per 100,000 population.

Chlamydia by Metropolitan Statistical

Area (MSA)

In 2006, the chlamydia case rate per

100,000 population in the 50 most

populous MSAs increased overall, among

both women and men (Table 7). Among

women, the 2006 case rate of 533.8 is a

4.4% increase over the 2005 case rate of

511.3 (Table 8). The 2006 case rate among

men (191.5 per 100,000 population)

increased 7.5% from the 2005 case rate

(178.2) (Table 9). In 2006, 56.7% of

chlamydia cases were reported by these

MSAs.

Chlamydia by County

Counties in the United States with the

highest chlamydia case rates per 100,000

population were located primarily in the

Southeast and West, including Alaska

(Figure 4). In 2006, 842 (26.8%) of 3,140

counties had rates greater than 300.0 cases

per 100,000 population. Rates per 100,000

population were 150.0 or less in 1,296

counties (41.3%) and between 150.1 and

300 in 1,002 counties (31.9%). Eighty-nine

counties and independent cities reported

50% of all chlamydia cases in 2006.

Fifty-four with the greatest number of cases

are shown in Table 6, with case rates

ranging from 213.3 (Miami-Dade County,

Florida) to 1330.3 (St. Louis (City),

Missouri) per 100,000 population.

Chlamydia by Reporting Source

The majority of chlamydia cases reported

in 2006 were reported from venues outside

of STD clinics (Figure 5, Table A2). Among

women, only 12.0% of chlamydia cases

were reported through an STD clinic

(93,169 of 775,788 total cases). In contrast,

among men, 32.7% of chlamydia cases

were reported through an STD clinic in

2006 (82,638 of 252,630 total cases).

Chlamydia by Race/Ethnicity

In 2006, chlamydia rates increased for all

racial and ethnic groups except

Asian/Pacific Islanders (Figure 6, Table

11B). The rate of chlamydia among African

Americans was over eight times higher than

that of whites (1,275.0 and 153.1 cases per

100,000, respectively). The rates among

American Indian/Alaska Natives (797.3)

and Hispanics (477.0) were also higher

8 Chlamydia National Profile STD Surveillance 2006
than that of whites (5.2 and 3.1 times

higher, respectively). In 2006, the

chlamydia case rate per 100,000

population among Asian/Pacific Islanders

was 132.1, a decrease of 11.0% from the

2005 rate (148.4).

Chlamydia by Sex

In 2006, the overall rate of reported

chlamydial infection among women in the

United States (515.8 cases per 100,000

females) was almost three times as high as

the rate among men (173.0 cases per

100,000 males), likely reflecting a greater

number of women screened for this

infection (Figure 1, Tables 4 and 5). The

lower rates among men also suggest that

many of the sex partners of women with

chlamydia are not being diagnosed or

reported as having chlamydia. However,

with the advent of highly sensitive nucleic

acid amplification tests that can be

performed on urine, symptomatic and

asymptomatic men are increasingly being

diagnosed with chlamydial infection. From

2002 through 2006, the chlamydial

infection rate in men increased by 36.4%

(from 126.8 to 173.0 cases per 100,000

males) compared with a 15.9% increase in

women during the same period (from

445.0 to 515.8 cases per 100,000 females).

Chlamydia by Age and Sex

Among women, the highest age-specific

rates of reported chlamydia in 2006 were

among those 15 to 19 years of age

(2,862.7 cases per 100,000 females) and

20 to 24 years of age (2,797.0 cases per

100,000 females) (Figure 7, Table 10).

These increased rates in women may, in

part, reflect increased screening in this

group. Age-specific rates among men, while

substantially lower than the rates among

women, were highest in the 20- to

24-year-old age group (856.9 cases per

100,000 males) (Figure 7, Table 10).

Chlamydia Screening and Prevalence

Monitoring Project

Chlamydia screening and prevalence

monitoring activities were initiated in

Health and Human Services (HHS) Region

X (Alaska, Idaho, Oregon, Washington) in

1988 as a CDC-supported demonstration

project. In 1993, chlamydia screening

services for women were expanded to three

additional HHS regions (III, VII, and VIII)

and, in 1995, to the remaining HHS

regions (I, II, IV, V, VI, and IX). In some

regions, federally-funded chlamydia

screening supplements local-and

state-funded screening programs. Screening

criteria and practices vary by region and

state.

In 2006, the median state-specific

chlamydia test positivity among 15- to

24-year-old women who were screened

during visits to selected family planning

clinics in all states and outlying areas was

6.7% (range 2.8% to 16.9%) (Figures 8

and 9). See Appendix (Chlamydia,

Gonorrhea, and Syphilis Prevalence

Monitoring) for details.

To examine trends in regional chlamydia

positivity, rates are adjusted to account for

changes in laboratory test methods and

associated increases in test sensitivity

(Figure 10, see Appendix).7 Even after

adjustment, chlamydia test positivity has

remained fairly stable in all 10 HHS regions

between 2002 and 2006. Positivity slightly

decreased in three regions from 2005 to

2006, increased in five regions, and

remained the same in two regions.

Chlamydia Among Special

Populations

Additional information on chlamydia

screening programs for women of

reproductive age and chlamydia among

adolescents and minority populations can

be found in the Special Focus Profiles.

STD Surveillance 2006 National Profile Chlamydia 9
Chlamydia Summary

Both prevalence and reported cases of

genital Chlamydia trachomatis infections

remain high across age groups,

race/ethnicity groups, geographic locales,

and both sexes. The burden of chlamydia

appears higher among women, especially

those of younger age (15 to19 and 20 to 24

years of age), but this may be a reflection of

which persons are screened. Racial

differences also persist; case rates among

African Americans continue to be

substantially higher than rates among other

race/ethnicity groups.

10 Chlamydia National Profile STD Surveillance 2006

1 Datta SD, Sternberg M, Johnson RE, Berman S,

Papp JR, McQuillan G, Weinstock H.

Gonorrhea and chlamydia in the United States

among persons 14 to 39 years of age, 1999 to

2002. Ann Intern Med 2007;147(2):89-96.

2 Miller WC, Ford CA, Morris M, Handcock MD,

Schmitz JL, Hobbs MM, Cohen MS, Mullan

Harris K, Udry JR. Prevalence of chlamydial

and gonococcal infections among young adults

in the United States. JAMA 2004;291(18):

2229-36.

3 Scholes D, Stergachis A, Heidrich FE, Andrilla

H, Holmes KK, Stamm WE. Prevention of pelvic

inflammatory disease by screening for cervical

chlamydial infection. N Engl J Med

1996;34(21):1362-66.

4 Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.RR-11):38.

5 National Committee for Quality Assurance

(NCQA). HEDIS 2000: Technical Specifications,

Washington, DC, 1999, pp. 68-70, 285-286.

6 Dicker LW, Mosure DJ, Levine WC. Chlamydia

positivity versus prevalence: what’s the

difference? Sexually Transmitted Diseases

1998;25:251-3.

7 Dicker LW, Mosure DJ, Levine WC, et al.

Impact of switching laboratory tests on reported

trends in Chlamydia trachomatis infections. Am

J Epidemiol 2000;51:430-5.
STD Surveillance 2006 National Profile Chlamydia 11

Rate (per 100,000 population)

Men

Women

Total

0

120

240

360

480

600

1987 89 91 93 95 97 99 2001 03 05

Figure 1. Chlamydia — Rates: Total and by sex: United States, 1987–2006

Note: As of January 2000, all 50 states and the District of Columbia had regulations requiring the

reporting of chlamydia cases.

Rate (per 100,000 population)

West

Midwest

Northeast

South

0

80

160

240

320

400

1997 98 99 2000 01 02 03 04 05 06

Figure 2. Chlamydia — Rates by region: United States, 1997–2006
12 Chlamydia National Profile STD Surveillance 2006

Rate per 100,000

population

Guam 494

Puerto Rico 130

Virgin Is. 187

<=150

150.1-300

>300

(n= 1)

(n= 21)

(n= 32)

VT 191

NH 152

MA 241

RI 292

CT 312

NJ 232

DE 429

MD 390

DC 612

503

682

406 297

376 350

275

430

435

234

420 317

283

285 214

395

175

363

252

651

396

283

309 348

510

357

387

286

350

366

263

318

525

339

425

331

206

318

283

160

365

279

Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2006

Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 345.0 per 100,000 population. For further information on chlamydia

reporting, see Appendix (Chlamydia Morbidity Reporting).

Rate per 100,000

population

<=150.0 (n= 1,296)

150.1-300.0 (n= 1,002)

>300.0 (n= 842)

Figure 4. Chlamydia — Rates by county: United States, 2006
STD Surveillance 2006 National Profile Chlamydia 13

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0

150

300

450

600

750

1997 98 99 2000 01 02 03 04 05 06

Figure 5. Chlamydia — Cases by reporting source and sex: United States, 1997–2006

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

340

680

1020

1360

1700

1997 98 99 2000 01 02 03 04 05 06

Figure 6. Chlamydia — Rates by race/ethnicity: United States, 1997–2006
14 Chlamydia National Profile STD Surveillance 2006

Men Rate (per 100,000 population) Women

3000 2400 1800 1200 600 0 0 600 1200 1800 2400 3000 Age

11.6 121.5 10-14

545.1 15-19 2862.7

856.9 20-24 2797.0

480.8 1141.2 25-29

222.2 415.7 30-34

120.8 174.2 35-39

65.1 69.0 40-44

27.8 25.6 45-54

9.1 6.8 55-64

2.8 2.2 65+

173.4 517.0 Total

Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2006

Median state-specific positivity rate

0

2

4

6

8

10

1997 98 99 2000 01 02 03 04 05 06

Figure 8. Chlamydia — Median state-specific positivity among 15- to 24-year-old women

tested in family planning clinics: United States, 1997–2006

Note: As of 1997, all 10 Health and Human Services (HHS) regions, representing all 50 states,

the District of Columbia, and outlying areas, reported chlamydia positivity data. See

Appendix for definitions of HHS regions.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs;

Centers for Disease Control and Prevention
STD Surveillance 2006 National Profile Chlamydia 15

Positivity (%)

Puerto Rico 6.4

Virgin Is. 16.9

<5.0

5.0-9.9

>=10.0

(n= 8)

(n= 38)

(n= 7)

VT 3.9

NH 4.1

MA 4.7

RI 6.7

CT 5.7

NJ 7.5

DE 7.7

MD 5.7

DC 7.2

14.5

5.8

7.3 6.2

6.4 6.7

5.5

10.3

8.6

6.4

7.1 7.9

6.2

6.1 5.6

8.1

4.4

7.9

6.7

14.0

7.1

6.0

5.9 5.0

9.7

4.6

7.8

8.2

7.8

7.2

4.6

4.9

11.5

6.9

6.5

10.3

11.3

7.8

6.5

2.8

7.6

6.3

Figure 9. Chlamydia — Positivity among 15- to 24-year-old women tested in family planning

clinics by state: United States and outlying areas, 2006

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500

women aged 15-24 years screened during 2006.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Region I

Region I

Region II

Region II

Region III

Region III

Region IV

Region IV

Region V

Region V

Region VI

Region VI

Region VII

Region VII

Region VIII

Region VIII

Region IX

ion IX

Region X

Region X

6.1

02

5.5

03

5.4

04

5.5

05

5.5

06

9.1

02

10.2

03

9.7

04

7.8

05

7.5

06

6.8

02

6.9

03

7.5

04

7.4

05

6.7

06

10.1

02

9.6

03

10.9

04

11.0

05

11.0

06

8.2

02

8.7

03

8.8

04

9.0

05

9.2

06

11.8

02

11.7

03

11.7

04

11.5

05

11.3

06

6.5

02

6.5

03

6.8

04

6.8

05

7.6

06

7.4

02

7.3

03

7.6

04

7.4

05

8.4

06

8.0

02

8.5

03

8.5

04

8.1

05

8.6

06

6.7

02

7.5

03

7.7

04

7.4

05

7.5

06

IV

VII IX

I II

X

III

VI

V

VIII

Figure 10. Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family

planning clinics by HHS region, 2002–2006

Note: Trends adjusted for changes in laboratory test method and associated increases in test

sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for

more information. See Appendix for definitions of Health and Human Services (HHS) regions.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Gonorrhea

Background

Gonorrhea is the second most

commonly-reported notifiable disease in

the United States. Infections due to

Neisseria gonorrhoeae, like those resulting

from Chlamydia trachomatis, are a major

cause of PID in the United States. PID can

lead to serious outcomes in women such as

tubal infertility, ectopic pregnancy, and

chronic pelvic pain. In addition,

epidemiologic and biologic studies provide

strong evidence that gonococcal infections

facilitate the transmission of HIV infection.1

From 1975 through 1997, the national

gonorrhea rate declined 74% following

implementation of the national gonorrhea

control program in the mid-1970s (Table 1).

Gonorrhea rates subsequently appeared to

plateau for several years. However, rates

increased for the second consecutive year,

with 358,366 cases of gonorrhea reported

in the United States in 2006 (Figure 11 and

Table 1).

Increases in gonorrhea rates in 8 western

states from 2000 to 2005 have been

described among a wide variety of

populations in the affected states.2 Increases

in quinolone-resistant Neisseria

gonorrhoeae (QRNG) in 2006 led to

changes in national guidelines that now

limit the recommended treatment of

gonorrhea to a single class of drug, the

cephalosporins.3 The combination of

increases in gonorrhea morbidity with

increases in resistance and decreased

treatment options have increased the need

for better understanding of the

epidemiology of gonorrhea.

Although gonorrhea case reporting is useful

for monitoring trends in gonorrhea, true

increases or decreases in disease may be

masked by changes in screening practices

(affected by concomitant testing for

chlamydia and broader use of urine-based

testing), use of diagnostic tests with differing

test performance, and changes in reporting

practices.4

For most areas, the number of gonorrhea

cases reported to CDC is affected by many

factors, in addition to the occurrence of the

infection within the population. As with

reporting of other STDs, reporting of

gonorrhea cases to CDC is incomplete.5 For

these reasons, supplemental data on

gonorrhea prevalence in persons screened

in a variety of different settings are useful in

assessing disease burden in selected

populations.

Gonorrhea – United States

In 2006, 358,366 cases of gonorrhea were

reported in the United States. The rate of

reported gonorrhea in the United States

was 120.9 cases per 100,000 population in

2006 (Figure 11 and Table 1), an increase

of 5.5% since 2005. Gonorrhea rates

increased in 2006 for the second

consecutive year.

Gonorrhea by Region

As in previous years, in 2006 the South had

the highest gonorrhea rate among the four

regions of the country. Although the

gonorrhea rate in the South declined for

many years, in 2006 it rose by 12.3% from

2005 to a rate of 159.2 cases per 100,000

population. The rate in the West continued

STD Surveillance 2006 National Profile Gonorrhea 17
to increase, with an increase of 31.8% from

2002 to 2006. In contrast, the rate in the

Northeast decreased by 21.2% from 93.6

cases per 100,000 population in 2002 to

73.8 in 2006. The rate in the Midwest

(142.2 in 2002 and 136.9 in 2006) has

shown minimal change (Figure 13 and

Table 13).

An evaluation of increases in gonorrhea in

eight western states suggested that increases

were likely due to a variety of factors such

as changes in testing practices (increased

volume and use of more sensitive tests) as

well real increases in disease.2

Gonorrhea by State

In 2006, only four states and Puerto Rico

had gonorrhea rates below the HP2010

national target of 19 cases per 100,000

population (Figure 14 and Tables 12 &

13).6 Unfortunately this is two fewer states

than met the HP2010 target in 2005.

Gonorrhea by Metropolitan Statistical

Area (MSA)

The overall gonorrhea rate in the 50 most

populous MSAs was 131.1 cases per

100,000 population in 2006. This is a 3.3%

increase from 2005. All of these MSAs had

rates higher than the HP2010 target of 19

cases per 100,000 population (Table 17). In

2006, 58.3% of gonorrhea cases were

reported by these MSAs. Similar to

previous years, in 2006 the total gonorrhea

rate among females in these MSAs (130.1)

remained similar to that among males

(131.6) (Tables 18 and 19).

Gonorrhea by County

In 2006, 1,234 (39.3%) of 3,140 counties

in the United States had gonorrhea rates at

or below the HP2010 national target of 19

cases per 100,000 population. Rates per

100,000 population were between 19 and

100 in 1,134 counties (36.1%), and greater

than 100 in 772 counties (24.6%). The

majority of counties with greater than 100

cases per 100,000 population were located

in the South (Figure 15).

In 2006, 50% of reported gonorrhea cases

occurred in just 68 counties or independent

cities (Table 16).

Gonorrhea by Reporting Source

In 2006, 26.8% of gonorrhea cases were

reported by STD clinics (Table A2). This is

a change from 2002, when 35.2% of

gonorrhea cases were reported by STD

clinics. In 2006, a higher proportion of

male gonorrhea cases were reported from

STD clinics than female cases (37.9% and

16.7% respectively) (Figure 16).

Gonorrhea by Race/Ethnicity

Changes in gonorrhea rates between 2002

and 2006 differed by race/ethnic group.

Gonorrhea rates decreased by 7.7% during

this time period for African Americans from

713.7 to 658.4 cases per 100,000

population. However, the gonorrhea rate

among African Americans increased by

6.3% between 2005 and 2006, the first

increase for this population since 1998.

Other racial and ethnic groups have also

seen increases in gonorrhea rates. Since

2002, the gonorrhea rate among American

Indian/Alaska Natives increased 22.8%,

whites increased 17.7%, and Hispanics

increased 11.8%. The gonorrhea rate

among Asian/Pacific Islanders decreased

1.4% between 2002 and 2006(Figure 17

and Table 21B).

In 2006, the gonorrhea rate among African

Americans was 18 times greater than the

rate for whites. This is a decrease from

2002 when there was a 23-fold difference

in rates. Gonorrhea rates were 3.8 times

greater among American Indian/Alaska

Natives, and 2.1 times greater among

Hispanics than among whites in 2006.

Rates among Asian/Pacific Islanders were

18 Gonorrhea National Profile STD Surveillance 2006
1.7 times lower than among whites in

2006.

Gonorrhea by Sex

Prior to 1996, rates of gonorrhea among

men were higher than rates among women.

For the sixth consecutive year, however,

gonorrhea rates among women are slightly

higher than among men (Figure 12). In

2006, the gonorrhea rate among women

was 124.3 and the rate among men was

116.8 cases per 100,000 population (Tables

14 and 15).

Gonorrhea by Region and Sex

Between 2002 and 2006, gonorrhea rates

among women increased 39.3% in the

West and 1.3% in the South. Gonorrhea

rates among women decreased 22.0% in

the Northeast and were unchanged in the

Midwest during the same time period.

Between 2002 and 2006, gonorrhea rates

among men increased 25.7% in the West,

and decreased 20.1% in the Northeast,

8.1% in the Midwest, and 4.8% in the

South (Tables 14 and 15).

Gonorrhea by Age and Sex

In 2006, gonorrhea rates continued to be

highest among adolescents and young

adults. The overall gonorrhea rate was

highest for the 20- to 24-year-old age group

(527.5), which is over four times higher

than the national gonorrhea rate. Among

females in 2006, 15- to 19- and 20- to

24-year-old women had the highest rates of

gonorrhea (647.9 and 605.7, respectively);

20- to 24-year-old males had the highest

rate (454.1) (Figure 18 and Table 20).

Although the gonorrhea rate among those

15 to 19 years of age decreased in recent

years, in 2006 this rate increased 6.3%.

Similar slight increases were seen among

other younger age groups (4.4% among

those 20 to 24 years of age and 8.1%

among those 25 to 29 years of age) (Table

20). Similar increases were seen among

both males and females in all age groups

29 years of age and younger (8.4% for

males and 5.3% for females ages 15 to 19

years of age; 4.5% and 4.4% for males and

females aged 20 to 24 years of age,

respectively; and 7.6% for males and 8.8%

for females aged 25 to 29 years of age)

(Figures 19 and 20, and Table 20).

Gonorrhea by Race/Ethnicity and Sex

From 2002 to 2006 the overall rate in

African-American men decreased 8.8%

from 770.7 per 100,000 population to

702.7 despite an increase of 6.8% between

2005 and 2006. Increases were seen in this

time period for African-American men in

most age groups. The overall rate in

American Indian/Alaska Native men

increased 8.5% between 2005 and 2006,

7.4% among Hispanic men, and 2.5%

among white men. Gonorrhea rates among

Asian/Pacific Islander men decreased

24.0% between 2005 and 2006 (Table

21B).

Between 2002 and 2006 the overall rate

among African-American women decreased

6.6% from 662.1 per 100,000 population

to 618.1. However, increases of 5.8% were

seen between 2005 and 2006 overall for

African-American women and in most age

groups. Currently, 15- to 19-year-old

African-American women still have the

highest gonorrhea rate of any group

(2,898.1 per 100,000 population).

Rates among Hispanic women increased

6.5% between 2005 and 2006, 4.7%

among white women, and 3.5% among

American Indian/Alaska Native women. A

decrease of 8.1% was seen among

Asian/Pacific Island women (Table 21B).

Gonorrhea Prevalence Monitoring

Projects

Gonorrhea test positivity data are available

from a variety of settings. Screening criteria

STD Surveillance 2006 National Profile Gonorrhea 19
and practices may vary by state and over

time.

Family Planning Clinics

In 2006, the median state-specific

gonorrhea test positivity among 15- to

24-year-old women screened in selected

family planning clinics in 43 states, Puerto

Rico, the District of Columbia, and the

Virgin Islands was 1.1% (range 0.0% to

4.8%) (Figure 21). Median gonorrhea

positivity in family planning clinics has

shown minimal change in recent years

(0.9% in 2002).

Prenatal Clinics

For women attending selected prenatal

clinics in 20 states, Puerto Rico, and the

Virgin Islands, the median positivity was

1.0% (range 0.0% to 3.2%) (Figure F).

Median gonorrhea positivity in prenatal

clinics has shown minimal change in recent

years (0.9% in 2002).

National Job Training Program

For 16- to 24-year-old women entering the

National Job Training Program in 36 states,

Puerto Rico, and the District of Columbia in

2006, the median state-specific gonorrhea

prevalence was 2.4% (range 0.0% to 7.1%)

in 2006 (Figure M). Among men entering

the program from 20 states in 2006, the

median state-specific gonorrhea positivity

was 3.6% (range 0.0% to 6.2%) (Figure N).

Juvenile Corrections

In 2006, the median positivity for

gonorrhea in women entering 37 juvenile

corrections facilities was 3.8% (range 0.0%

to 12.2%), and in men entering 62 juvenile

corrections facilities was 0.9% (range 0.0%

to 4.5%) (Table CC).

Gonococcal Isolate Surveillance

Project (GISP)

Antimicrobial resistance remains an

important consideration in the treatment of

gonorrhea.3,7 , 10, 9 8,11, 12, 13, 14 In 1986, the Gonococcal

Isolate Surveillance Project (GISP), a

national sentinel surveillance system, was

established to monitor trends in

antimicrobial susceptibilities of strains of

Neisseria gonorrhoeae in the United States

among selected STD clinics or sites14

(Figure 22).

Overall, 25.6% of isolates collected in 2006

in 28 GISP sites were resistant to penicillin,

tetracycline, ciprofloxacin, or some

combination of those antibiotics (Figure

23).

Quinolone-resistant N. Gonorrhoeae

(QRNG)

Resistance to ciprofloxacin (a fluoroquinolone

in the quinolone family of antimicrobials) was

first identified in GISP sites in 1991. From

1991 through 1998, fewer than nine

quinolone-resistant N. gonorrhoeae (QRNG)

isolates were identified each year, and such

isolates were identified in only a few GISP

clinics. However since 1999 QRNG

prevalence has steadily increased, first in

Hawaii and in the Pacific Islands, then in the

Western states, and then among MSM.15

In 2006, 843 (13.8% of the total) GISP

isolates were identified as QRNG, an increase

from 2005, when 581 (9.4% of the total)

isolates were identified as QRNG. QRNG

isolates were submitted from 27 of 28 GISP

clinics in 2006 (Figures 22 and 24).

QRNG by Region

In 2006, 34 (35.8%) of 95 isolates

submitted from Honolulu demonstrated

ciprofloxacin-resistance, up from 17

(19.3%) of 88 isolates in 2005.

In California, increases in the number of

isolates resistant to ciprofloxacin were

identified in all GISP sites. In Los Angeles,

20 Gonorrhea National Profile STD Surveillance 2006

3,7-14

8-11,13,15
22.7% of isolates in 2006 were

ciprofloxacin-resistant compared with

14.5% in 2005; in Long Beach, 28.4%

were resistant in 2006 compared with

23.5% in 2005; in Orange County, 34.6%

were resistant in 2006 compared with

27.5% in 2005; in San Diego, 35.1% were

resistant in 2006 compared to 26.2% with

2005; and in San Francisco, 44.5% were

resistant in 2006 compared with 31.3% in

2005.

Similarly in other West Coast sites, Denver,

Las Vegas, Phoenix, Portland, and Seattle

the prevalence of QRNG remains high.

Between 2005 and 2006, in Denver, the

prevalence increased to 15.7% from

10.9%; in Las Vegas, increased to 8.7%

from 5.4%; in Phoenix, to 11.9% from

7.1%; in Portland, to 27.2% from 23.1%;

and in Seattle the prevalence almost tripled

to 31.8% from 11.6%.

In the South, increases in the prevalence of

QRNG continued to be observed in

Atlanta, Dallas, Greensboro, Miami, New

Orleans, and Oklahoma City. Between

2005 and 2006 in Atlanta, QRNG

resistance increased to 5.7% from 3.8%; in

Dallas, the prevalence doubled to 6.1%

from 3.2%; in Greensboro it increased to

1.7% from 0.6%; in Miami it doubled to

19.8% from 9.1%; in New Orleans, the

prevalence of QRNG increased to 10.2%

from 6.3%; and in Oklahoma City, it

increased to 4.3% from 2.3%. In Baltimore,

the prevalence was slightly down to 1.4% in

2006 from 3% in 2005. In Birmingham, the

prevalence remained the same at 1.1%.

In the Midwest and Northeast, increases in

prevalence of QRNG were seen in

Cleveland and Philadelphia. In Cleveland,

the prevalence of isolates that were resistant

to ciprofloxacin increased to 3.1% in 2006

from 2.8% in 2005 and in Philadelphia, the

prevalence more than doubled to 30.3% in

2006 from 14.3% in 2005. There was a

slight decrease in QRNG prevalence in

Chicago to 4.1% in 2006 from 4.7% in

2005; in Cincinnati to 0.7% from 1%; and

in Minneapolis to 5.7% from 8%. The

prevalence remained the same for Detroit

at 0.3%.

Sites that identified ciprofloxacin-resistant

isolates for the first time in GISP in 2006

included Albuquerque and New York City

(which joined GISP in 2006). Tripler Army

Medical Center did not identify any QRNG

isolates in 2006 (Figure 22).

Additional information on antimicrobial

susceptibility data and treatment

recommendations from state and local

health departments may be found in the

2006 GISP report9 or the GISP website:

http://www.cdc.gov/std/GISP

QRNG by Sexual Behavior

The number of QRNG isolates from MSM

has continued to increase in 2006 to 499

(39% of all specimens from MSM) from 387

(29%) isolates in 2005. During the same

time period, the number of these isolates

from heterosexuals almost doubled from

183 (3.8%) to 328 (7%) (Figure 25).

As a result of this continued high

prevalence of QRNG among MSM and

more recently among heterosexuals, in

April 2007, CDC revised the 2006 CDC

STD Treatment Guidelines.

Fluoroquinolones are no longer

recommended for use in the treatment of

gonorrhea and associated conditions such

as pelvic inflammatory disease.12

Other Antimicrobial Susceptibility

Testing

To date, cephalosporin resistance has not

been identified in GISP, and the proportion

of GISP isolates demonstrating decreased

susceptibility to ceftriaxone or cefixime has

remained very low over time. In 2001,

three GISP isolates with decreased

susceptibility to cefixime were also found to

be resistant to penicillin, tetracycline, and

ciprofloxacin; such multi-drug resistance in

STD Surveillance 2006 National Profile Gonorrhea 21
combination with decreased susceptibility

to cefixime had not previously been

identified in the United States.13 In 2004,

two GISP isolates had decreased

susceptibility to cefixime; one of those

isolates demonstrated the same resistance

pattern as the 2001 isolates described

above. In 2005, there were no GISP

isolates that had decreased susceptibility to

ceftriaxone or cefixime; in 2006, one GISP

isolate had decreased susceptibility to

cefixime only.

The proportion of GISP isolates

demonstrating elevated minimum inhibitory

concentrations (MICs) to azithromycin has

been increasing since GISP began

monitoring azithromycin susceptibility in

1992. In 2005, there was a change in the

media used for antimicrobial susceptibility

testing which resulted in an observational

shift of the MIC curve for azithromycin.

Thus, the azithromycin MIC for decreased

susceptibility was changed from > 1.0

μg/ml to > 2.0 μg/ml from 2005 and

thereafter. In 2006, 0.2% (14/6,089)

isolates had azithromycin MIC > 2.0 μg/ml

which is a slight decrease from 0.6%

(35/6,199) isolates from 2005.

Gonorrhea Among Special

Populations

Additional information about gonorrhea in

racial and ethnic minority populations,

adolescents, MSM, and other at risk

populations can be found in the Special

Focus Profiles.

Gonorrhea Summary

In summary, the national gonorrhea rate

increased in 2006 for the second

consecutive year. Gonorrhea rates

increased in all regions of the country

except the Northeast, among most age

groups, and among all race/ethnic groups

except Asian/Pacific Islanders.

Of particular concern are increases noted

for the first time since 1998 among African

Americans, the population with the greatest

burden of disease and experiencing the

greatest disparity as compared to other

race/ethnic groups.

Rates among adolescent and young adults

had been decreasing in recent years, but

2006 data demonstrate increases in these

populations as well.

In addition, 2006 GISP data shows notable

increases in QRNG prevalence, especially

in the Midwest and Northeast; regions

where previously it had been lower. As a

response, modifications were made to the

2006 CDC STD Treatment Guidelines.

3

22 Gonorrhea National Profile STD Surveillance 2006

1 Fleming DT, Wasserheit JN. From

epidemiological synergy to public health policy

and practice: the contribution of other sexually

transmitted diseases to sexual transmission of

HIV infection. Sex Transm Infect, 1999

Feb;75(1):3-17.

2 Centers for Disease Control and Prevention.

Increases in gonorrhea – Eight western states,

2000-2005. MMWR 2007;56:222-225.

3 Centers for Disease Control and Prevention.

Update to CDC’s Sexually Transmitted

Diseases Treatment Guidelines, 2006:

Fluoroquinolones No Longer Recommended for

Treatment of Gonococcal Infections. MMWR,

2007;56: 332-336.

4 Centers for Disease Control and Prevention.

Gonorrhea – United States, 1998. MMWR

2000;49:538-42.
STD Surveillance 2006 National Profile Gonorrhea 23

5 Sexually Transmitted Diseases in America: How

Many Cases and At What Cost? Prepared for

the Kaiser Family Foundation by: American

Social Health Association, December 1998,

ASHA: Research Triangle Park, NC, Kaiser

Family Foundation: Menlo Park, CA 94025.

6 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

7 Fox KK, Whittington W, Levine WC, Moran JS,

Zaidi AA, Nakashima AN. Gonorrhea in the

United States, 1981–1996: demographic and

geographic trends. Sexually Transmitted

Diseases 1998;25(7):386-93.

8 Centers for Disease Control and Prevention.

Fluoroquinolone-resistance in Neisseria

gonorrhoeae, Hawaii, 1999, and decreased

susceptibility to azithromycin in N. gonorrhoeae,

Missouri, 1999. MMWR 2000;49:833-837.

9 Centers for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance 2006

Supplement: Gonococcal Isolate Surveillance

Project (GISP) Annual Report 2006. Atlanta,

GA: U.S. Department of Health and Human

Services (available first quarter 2008).

10Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae – Hawaii and California, 2001

MMWR 2002;51:1041-1044.

11Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae among men who have sex with

men – United States, 2003, and revised

recommendations for gonorrhea treatment,

2004. MMWR 2004;53:335-338.

12Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.RR-11).

13Wang SA, Lee MV, Iverson CJ, Ohye RG,

Whiticar PM, Hale JA, Trees DL, Knapp JS,

Effler PV, Weinstock HS. Multi-drug resistant

Neisseria gonorrhoeae with decreased

susceptibility to cefixime, Hawaii, 2001. CID

2003;37:849-52.

14Schwarcz, S, Zenilman J, Schnell D, et al.

National Surveillance of Antimicrobial

Resistance in Neisseria gonorrhoeae. JAMA

1990;264: 1413-1417.

15Wang SA, Harvey AB, Conner SM, et al.

Antimicrobial Resistance for Neisseria

gonorrhoeae in the United States, 1988 to

2003: The Spread of Fluoroquinolone

Resistance. Annals of Internal Medicine

2007;147:81-89.
24 Gonorrhea National Profile STD Surveillance 2006

Rate (per 100,000 population)

Gonorrhea

2010 Target

0

100

200

300

400

500

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

Figure 11. Gonorrhea — Rates: United States, 1941–2006 and the Healthy People 2010

target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Rate (per 100,000 population)

Male

Female

Total

2010 Target

0

80

160

240

320

400

1987 89 91 93 95 97 99 2001 03 05

Figure 12. Gonorrhea — Rates: Total and by sex: United States, 1987–2006 and the

Healthy People 2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.
STD Surveillance 2006 National Profile Gonorrhea 25

Rate (per 100,000 population)

West

Midwest

Northeast

South

2010 Target

0

60

120

180

240

300

1997 98 99 2000 01 02 03 04 05 06

Figure 13. Gonorrhea — Rates by region: United States 1997–2006 and the Healthy People

2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Rate per 100,000

population

Guam 58.1

Puerto Rico 7.7

Virgin Is. 31.3

<=19.0

19.1-100.0

>100

(n= 5)

(n= 27)

(n= 22)

VT 11.6

NH 13.7

MA 38.0

RI 47.2

CT 74.4

NJ 63.0

DE 176.0

MD 130.8

DC 342.8

234.0

94.9

100.2 154.9

93.4 79.2

134.8

216.8

69.4

14.4

158.2 139.2

66.3

80.5 78.5

240.6

10.4

154.9

64.4

257.1

175.9

20.7

81.5 115.6

89.9

90.7

199.4

24.0

167.4

139.5

40.1

92.2

242.5

47.3

162.6

133.2

36.0

85.6

67.3

52.5

125.1

23.6

Figure 14. Gonorrhea — Rates by state: United States and outlying areas, 2006

Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 119.4 per 100,000 population. The Healthy People 2010 target is 19.0

cases per 100,000 population.
26 Gonorrhea National Profile STD Surveillance 2006

Rate per 100,000

population

<=19.0 (n= 1,234)

19.1-100.0 (n= 1,134)

>100.0 (n= 772)

Figure 15. Gonorrhea — Rates by county: United States, 2006

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0

40

80

120

160

200

1997 98 99 2000 01 02 03 04 05 06

Figure 16. Gonorrhea — Cases by reporting source and sex: United States, 1997–2006
STD Surveillance 2006 National Profile Gonorrhea 27

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

180

360

540

720

900

1997 98 99 2000 01 02 03 04 05 06

Figure 17. Gonorrhea — Rates by race/ethnicity: United States, 1997–2006

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Age

6.3 35.1 10-14

279.1 15-19 647.9

454.1 20-24 605.7

320.9 294.9 25-29

185.7 125.5 30-34

130.8 65.7 35-39

93.5 33.9 40-44

53.0 12.9 45-54

18.4 2.9 55-64

4.2 0.7 65+

117.1 124.6 Total

Figure 18. Gonorrhea — Age- and sex-specific rates: United States, 2006
28 Gonorrhea National Profile STD Surveillance 2006

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

0

200

400

600

800

1,000

1997 98 99 2000 01 02 03 04 05 06

Figure 19. Gonorrhea — Age-specific rates among women 15 to 44 years of age:

United States, 1997–2006

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

0

150

300

450

600

750

1997 98 99 2000 01 02 03 04 05 06

Figure 20. Gonorrhea — Age-specific rates among men 15 to 44 years of age: United

States, 1997–2006
STD Surveillance 2006 National Profile Gonorrhea 29

Positivity (%)

Puerto Rico 0.1

Virgin Is. 1.9

See*

<1.0

1.0-1.9

>=2.0

(n= 7)

(n= 20)

(n= 16)

(n= 10)

VT 0.0

NH 0.3

MA

RI

CT 0.5

NJ 1.2

DE 1.7

MD

DC 2.3

3.9

0.3

0.9 1.8

1.4 0.6

1.3

2.9

0.7

0.3

1.3 1.4

0.7

0.7 0.8

2.1

0.1

2.6

0.6

3.3

1.4

1.7

0.6 0.6

1.3

0.4

1.6

2.0

1.0

0.8

2.2

1.0

2.2

1.0

1.2

0.5

4.8

0.2

Figure 21. Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning

clinics by state: United States and outlying areas, 2006

*States/areas not meeting minimum inclusion criteria.

Note: Includes states and outlying areas that reported positivity data on at least 500 women aged

15-24 years screened during 2006.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

0%

25%

50%

'03 '04 '05 '06

QRNG Prevalence

BHM PHX

LBC

LAX

ORA

SDG

SFO DEN

MIA

ATL

HON

TRP

CHI

NOR

BAL

DTR

MIN

LVG

ALB

NYC

GRB

CIN

CLE

OKC

POR

PHI

DAL

SEA

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Prevalence of ciprofloxacin

resistant Neisseria gonorrhoeae by GISP site, 2003-2006

Note: Not all clinics participated in GISP for the last 4 years. Clinics include: ALB=Albuquerque, NM;

ATL=Atlanta, GA; BAL=Baltimore, MD; BHM=Birmingham, AL; CHI=Chicago, IL;

CIN=Cincinnati, OH; CLE=Cleveland, OH; DAL=Dallas, TX; DEN=Denver, CO; DTR=Detroit,

MI; HON=Honolulu, HI; LAX=Los Angeles, CA; LBC=Long Beach, CA; LVG=Las Vegas, NV;

MIA=Miami, FL; MIN=Minneapolis, MN; GRB=Greensboro, NC; NOR=New Orleans, LA;

NYC=New York City, NY; OKC=Oklahoma City, OK; ORA=Orange County, CA;

PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; SDG=San Diego, CA;

SEA=Seattle, WA; SFO=San Francisco, CA; and TRP=Tripler Army Medical Center, HI.
30 Gonorrhea National Profile STD Surveillance 2006

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

74.4%

1.2%

8.2%

3.4%

2.4%

0.4%

2.5%

7.5%

Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Penicillin, tetracycline, and

ciprofloxacin resistance among GISP isolates, 2006

Note: PenR=penicillinase producing N. gonorrhoeae and chromosomally mediated penicillin-resistant

N. gonorrhoeae; TetR=chromosomally and plasmid mediated tetracycline-resistant N.

gonorrhoeae; QRNG=ciprofloxacin resistant N. gonorrhoeae.

Percent

Resistant

Intermediate resistance

0.0

4.0

8.0

12.0

16.0

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 04 05 06

Figure 24. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance or intermediate resistance to

ciprofloxacin, 1990–2006

Note: Resistant isolates have ciprofloxacin MICs  1 g/ml. Isolates with intermediate resistance

have ciprofloxacin MICs of 0.125 - 0.5 g/ml. Susceptibility to ciprofloxacin was first

measured in GISP in 1990.
STD Surveillance 2006 National Profile Gonorrhea 31

Percent Ciprofloxacin Resistant

Heterosexual men

Men who have sex with men (MSM)

0

8

16

24

32

40

2001 2002 2003 2004 2005 2006

Figure 25. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,

2001–2006

Syphilis

Background

Syphilis, a genital ulcerative disease, causes

significant complications if untreated and

facilitates the transmission of HIV.

Untreated early syphilis in pregnant women

results in perinatal death in up to 40% of

cases and, if acquired during the four years

preceding pregnancy, may lead to infection

of the fetus in 80% of cases.1

The rate of primary and secondary (P&S)

syphilis reported in the United States

decreased during the 1990s; in 2000, the

rate was the lowest since reporting began in

1941 (Figure 26). The low rate of infectious

syphilis and the concentration of the

majority of syphilis cases in a small number

of geographic areas in the United States led

to the development of the CDC's National

Plan to Eliminate Syphilis, which was

announced by Surgeon General David

Satcher in October 1999 and revised in

May 2006.2

Although the rate of P&S syphilis in the

United States declined 89.7% between

1990 and 2000, the rate of P&S syphilis

increased between 2001 and 2006. Overall

increases in rates between 2001 and 2006

were observed primarily among men (from

3.0 cases per 100,000 population to 5.7

cases per 100,000 population). After

persistent declines since 1990, the rate of

P&S syphilis among women increased from

0.8 cases per 100,000 population in 2004

to 0.9 cases per 100,000 population in

2005 to 1.0 case per 100,000 population in

2006.

Syphilis remains an important problem in

the South and in urban areas in other

regions of the country. Increases in cases

among MSM have occurred and have been

characterized by high rates of HIV

co-infection and high-risk sexual

behavior.3,4,5,6,7The estimated proportion of

P&S syphilis cases attributable to MSM

increased from 4% in 2000 to 62% in

2004.8,9 In 2005, CDC requested that all

state health departments report gender of

sex partners for persons with syphilis. In

2006, the first full year for which data are

available, 64% of all P&S syphilis cases

from 30 areas (29 states and Washington,

D.C.) with available information were

among MSM.10

Syphilis - All Stages (P&S, Early

Latent, Late, Late Latent,

Congenital)

Between 2005 and 2006, the number of

cases of early latent syphilis reported to

CDC increased 12.4% (from 8,176 to

9,186), while the number of cases of late

and late latent syphilis increased 9.9%

(from 16,049 to 17,644) (Table 1). The

total number of cases of syphilis (all stages:

P&S, early latent, late, late latent, and

congenital syphilis) reported to CDC

increased 11.0% (from 33,288 to 36,935)

between 2005 and 2006 (Table 1).

P&S Syphilis - United States

In 2006, P&S syphilis cases reported to

CDC increased to 9,756 from 8,724 in

2005, an increase of 11.8%. The rate of

P&S syphilis in the United States in 2006

(3.3 cases per 100,000 population) was

13.8% higher than the rate in 2005 (2.9

cases per 100,000 population), and it is

greater than the HP 2010 target of 0.2 case

per 100,000 population (Figure 27, Table

STD Surveillance 2006 National Profile Syphilis 33

3-7
1).11 Between 2005 and 2006, P&S syphilis

rates in most age groups increased (Table

32).

P&S Syphilis by Region

The South accounted for 47.1% of the P&S

syphilis cases in 2006 and 46.4% in 2005.

Between 2005 and 2006, rates increased

13.2% in the South (from 3.8 to 4.3 cases

per 100,000 population), 13.0% in the

Northeast (from 2.3 to 2.6), and 15.2% in

the West (from 3.3 to 3.8); rates remained

the same in the Midwest (1.8). The 2006

rates in all regions were greater than the HP

2010 target of 0.2 cases per 100,000

population (Figure 28, Table 25).

P&S Syphilis by State

In 2006, P&S syphilis rates in four states

were less than or equal to the HP 2010

target of 0.2 case per 100,000 population

(Figure 29, Table 24). Five states and two

outlying areas reported five or fewer cases

of P&S syphilis in 2006 (Table 24).

P&S Syphilis by Metropolitan

Statistical Area (MSA)

The rate of P&S syphilis in 2006 for the 50

most populous MSAs (4.9) exceeded the

HP 2010 target of 0.2 case per 100,000

population (Table 29).

P&S Syphilis by County

In 2006, 2,360 of 3,140 counties (75.2%)

in the United States reported no cases of

P&S syphilis compared with 2,434 (77.5%)

in 2005. Of 780 counties reporting at least

one case of P&S syphilis in 2006, 7 (0.9%)

had rates at or below the HP2010 target of

0.2 cases per 100,000 population. Rates of

P&S syphilis were above the HP2010 target

for 773 counties in 2006 (Figure 30). These

773 counties (24.6% of the total number of

counties in the United States) accounted for

99.9% of the total P&S syphilis cases

reported in 2006.

In 2006, half of the total number of P&S

syphilis cases were reported from 20

counties and two cities (Table 28).

P&S Syphilis by Reporting Source

Between 1990 and 2006, the proportion of

P&S syphilis cases reported from sources

other than STD clinics increased from

25.6% to 65% (Figure 31, Table A2).

Between 2001 and 2006, the number of

cases among males reported from non-STD

clinic sources increased sharply while the

number from STD clinics remained stable

(Figure 31).

P&S Syphilis by Age

In 2006, the rate of P&S syphilis was

highest in persons in the 25- to 29-year-old

age group (7.8 cases per 100,000

population) (Table 32).

P&S Syphilis by Race/Ethnicity

From 2005 to 2006, the rate of P&S

syphilis increased in all racial and ethnic

groups. The rate increased 5.6% among

non-Hispanic whites (from 1.8 to 1.9),

16.5% among African Americans (from 9.7

to 11.3), 12.5% among Hispanics (from 3.2

to 3.6), 18.2% among Asian/Pacific

Islanders (from 1.1 to 1.3), and 37.5%

among American Indian/Alaska Natives

(from 2.4 to 3.3) (Table 33B).

P&S Syphilis by Sex

The rate of P&S syphilis increased 11.8%

among men (from 5.1 cases to 5.7 cases

per 100,000 men) between 2005 and 2006

(Figure 27, Table 27). During this time, the

rate increased 11.1% among women from

0.9 to 1.0 cases per 100,000 women

(Figure 27, Table 26).

P&S Syphilis by Male-to-Female Rate

Ratio

The male-to-female rate ratio for P&S

syphilis has risen steadily since 1996 when

34 Syphilis National Profile STD Surveillance 2006
it was 1.2 (Figure 33), suggesting an

increase in syphilis among MSM during this

time. In 2006, the rate of syphilis in males

was 5.7 times that in females.

Between 2005 and 2006, the

male-to-female rate ratio for P&S syphilis

increased among whites (from 11.0 to

11.7), African Americans (from 3.5 to 3.7),

Hispanics (from 6.0 to 7.9), Asian/Pacific

Islanders (from 11.0 to 25.0), and

American Indians/Alaska Natives (from 2.1

to 2.5) (Table 33B).

An increase in the male-to-female rate ratio

for P&S syphilis occurred in the District of

Columbia, Puerto Rico, and in 20 of 34

states (59%) that reported at least 25 cases

in 2006.

P&S Syphilis by Race/Ethnicity and

Sex

From 2005 to 2006, the rate among

non-Hispanic white males increased 6.1%

(from 3.3 to 3.5), but remained the same

among non-Hispanic white females (0.3).

The rate increased 18.1% among

African-American males (from 15.5 to 18.3)

and 11.4% among African-American

females (from 4.4 to 4.9). The rate

increased 16.7% among Hispanic males

(from 5.4 to 6.3), but decreased 11.1%

among Hispanic females (from 0.9 to 0.8).

The rate increased 13.6% among

Asian/Pacific Island males (from 2.2 to 2.5),

but decreased among Asian/Pacific Island

females from 0.2 to 0.1. The rate increased

42.4% among American Indian/Alaska

Native males (from 3.3 to 4.7) and 18.8%

among American Indian/Alaska Native

females (from 1.6 to 1.9) (Table 33B).

P&S Syphilis by Race/Ethnicity, Age,

and Sex

In 2006, the rate of P&S syphilis among

African Americans was highest among

women aged 20 to 24 years (14.9) and

among men aged 25 to 29 years (48.8). For

non-Hispanic whites, the rate was highest

among women aged 25 to 29 years (0.8)

and among men aged 35 to 39 years (9.9).

For Hispanics, the rate was highest among

women aged 25 to 29 years (1.9) and

among men aged 35 to 39 years (14.6). For

Asian/Pacific Islanders, the rate was highest

among women aged 30 to 34 years (0.5)

and among men aged 25 to 29 years (6.2).

For American Indian/Alaska Natives, the

rate was highest among women aged 35 to

39 years (6.1) and among men aged 30 to

34 years (12.8) (Table 33B).

Congenital Syphilis - United States

After 14 years of decline in the United

States, the rate of congenital syphilis

increased 3.7% between 2005 and 2006

(from 8.2 to 8.5 cases per 100,000 live

births) (Figure 38, Table 39). In 2006, 349

cases were reported, an increase from 339

in 2005. This small increase in the rate of

congenital syphilis (Figure 38) may relate to

the increase in the rate of P&S syphilis

among women that has occurred in recent

years (Figure 37).

Between 1996 and 2005, the average

yearly percentage decrease in the

congenital syphilis rate was 14.1% (Figure

38). Overall, there has been a 74.2%

decrease in the rate of congenital syphilis

since 1996.

Congenital Syphilis by State

In 2006, 26 states, the District of Columbia,

and one outlying area had rates of

congenital syphilis that exceeded the HP

2010 target of one case per 100,000 live

births (Table 38).

Syphilis Among Special Populations

Additional information about syphilis and

congenital syphilis in racial and ethnic

minority populations, adolescents, MSM,

and other at-risk populations can be found

in the Special Focus Profiles.

STD Surveillance 2006 National Profile Syphilis 35
Syphilis Summary

In recent years, MSM have accounted for

an increasing number of estimated syphilis

cases in the United States9 and now

account for 64% of syphilis in the United

States based on information available from

29 states and Washington, D.C.10 Given the

recent request of CDC for states to collect

and report gender of sex partners, it is

expected that the availability and

completeness of this information will

increase. Despite the majority of U.S.

syphilis cases occurring among MSM,

heterosexual syphilis cases may be an

emerging problem given the recent

increases among women and infants.

36 Syphilis National Profile STD Surveillance 2006

1 Ingraham NR. The value of penicillin alone in

the prevention and treatment of congenital

syphilis. Acta Derm Venereol 1951, 31 (suppl

24):60-88.

2 CDC. The National Plan to Eliminate Syphilis

from the United States. Atlanta, GA: U.S.

Department of Health and Human Services,

May 2006.

3 Centers for Disease Control and Prevention.

Resurgent bacterial sexually transmitted disease

among men who have sex with men – King

County, Washington, 1997–1999. MMWR

1999;48:773-777.

4 Centers for Disease Control and Prevention.

Outbreak of syphilis among men who have sex

with men – Southern California, 2000. MMWR

2001;50(7):117-20.

5 Centers for Disease Control and Prevention.

Primary and secondary syphilis among men

who have sex with men – New York City, 2001.

MMWR 2002;51:853-6.

6 Chen SY, Gibson S, Katz MH, Klausner JD,

Dilley JW, Schwarcz SK, Kellogg TA, McFarland

W. Continuing increases in sexual risk behavior

and sexually transmitted diseases among men

who have sex with men: San Francisco,

California, 1999–2001 [Letter]. Am J Public

Health 2002;92:1387-8.

7 D’Souza G, Lee JH, Paffel JM. Outbreak of

syphilis among men who have sex with men in

Houston, Texas. Sexually Transmitted Diseases

2003;30:872-3.

8 Centers for Disease Control and Prevention.

Primary and secondary syphilis – United States,

2003-2004. MMWR 2006;55:269-73.

9 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 Public

Health 2007;97:1076-1083.

10Beltrami JF, Weinstock H.S. Primary and

secondary syphilis among men who have sex

with men in the United States, 2006. In:

program and abstracts of the 17th Biennial

meeting of the ISSTDR, Seattle, WA, July

29-August 1, 2007 [abstract O-069].

11U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.
STD Surveillance 2006 National Profile Syphilis 37

Cases (in thousands)

P&S

Early Latent

Total Syphilis

0

120

240

360

480

600

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

Figure 26. Syphilis — Reported cases by stage of infection: United States, 1941–2006

Rate (per 100,000 population)

Male

Female

Total

2010 Target

0

5

10

15

20

25

1987 89 91 93 95 97 99 2001 03 05

Figure 27. Primary and secondary syphilis — Rates: Total and by sex: United States,

1987–2006 and the Healthy People 2010 target

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.
38 Syphilis National Profile STD Surveillance 2006

Rate (per 100,000 population)

West

Midwest

Northeast

South

2010 Target

0

2

4

6

8

10

1997 98 99 2000 01 02 03 04 05 06

Figure 28. Primary and secondary syphilis — Rates by region: United States, 1997–2006

and the Healthy People 2010 target

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

Rate per 100,000

population

Guam 1.8

Puerto Rico 3.8

Virgin Is. 0.9

<=0.2

0.21-4.0

>4.0

(n= 4)

(n= 40)

(n= 10)

VT 0.5

NH 1.0

MA 1.9

RI 1.3

CT 1.8

NJ 2.0

DE 2.4

MD 5.4

DC 21.1

7.0

1.7

3.4 2.8

5.1 1.5

4.0

6.4

1.4

0.2

3.4 1.5

0.6

1.0 1.7

7.6

0.7

1.2

0.9

2.9

2.9

0.1

0.4 5.7

4.1

3.8

3.6

0.2

1.6

2.0

0.8

2.1

1.6

1.7

4.2

4.7

0.9

2.5

2.9

0.6

1.2

0.0

Figure 29. Primary and secondary syphilis — Rates by state: United States and outlying

areas, 2006

Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 3.3 per 100,000 population. The Healthy People 2010 target is 0.2 case per

100,000 population.
STD Surveillance 2006 National Profile Syphilis 39

Rate per 100,000

population

<=0.2 (n= 2,367)

0.21-2.2 (n= 377)

>2.2 (n= 396)

Figure 30. Primary and secondary syphilis — Rates by county: United States, 2006

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2006,

2,360 (75.2%) of 3,140 counties in the U.S. reported no cases of P&S syphilis.

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

0.0

1.5

3.0

4.5

6.0

7.5

1997 98 99 2000 01 02 03 04 05 06

Figure 31. Primary and secondary syphilis — Cases by reporting source and sex:

United States, 1997–2006
40 Syphilis National Profile STD Surveillance 2006

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

8

16

24

32

40

1997 98 99 2000 01 02 03 04 05 06

Figure 32. Primary and secondary syphilis — Rates by race/ethnicity: United States,

1997–2006

Male-Female rate ratio

0

2:1

4:1

6:1

8:1

10:1

1997 98 99 2000 01 02 03 04 05 06

Figure 33. Primary and secondary syphilis — Male-to-female rate ratios: United States,

1997–2006
STD Surveillance 2006 National Profile Syphilis 41

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 0 3 6 9 12 15 Age

0.0 0.1 10-14

3.1 2.3 15-19

10.0 20-24 2.9

13.0 25-29 2.5

10.4 1.6 30-34

13.5 35-39 1.5

12.0 40-44 1.3

6.1 0.8 45-54

2.3 0.2 55-64

0.5 0.0 65+

5.7 1.0 Total

Figure 34. Primary and secondary syphilis — Age- and sex-specific rates: United States, 2006

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

0

2

4

6

8

10

1997 98 99 2000 01 02 03 04 05 06

Figure 35. Primary and secondary syphilis — Age-specific rates among women 15 to 44

years of age: United States, 1997–2006
42 Syphilis National Profile STD Surveillance 2006

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

0

3

6

9

12

15

1997 98 99 2000 01 02 03 04 05 06

Figure 36. Primary and secondary syphilis — Age-specific rates among men 15 to 44 years

of age: United States, 1997–2006

CS cases (in thousands) P&S rate (per 100,000 women)

P&S Syphilis

0.0

0.3

0.6

0.9

1.2

1997 98 99 2000 01 02 03 04 05 06

0

1

2

3

4

Figure 37. Congenital syphilis (CS) — Reported cases for infants < 1 year of age and rates

of primary and secondary syphilis among women: United States, 1997–2006
STD Surveillance 2006 National Profile Syphilis 43

Rate (per 100,000 live births)

Congenital Syphilis

2010 Target

0

10

20

30

40

50

1997 98 99 2000 01 02 03 04 05 06

Figure 38. Congenital syphilis — Rates for infants < 1 year of age: United States,

1997–2006 and the Healthy People 2010 target

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births.

Other Sexually Transmitted

Diseases

Chancroid

Since 1987, reported cases of chancroid

declined steadily until 2001 when 38 cases

were reported (Figure 39, Table 1). In 2006,

33 cases of chancroid were reported in the

United States. Only eight states reported

one or more cases of chancroid in 2006

(Table 41). Although the overall decline in

reported chancroid cases most likely reflects

a decline in the incidence of this disease,

these data should be interpreted with

caution since Haemophilus ducreyi, the

causative organism of chancroid, is difficult

to culture and, as a result, this condition

may be substantially under-diagnosed.1,2

Human Papillomavirus

Persistent infection with high risk human

papillomavirus (HR-HPV) can lead to

development of anogenital cancers (i.e.

cervical cancer). In June 2006, a

quadrivalent HPV vaccine was licensed for

use in the United States. The vaccine

provides protection against types 6, 11, 16,

and 18. Types 6 and 11 are associated with

genital warts while types 16 and 18 are

high risk types associated with anogenital

cancers.

Sentinel surveillance for cervical infection

with high-risk human papillomavirus types

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58,

59, 68 was conducted in 29 STD, family

planning and primary care clinics in six

locations (Boston, Baltimore, New Orleans,

Denver, Seattle and Los Angeles) as part of

an effort to estimate national burden of

disease and inform prevention programs

such as vaccine programs in the U.S.3

Testing was performed using a

commercially available test for HR-HPV

DNA (Digene Hybrid Capture 2,

Gaithersburg). Interim results from

2003–2004 document an overall HR-HPV

prevalence of 22.5%. Prevalence in STD

clinics was 28%, 24% in family planning

clinics, and 16% in primary care clinics.

Prevalence by age group was: 14 to 19

years 35%; 20 to 29 years 29%; 30 to 39

years 14%; 40 to 49 years 12%; and 50 to

65 years 6%.

PCR based typing provided estimates of

prevalence for types 16 and 18. Overall

prevalence of HPV 16/18 was 8%.

Prevalence of HPV 16/18 by age group

was: 16% in 14 to 19 year olds; 10% in 20

to 29 year olds; 3% in 30 to 39 year olds;

2% in 40 to 49 year olds and 1% in 50 to

65 year olds.3,4

In 2007, data were published from the

National Health and Nutrition Examination

Survey (NHANES) reporting prevalence of

both HR-HPV and low-risk HPV (LR-HPV,

which is associated with development of

anogenital warts) in the civilian,

non-institutionalized female population of

the U.S., 2003-20045 (Figure 43). The

overall HPV prevalence of high- and lowrisk types was 26.8% (95% confidence

interval [CI], 23.3%-30.9%) among US

females aged 14 to 59 years (n = 1921).

HPV prevalence was 24.5% (95% CI,

19.6%-30.5%) among females aged 14 to

19 years, 44.8% (95% CI, 36.3%-55.3%)

among women aged 20 to 24 years, 27.4%

(95% CI, 21.9%-34.2%) among women

STD Surveillance 2006 National Profile Other Sexually Transmitted Diseases 45
aged 25 to 29 years, 27.5% (95% CI,

20.8%-36.4%) among women aged 30 to

39 years, 25.2% (95% CI, 19.7%-32.2%)

among women aged 40 to 49 years, and

19.6% (95% CI, 14.3%-26.8%) among

women aged 50 to 59 years. HPV vaccine

types 6 and 11 (low-risk types) and 16 and

18 (high-risk types) were detected in 3.4%

of female participants; HPV-6 was detected

in 1.3% (95% CI, 0.8%-2.3%), HPV-11 in

0.1% (95% CI, 0.03%-0.3%), HPV-16 in

1.5% (95% CI, 0.9%-2.6%), and HPV-18

in 0.8% (95% CI, 0.4%-1.5%) of female

participants.

Data from the National Disease and

Therapeutic Index suggest that genital warts

(Figure 41) as measured by initial visits to

physicians' offices, may be increasing.

Pelvic Inflammatory Disease

For data on Pelvic Inflammatory Disease

(PID), see the Special Focus Profile on

Women and Infants.

Other Sexually Transmitted Diseases

Case reporting data for genital herpes

simplex virus (HSV) are not available.

Trend data are limited to estimates of the

initial office visits in physicians’ office

practices for these conditions from the

National Disease and Therapeutic Index

(NDTI) (Figure 40 and Table 42). Despite

reported declines in seroprevalence in HSV

types 1 and 2,6 genital herpes trends as

measured through NDTI suggest possible

recent increases.

Similarly, case reporting data are not

available for trichomoniasis, and trend data

for this infection is also limited to estimates

of initial physician office visits from NDTI

(Figure 42 and Table 42).

46 Other Sexually Transmitted Diseases National Profile STD Surveillance 2006

1 Schulte JM, Martich FA, Schmid GP. Chancroid

in the United States, 1981–1990: Evidence for

underreporting of cases. MMWR 1992;41(no.

SS-3):57-61.

2 Mertz KJ, Trees D, Levine WC, et al. Etiology of

genital ulcers and prevalence of human

immunodeficiency virus coinfection in 10 US

cities. J Infect Dis 1998;178:1795-8.

3 Datta SD, Koutsky L, Douglas J, et al. Sentinel

surveillance for human papillomavirus among

women in the United States, 2003-2004

[Abstract no. MO-306]. In: Program and

abstracts of the 16th Biennial Meeting of the

International Society for Sexually Transmitted

Diseases Research, Amsterdam, The

Netherlands, July 10-13, 2005.

4 Datta SD, Koutsky L, Ratelle S, et al.

Type-Specific High-Risk HPV Prevalence from

the HPV Sentinel Surveillance Project, US,

2003-2005 [Abstract no. P-099]. In Program

and abstracts of the International Human

Papillomavirus Meeting, Prague, Czech

Republic, September 2006.

5 Dunne EF, Unger ER, Sternberg M, McQuillan

G, Swan DC, Patel SS, Markowitz LE.

Prevalence of HPV infection among females in

the United States. JAMA. 2007 Feb

28;297(8):813-9.

6 Xu F, Sternberg MR, Kottiri BJ, McQuillan G,

Lee FK, Nahmias AJ, Berman SM, Markowitz

LE. Trends in Herpes Simplex Virus Type 1 and

Type 2 seroprevalence in the United States.

JAMA 2006 Aug 23/30 (8):964-973.
STD Surveillance 2006 National Profile Other Sexually Transmitted Diseases 47

Cases (in thousands)

0

1

2

3

4

5

1981 83 85 87 89 91 93 95 97 99 2001 03 05

Figure 39. Chancroid — Reported cases: United States, 1981–2006

Visits (in thousands)

0

80

160

240

320

400

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 40. Genital herpes — Initial visits to physicians’ offices: United States, 1966–2006

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

herpes estimates range from 20% to 30%.

SOURCE: National Disease and Therapeutic Index (IMS Health)
48 Other Sexually Transmitted Diseases National Profile STD Surveillance 2006

Visits (in thousands)

0

90

180

270

360

450

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 41. Genital warts — Initial visits to physicians’ offices: United States, 1966–2006

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

warts estimates range from 20% to 40%.

SOURCE: National Disease and Therapeutic Index (IMS Health)

Visits (in thousands)

Trichomoniasis

Other Vaginitis

0

900

1,800

2,700

3,600

4,500

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Figure 42. Trichomoniasis and other vaginal infections in women — Initial visits to

physicians’ offices: United States, 1966–2006

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for

trichomoniasis estimates range from 16% to 30% and for other vaginitis estimates range

from 9% to 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health)
STD Surveillance 2006 National Profile Other Sexually Transmitted Diseases 49

Prevalence

Low Risk HPV

High Risk HPV

0

5

10

15

20

25

30

35

40

45

14-19 20-24 25-29 30-39 40-49 50-59

Figure 43. Prevalence of high-risk and low-risk human papillomavirus types among

females aged 14 to 59 years, 2003-2004

Note: Error bars indicate 95% confidence intervals. Both high-risk and low-risk HPV types were

detected in some females.

SOURCE: National Health and Nutrition Examination Survey

JAMA, 2007, 297;813-19 Copyright © 2007, American Medical Association. All Rights reserved.

SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
Special Focus Profiles

The Special Focus Profiles highlight trends

and distribution of STDs in populations of

particular interest for STD and HIV prevention

programs in state and local health

departments. These populations are most

vulnerable to STDs and their consequences:

women and infants, adolescents and young

adults, minorities, MSM, and persons

entering corrections facilities. The Special

Focus Profiles refer to figures located in

disease-specific sections in the National

Profile and additional figures and tables

(Figures A-EE and Tables AA-FF) that

highlight specific points made in the text.

STD Surveillance 2006 Special Focus Profiles 51

STDs in Women and Infants

Public Health Impact

Women and infants disproportionately bear

the long term consequences of STDs.

Women infected with Neisseria gonorrhoeae

or Chlamydia trachomatis can develop PID,

which, in turn, may lead to reproductive

system morbidity such as ectopic pregnancy

and tubal factor infertility. If not adequately

treated, 20% to 40% of women infected

with chlamydia1 and 10% to 40% of women

infected with gonorrhea2 may develop PID.

Among women with PID, tubal scarring can

cause involuntary infertility in 20%, ectopic

pregnancy in 9%, and chronic pelvic pain in

18%.3 Approximately 70% of chlamydial

infections and 50% of gonococcal infections

in women are asymptomatic.4,5,6 These

infections are detected primarily through

screening programs. The vague symptoms

associated with chlamydial and gonococcal

PID cause 85% of women to delay seeking

medical care, thereby increasing the risk of

infertility and ectopic pregnancy.7 Data from

a randomized controlled trial of chlamydia

screening in a managed care setting suggest

that such screening programs can reduce the

incidence of PID by as much as 60%.8

Human papillomavirus (HPV) infections are

highly prevalent, especially among young

sexually-active women. While the great

majority of HPV infections in women

resolve within one year, they are a major

concern because persistent infection with

specific types are causally related to cervical

cancer; these types also cause Pap smear

abnormalities. Other types cause genital

warts, low grade Pap smear abnormalities

and, rarely, recurrent respiratory

papillomatosis in infants born to infected

mothers.9

Direct Impact on Pregnancy

Gonorrhea and chlamydia can result in

adverse outcomes of pregnancy, including

neonatal ophthalmia and, in the case of

chlamydia, neonatal pneumonia. Although

topical prophylaxis of infants at delivery is

effective for prevention of gonococcal

ophthalmia neonatorum, prevention of

neonatal pneumonia requires prenatal

detection and treatment.

Genital infections with herpes simplex virus

are extremely common, may cause painful

outbreaks, and may have serious

consequences for pregnant women

including potentially fatal neonatal

infections.10

When a woman has a syphilis infection

during pregnancy, she may transmit the

infection to the fetus in utero. This may

result in fetal death or an infant born with

physical and mental developmental

disabilities. Most cases of congenital

syphilis are easily preventable if women

are screened for syphilis and treated early

during prenatal care.11

Observations

Chlamydia – United States

Between 2005 and 2006, the rate of

chlamydial infections in women increased

from 492.2 to 515.8 per 100,000 females

(Figure 1, Table 4). Chlamydia rates

exceed gonorrhea rates among women in

all states (Figures A and B, Tables 4 and

14).

STD Surveillance 2006 Special Focus Profiles STDs in Women and Infants 53

4-6
Chlamydia – Infertility Prevention

Program

Prenatal Clinics - In 2006, the median

state-specific chlamydia test positivity

among 15- to 24-year-old women screened

in selected prenatal clinics in 23 states,

Puerto Rico, and the Virgin Islands was

8.1% (range 3.5% to 16.7%) (Figure E).

Family Planning Clinics - In 2006, the

median state-specific chlamydia test

positivity among 15- to 24-year-old women

who were screened during visits to selected

family planning clinics in all states and

outlying areas was 6.7% (range 2.8% to

16.9%) (Figures 8 and 9).

Gonorrhea – United States

Gonorrhea rates among women were higher

than the overall HP 2010 target of 19.0

cases per 100,000 population12 in 46 states,

Washington D.C., and two outlying areas in

2006 (Figure B, Table 14 ).

Like chlamydia, gonorrhea is often

asymptomatic in women. Gonorrhea

screening, therefore, is an important strategy

for the identification of gonorrhea among

women. Large-scale screening programs for

gonorrhea in women began in the 1970s.

After an initial increase in cases detected

through screening, gonorrhea rates for both

women and men declined steadily

throughout the 1980s and early 1990s, and

then reached a plateau (Figure 11). The

gonorrhea rate for women (124.3 per

100,000 females) increased slightly in 2006

for the second consecutive year (Table 14).

Although the gonorrhea rate in men has

historically been higher than the rate in

women, the gonorrhea rate among women

has been higher than the rate among men

for six consecutive years (Figure 12 and

Tables 14 and 15).

Gonorrhea – Infertility Prevention

Program

Prenatal Clinics - In 2006, the median

state-specific gonorrhea test positivity

among 15- to 24-year-old women

screened in selected prenatal clinics in 20

states, Puerto Rico, and the Virgin Islands

was 1.0% (range 0.0% to 3.2%) (Figure

F). Median gonorrhea positivity in prenatal

clinics has shown minimal change in recent

years.

Family Planning Clinics - In 2006, the

median state-specific gonorrhea test

positivity among 15- to 24-year-old

women screened in selected family

planning clinics in 43 states, Puerto Rico,

the District of Columbia, and the Virgin

Islands was 1.1% (range 0.0%-4.8%)

(Figure 21). Median gonorrhea positivity in

family planning clinics has shown minimal

change in recent years.

Primary and Secondary Syphilis by

State

The HP 2010 target for primary and

secondary (P&S) syphilis is 0.2 cases per

100,000 population. In 2006, 32 states,

the District of Columbia, and two outlying

areas had rates of P&S syphilis for women

that were greater than 0.2 case per

100,000 population (Table 26).

Congenital Syphilis

The HP 2010 target for congenital syphilis

is 1.0 case per 100,000 live births. In

2006, 26 states, the District of Columbia,

and Puerto Rico had rates higher than this

target (Table 38).

Trends in congenital syphilis usually follow

trends in P&S syphilis among women, with

a lag of one to two years (Figure 37). The

congenital syphilis rate peaked in 1991 at

107.3 cases per 100,000 live births, and

declined by 92.4% to 8.2 cases per

100,000 live births in 2005 (Figure 38,

Table 39). The rate of P&S syphilis among

54 STDs in Women and Infants Special Focus Profiles STD Surveillance 2006
women declined 94.8% (from 17.3 to 0.9

cases per 100,000 females) during

1990–2005 (Figure 27).

After 14 years of decline in the United

States, the rate of congenital syphilis

increased 3.7% between 2005 and 2006

(from 8.2 to 8.5 cases per 100,000 live

births) (Figure 38, Table 39).

The 2006 rate of congenital syphilis for the

United States is currently 8.5 times higher

than the HP 2010 target of 1.0 case per

100,000 live births (Table 38).

While most cases of congenital syphilis

occur among infants whose mothers have

had some prenatal care, late or limited

prenatal care has been associated with

congenital syphilis. Failure of health care

providers to adhere to maternal syphilis

screening recommendations also contributes

to the occurrence of congenital syphilis.13

Pelvic Inflammatory Disease

Accurate estimates of pelvic inflammatory

disease (PID) and tubal factor infertility

resulting from gonococcal and chlamydial

infections are difficult to obtain. Definitive

diagnoses of these conditions can be

complex. Hospitalizations for PID have

declined steadily throughout the 1980s and

early 1990s,14,15 but have remained relatively

constant between 1995 and 2005 (Figure

H).

The estimated number of initial visits to

physicians’ offices for PID from the National

Disease and Therapeutic Index (NDTI) has

generally declined from 1993 through

2006 (Figure I and Table 42).

In 2004, an estimated 170,076 cases of

PID were diagnosed in emergency

departments among women 15 to 44

years of age. In 2005 this estimate

decreased to 147,642 (National Hospital

Ambulatory Medical Care Survey, NCHS).

As of the date of publication of this report,

2006 data are not available.

Racial disparities in diagnosed PID have

been observed in both ambulatory and

hospitalized settings. Black women had

rates of disease that were two to three

times those in white women. Because of

the subjective methods by which PID is

diagnosed, racial disparity data should be

interpreted with caution.15

Ectopic Pregnancy

Evidence suggests that health care

practices associated with clinical

management of ectopic pregnancy

changed in the late 1980s and early 1990s.

Before that time, treatment of ectopic

pregnancy usually required admission to a

hospital. Hospitalization statistics were

therefore useful for monitoring trends in

ectopic pregnancy. From 1996 to 2005,

hospitalizations for ectopic pregnancy have

remained generally stable (Figure G). As of

the date of publication of this report, 2006

data are not available. Data suggest that

nearly half of all ectopic pregnancies are

treated on an outpatient basis.16

STD Surveillance 2006 Special Focus Profiles STDs in Women and Infants 55
56 STDs in Women and Infants Special Focus Profiles STD Surveillance 2006

1 Stamm WE, Guinan ME, Johnson C. Effect of

treatment regimens for Neisseria gonorrhoeae

on simultaneous infections with Chlamydia

trachomatis. N Engl J Med 1984;310:545-9.

2 Platt R, Rice PA, McCormack WM. Risk of

acquiring gonorrhea and prevalence of

abnormal adnexal findings among women

recently exposed to gonorrhea. JAMA

1983;250:3205-9.

3 Westrom L, Joesoef R, Reynolds G, et al. Pelvic

inflammatory disease and fertility: a cohort

study of 1,844 women with laparoscopically

verified disease and 657 control women with

normal laparoscopy. Sexually Transmitted

Diseases 1992;9:185-92.

4 Hook EW III, Handsfield HH. Gonococcal

infections in the adult. In: Holmes KK, Mardh

PA, Sparling PF, et al, eds. Sexually

Transmitted Diseases, 2nd edition. New York

City: McGraw-Hill, Inc, 1990:149-65.

5 Stamm WE, Holmes KK. Chlamydia trachomatis

infections in the adult. In: Holmes KK, Mardh

PA, Sparling PF, et al, eds. Sexually

Transmitted Diseases, 2nd edition. New York

City: McGraw-Hill, Inc, 1990:181-93.

6 Zimmerman HL, Potterat JJ, Dukes RL, et al.

Epidemiologic differences between chlamydia

and gonorrhea. Am J Public Health

1990;80:1338-42.

7 Hillis SD, Joesoef R, Marchbanks PA, et al.

Delayed care of pelvic inflammatory disease as

a risk factor for impaired fertility. Am J Obstet

Gynecol 1993;168:1503-9.

8 Scholes D, Stergachis A, Heidrich FE, Andrilla

H, Holmes KK, Stamm WE. Prevention of pelvic

inflammatory disease by screening for cervical

chlamydial infection. N Engl J Med

1996;34(21):1362-6.

9 Division of STD Prevention. Prevention of

Genital HPV Infection and Sequelae: Report of

an External Consultants’ Meeting. National

Center for HIV, STD, and TB Prevention,

Centers for Disease Control and Prevention,

Atlanta, December 1999.

10Handsfield HH, Stone KM, Wasserheit JN.

Prevention agenda for genital herpes. Sexually

Transmitted Diseases 1999;26:228-231.

11Centers for Disease Control. Guidelines for

prevention and control of congenital syphilis.

MMWR 1988;37(No.S-1).

12U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

13Centers for Disease Control and Prevention.

Congenital syphilis – United States, 2002.

MMWR 2004;53:716-9.

14Rolfs RT, Galaid EI, Zaidi AA. Pelvic

inflammatory disease: trends in hospitalization

and office visits, 1979 through 1988. Am J

Obstet Gynecol 1992;166:983-90.

15Sutton MY, Sternberg M, Zaidi A, St. Louis ME,

Markowitz LE. Trends in pelvic inflammatory

disease hospital discharges and ambulatory

visits, United States, 1985-2001. Sexually

Transmitted Diseases 2005;32(12)778-784.

16Centers for Disease Control and Prevention.

Ectopic pregnancy in the United States,

1990–1992. MMWR 1995;44:46-8
STD Surveillance 2006 Special Focus Profiles STDs in Women and Infants 57

Rate per 100,000

population

Guam 837

Puerto Rico 201

Virgin Is. 253

<=300

300.1-500

>500

(n= 8)

(n= 21)

(n= 25)

VT 284

NH 223

MA 339

RI 391

CT 455

NJ 371

DE 607

MD 601

DC 867

764

957

623 466

537 521

425

666

651

342

612 468

409

455 298

615

247

543

358

989

571

412

445 522

761

489

619

386

519

539

360

445

874

493

603

526

281

460

414

238

523

416

Figure A. Chlamydia — Rates among women by state: United States and outlying areas, 2006

Note: The total chlamydial infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 511.7 per 100,000 female population.

Rate per 100,000

population

Guam 59.3

Puerto Rico 7.5

Virgin Is. 40.5

<=19.0

19.1-100.0

>100.0

(n= 5)

(n= 26)

(n= 23)

VT 12.3

NH 14.6

MA 36.8

RI 49.1

CT 81.9

NJ 63.3

DE 191.8

MD 133.4

DC 279.2

255.0

111.1

96.0 154.1

86.7 81.4

137.1

218.1

74.4

15.9

168.3 151.0

78.3

96.1 80.5

241.2

8.0

173.0

70.2

292.9

194.0

26.2

97.3 106.0

102.3

85.4

197.6

27.0

178.8

154.9

33.3

97.2

247.9

55.1

167.8

136.2

30.0

85.5

61.5

52.6

144.8

28.1

Figure B. Gonorrhea — Rates among women by state: United States and outlying areas, 2006

Note: The total gonorrhea infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 122.7 per 100,000 female population.
58 STDs in Women and Infants Special Focus Profiles STD Surveillance 2006

Rate per 100,000

population

Guam 1.2

Puerto Rico 2.3

Virgin Is. 0.0

<=0.2

0.21-4.0

>4.0

(n= 19)

(n= 33)

(n= 2)

VT 0.0

NH 0.0

MA 0.2

RI 0.0

CT 0.1

NJ 0.3

DE 0.9

MD 2.1

DC 2.1

4.9

0.6

1.1 2.5

0.7 0.2

1.1

0.9

0.2

0.3

0.6 0.3

0.4

0.1 0.3

5.3

0.3

0.5

0.2

2.4

0.6

0.0

0.1 2.9

2.2

0.3

1.5

0.0

0.7

1.1

0.0

0.5

0.5

1.3

2.4

2.3

0.2

0.6

0.1

0.1

0.1

0.0

Figure C. Primary and secondary syphilis — Rates among women by state: United States and

outlying areas, 2006

Note: The total rate of P&S syphilis among women in the United States and outlying areas (Guam,

Puerto Rico, and Virgin Islands) was 1.0 per 100,000 female population.

Rate per 100,000

live births

Guam 0.0

Puerto Rico 25.4

Virgin Is. 0.0

<=1.0

1.1-10.0

>10.0

(n= 26)

(n= 16)

(n= 12)

VT 0.0

NH 0.0

MA 0.0

RI 0.0

CT 0.0

NJ 13.0

DE 0.0

MD 25.5

DC 12.6

15.1

0.0

17.1 18.1

12.1 2.9

9.6

6.5

0.0

0.0

8.3 0.0

0.0

2.5 1.8

19.9

0.0

10.0

1.4

0.0

3.9

0.0

0.0 42.6

24.7

6.0

5.0

0.0

0.0

3.9

0.0

0.0

3.5

0.0

7.5

20.7

3.9

2.9

0.0

0.0

0.0

0.0

Figure D. Congenital syphilis — Rates for infants < 1 year of age by state: United States and

outlying areas, 2006

Note: The total rate of congenital syphilis for infants < 1 year of age for the United States and outlying

areas (Guam, Puerto Rico, and Virgin Islands) was 8.5 per 100,000 live births. The Healthy

People 2010 target is 1.0 case per 100,000 live births.
STD Surveillance 2006 Special Focus Profiles STDs in Women and Infants 59

Positivity (%)

Puerto Rico 16.4

Virgin Is. 16.7

See*

<5.0

5.0-9.9

>=10.0

(n= 28)

(n= 4)

(n= 13)

(n= 8)

VT

NH

MA

RI

CT

NJ

DE

MD 3.8

DC

7.4

5.1

11.8 11.6

8.8

8.1 5.6

9.7

14.4

11.7

7.6

5.3

3.5

7.9

6.7

4.6

10.6

13.6

5.5

9.0

3.7 8.7

Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2006

*States/areas not meeting minimum inclusion criteria in prenatal clinics.

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 100

women aged 15 to 24 years during 2006.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Positivity (%)

Puerto Rico 0.3

Virgin Is. 3.1

See*

<1.0

1.0-1.9

>=2.0

(n= 31)

(n= 11)

(n= 7)

(n= 4)

VT

NH

MA

RI

CT

NJ

DE

MD

DC

1.7

0.7

1.7 0.0

0.4

0.4 0.4

2.6

3.2

0.0

0.9

0.8

0.2

1.4

1.0

2.3

0.0

1.0

1.3

1.2

Figure F. Gonorrhea — Positivity in 15- to 24-year-old women tested in prenatal

clinics by state: United States and outlying areas, 2006

*States/areas not meeting minimum inclusion criteria in prenatal clinics.

Note: Includes states and outlying areas that reported gonorrhea positivity data on at least 100

women aged 15 to 24 years during 2006.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention
60 STDs in Women and Infants Special Focus Profiles STD Surveillance 2006

Hospitalizations (in thousands)

0

10

20

30

40

50

1996 97 98 99 2000 01 02 03 04 05

Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age: United

States, 1996–2005

Note: The relative standard error for these estimates is 11.4%. Data only available through 2005.

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)

Hospitalizations (in thousands)

Acute, Unspec.

Chronic

0

15

30

45

60

75

1996 97 98 99 2000 01 02 03 04 05

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years

of age: United States, 1996–2005

Note: The relative standard error for these estimates of the total number of acute unspecified PID

cases ranges from 8% to 11%. The relative standard error for these estimates of the total

number of chronic PID cases ranges from 11% to 18%. Data only available through 2005.

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)
STD Surveillance 2006 Special Focus Profiles STDs in Women and Infants 61

Visits (in thousands)

0

60

120

180

240

300

1997 98 99 2000 01 02 03 04 05 06

Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women

15 to 44 years of age: United States, 1997–2006

Note: The relative standard error for these estimates range from 19% to 30%. See Appendix

(Other Data Sources) and Table 42.

SOURCE: National Disease and Therapeutic Index (IMS Health)

STDs in Adolescents and Young

Adults

Public Health Impact

Compared to older adults, sexually-active

adolescents 10 to 19 years of age and

young adults 20 to 24 years of age are at

higher risk for acquiring STDs for a

combination of behavioral, biological, and

cultural reasons. For some STDs, for

example, Chlamydia trachomatis,

adolescent women may have a

physiologically increased susceptibility to

infection due to increased cervical ectopy.

The higher prevalence of STDs among

adolescents also reflects multiple barriers to

accessing quality STD prevention services,

including lack of insurance or other ability to

pay, lack of transportation, discomfort with

facilities and services designed for adults,

and concerns about confidentiality. Recent

estimates suggest that while representing

25% of the ever sexually active population,

15 to 24 years of age acquire nearly half of

all new STDs.1

Observations

Chlamydia

After adjusting trends in chlamydia positivity

to account for changes in laboratory test

methods and associated increases in test

sensitivity (see Appendix), chlamydia test

positivity in 15- to 19-year-old women

decreased in two of 10 HHS regions

between 2005 and 2006, increased in seven

regions, and remained the same in one

region (Figure J).

Numerous prevalence studies in various

clinic populations have shown that

sexually-active adolescents have high rates

of chlamydial infection.2,3 The Infertility

Prevention Project (IPP) provides routine

screening for detecting chlamydial

infections among women attending family

planning clinics. IPP prevalence data

demonstrate that younger women

consistently have higher positivity than

older women, even when overall

prevalence declines.

Gonorrhea

For the second consecutive year,

gonorrhea rates for persons 15 to 19 and

20 to 24 years of age increased. Between

2005 and 2006, the increase for those 15

to 19 years of age was 6.3%, and for those

20 to 24 years of age was 4.4% (Table 20).

15- to 19-Year-Old Women - As in

previous years, in 2006 15- to 19-year-old

women had the highest rate of gonorrhea

(647.9 per 100,000 population) compared

to any other age/sex group (Figure 19 and

Table 20).

20- to 24-Year-Old Women - In 2006,

as in previous years, 20- to 24-year-old

women had the second highest rate of

gonorrhea (605.7 per 100,000 population)

compared to any other age/sex group.

15- to 19-Year-Old Men - Gonorrhea

rates for 15- to 19-year-old men increased

8.4% from 257.5 per 100,000 population

in 2005 to 279.1 per 100,000 population

in 2006 (Figure 20, Table 20).

20- to 24-Year-Old Men - As in previous

years in 2006, 20- to 24-year old men had

STD Surveillance 2006 Special Focus Profiles STDs in Adolescents and Young Adults 63
the highest rate of gonorrhea (454.1 per

100,000 population).

Primary and Secondary Syphilis

Syphilis rates among 15- to 19- year old

women have increased since 2004 from 1.5

cases per 100,000 population, to 1.9 in

2005 and to 2.3 in 2006. Rates in women

have been the highest each year in the 20 to

24 year age group. In this age group there

were 2.9 cases per 100,000 population in

2006 (Figure 34, Table 32).

In men, rates among those 15 to 19 years of

age have increased since 2002 from 1.3

cases per 100,000 population in 2002 to 2.3

in 2005 and 3.1 in 2006. Rates in men have

been the highest each year in the 35 to 39

year old age group. There were 13.5 cases

per 100,000 population in 2006 (Figure 34,

Table 32).

National Job Training Program

Since 1990, approximately 20,000 female

National Job Training Program entrants

have been screened each year for

chlamydia. This program, administered by

the National Job Training Program at more

than 100 sites throughout the country, is a

job training program for economicallydisadvantaged youth aged 16 to 24 years of

age.

Chlamydial infection is widespread

geographically and highly prevalent among

economically-disadvantaged young women

and men in the National Job Training

Program.4,5,6 Specimens from at least 100

students from each state and outlying area

were tested by a national contract

laboratory.* Among women entering the

program from 40 states, the District of

Columbia, and Puerto Rico in 2006, based

on their place of residence before program

entry, the median state-specific chlamydia

prevalence was 13.1% (range 4.9% to

20.0%) (Figure K). This reflects a substantial

increase from 2005 when the median

state-specific chlamydia prevalence was

9.2%, and it appears due to the use of

more sensitive tests. Among men entering

the program from 48 states, the District of

Columbia, and Puerto Rico in 2006, the

median state-specific chlamydia

prevalence was 7.9% (range 1.8% to

12.4%) (Figure L), which is little change

from the chlamydia prevalence of 8.1% in

2005. There was no change in the test

types used among men.

Data from National Job Training Program

centers that submit gonorrhea specimens

from female students aged 16 to 24 years

to a national contract laboratory indicated

a high prevalence of gonococcal infection

in this population. Specimens from at least

100 students from each state and outlying

areas were tested by the contract

laboratory. Among women entering the

program from 36 states, the District of

Columbia, and Puerto Rico the median

state-specific gonorrhea prevalence was

2.4% (range 0.0% to 7.1%) in 2006

(Figure M). Among men entering the

program from 20 states in 2006, the

median state-specific gonorrhea

prevalence was 3.6% (range 0.0% to

6.2%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women attending

juvenile corrections facilities, data from the

Corrections STD Prevalence Monitoring

Project identified a median chlamydia

positivity of 14.2% (range 2.8% to 29.4%)

(Table AA) and a median gonorrhea

positivity of 3.8% (range 0.0% to 12.2%)

(Table CC). See Special Focus Profiles

(STDs in Persons Entering Corrections

Facilities).

*Laboratory data are provided by the

Center for Disease Detection, San Antonio,

Texas.

64 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2006

4-6
STD Surveillance 2006 Special Focus Profiles STDs in Adolescents and Young Adults 65

1 Weinstock, H, Berman, S, Cates, W, Jr.

Sexually Transmitted Diseases among American

Youth: Incidence and Prevalence Estimates,

2000. Perspect Sex Reprod Health,

2004:36(1):6-10.

2 Centers for Disease Control and Prevention.

Recommendations for the prevention and

management of Chlamydia trachomatis

infections, 1993. MMWR 1993;42(No. RR-12).

3 Lossick J, DeLisle S, Fine D, Mosure DJ, Lee V,

Smith C. Regional program for widespread

screening for Chlamydia trachomatis in family

planning clinics. In: Bowie WR, Caldwell HD,

Jones RP, et al., eds. Chlamydial Infections:

Proceedings of the Seventh International

Symposium of Human Chlamydial Infections,

Cambridge, Cambridge University Press 1990,

pp. 575-9.

4 Mertz KJ, Ransom RL, St. Louis ME, Groseclose

SL, Hadgu A, Levine WC, Hayman C. Decline

in the prevalence of genital chlamydia infection

in young women entering a National Job

Training Program, 1990–1997. Am J Pub

Health 2001;91(8):1287-1290.

5 Joesoef MR, Mosure DJ. Prevalence of

chlamydia in young men in the United States

from newly implemented universal screening in

a National Job Training Program. Sexually

Transmitted Diseases 2006;33(10):636-639.

6 Joesoef MR, Mosure DJ. Prevalence of

chlamydia in young women entering the

National Job Training Program 1998–2004.

Sexually Transmitted Diseases

2006;33(9):571-575.
66 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2006

Region I

Region I

Region II

Region II

Region III

Region III

Region IV

Region IV

Region V

Region V

Region VI

Region VI

Region VII

Region VII

Region VIII

Region VIII

Region IX

ion IX

Region X

Region X

6.5

02

5.9

03

5.7

04

6.3

05

6.4

06

11.7

02

12.9

03

12.5

04

10.0

05

9.7

06

8.3

02

8.3

03

9.1

04

8.9

05

8.0

06

12.2

02

11.8

03

13.0

04

13.1

05

13.5

06

9.4

02

9.9

03

10.1

04

10.5

05

10.8

06

14.4

02

13.9

03

14.1

04

14.3

05

14.3

06

7.5

02

7.3

03

7.9

04

7.9

05

8.7

06

8.4

02

7.8

03

7.8

04

7.7

05

9.0

06

9.0

02

9.5

03

10.0

04

9.4

05

10.4

06

7.6

02

8.7

03

9.0

04

8.5

05

8.6

06

IV

VII IX

I II

X

III

VI

V

VIII

Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women tested in family

planning clinics by HHS region, 2002–2006

Note: Trends adjusted for changes in laboratory test method and associated increases in test

sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for

more information. See Appendix for definitions of Health and Human Services (HHS) regions.

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers

for Disease Control and Prevention

Prevalence (%)

Puerto Rico 10.2

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 11)

(n= 9)

(n= 22)

(n= 11)

VT 4.9

NH

MA 10.0

RI 8.9

CT 12.0

NJ 11.1

DE 11.8

MD 14.7

DC 15.6

17.8

13.1 14.0

10.3

16.4

14.9

13.0

8.7

14.7 14.1

12.4 16.5

19.4

5.3

17.2

18.5

14.6

7.4

14.9

12.4

16.4

6.0

15.8

14.0

8.3

10.2

20.0

13.3

20.0

7.9

12.0

7.5

10.8

Figure K. Chlamydia — Prevalence among 16- to 24-year-old women entering the National Job

Training Program by state of residence: United States and outlying areas, 2006

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2006.
STD Surveillance 2006 Special Focus Profiles STDs in Adolescents and Young Adults 67

Prevalence (%)

Puerto Rico 5.3

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 3)

(n= 34)

(n= 16)

VT 2.5

NH

MA 5.9

RI 8.8

CT 7.8

NJ 9.3

DE 4.5

MD 10.0

DC 8.8

10.9

3.9

5.1 9.6

4.6 1.8

8.0

12.0

11.0

4.0

12.0 11.2

2.4

9.2 9.1

12.4

2.1

11.0

7.6

10.7

9.4

4.2

5.4 6.5

3.5

8.7

10.8

2.4

10.0

6.5

4.3

7.0

10.4

1.8

11.7

10.8

3.3

10.1

3.4

6.0

10.7

Figure L. Chlamydia — Prevalence among 16- to 24-year-old men entering the National Job

Training Program by state of residence: United States and outlying areas, 2006

*Fewer than 100 men residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2006.

Prevalence (%)

Puerto Rico 0.0

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 15)

(n= 15)

(n= 21)

(n= 2)

VT 2.0

NH

MA 0.9

RI 1.4

CT 1.2

NJ 2.1

DE 3.7

MD

DC 3.8

6.6

2.3 0.6

1.9

4.3

3.8

0.0

3.3 3.4

3.6

7.1

1.1

4.6

4.7

3.3

1.8

1.8

1.7

3.3

0.0

4.5

2.6

1.7

1.0

4.9

3.5

3.8

3.7

1.1

2.2

Figure M. Gonorrhea — Prevalence among 16- to 24-year-old women entering the National Job

Training Program by state of residence: United States and outlying areas, 2006

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for gonorrhea by the national contract laboratory in 2006.

Note: Many training centers test female students for gonorrhea using local laboratories; these

results are not available to CDC. For this map, gonorrhea test results for students at centers

submitting specimens to the national contract laboratory were included if the number of

gonorrhea tests submitted was greater than 90% of the number of chlamydia tests submitted.
68 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2006

Prevalence (%)

Puerto Rico

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 33)

(n= 6)

(n= 10)

(n= 4)

VT

NH

MA

RI

CT

NJ

DE

MD 1.6 DC

4.6

4.2

3.0

3.8

6.2

1.5

4.8

5.3

3.4

1.8

2.0

3.0

5.9

1.5

0.9

5.1

0.0

4.0 4.5

Figure N. Gonorrhea — Prevalence among 16- to 24-year-old men entering the National Job

Training Program by state of residence: United States and outlying areas, 2006

*Fewer than 100 men residing in these states/areas and entering the National Job Training Program

were screened for gonorrhea by the national contract laboratory in 2006.

Note: Many training centers test male students for gonorrhea using local laboratories; these results

are not available to CDC. For this map, gonorrhea test results for students at centers submitting

specimens to the national contract laboratory were included if the number of gonorrhea tests

submitted was greater than 90% of the number of chlamydia tests submitted.
STDs in Racial and Ethnic

Minorities

Public Health Impact

Surveillance data show higher rates of

reported STDs among some minority racial

or ethnic groups when compared with rates

among whites. Race and ethnicity in the

United States are risk markers that correlate

with other more fundamental determinants

of health status such as poverty, access to

quality health care, health care seeking

behavior, illicit drug use, and living in

communities with high prevalence of STDs.

Acknowledging the disparity in STD rates by

race or ethnicity is one of the first steps in

empowering affected communities to

organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of

STDs reported to state and local health

departments (see Appendix). In many

areas, reporting from public sources, (for

example, STD clinics) is thought to be more

complete than reporting from private

sources. Since minority populations may

utilize public clinics more than whites,

differences in rates between minorities and

whites may be increased by this reporting

bias. However, prevalence data from

community-based surveys such as the

National Health and Nutrition Exam Survey

(NHANES) and AddHealth confirm the

existence of marked STD disparities.1,2

Completeness of Race/Ethnicity Data

Chlamydia - In 2006, 26.3% of reports on

chlamydia cases were missing race or

ethnicity (Table A1).

Gonorrhea - In 2006, 21.6% of reports

on gonorrhea cases were missing

information on race or ethnicity (ranging

by state from 0.0% to 46.8%).

Syphilis - In 2006, only 4.1% of reports

on syphilis cases were missing information

on race or ethnicity (ranging by state from

0.0% to 33.3%).

To adjust for missing data, cases for which

information is unknown are redistributed

according to the distribution of cases in

which race or ethnicity is known. This

process may exacerbate the reporting bias.

Observations

Chlamydia

All racial and ethnic groups except

Asian/Pacific Islanders reported increases

in chlamydia rates from 2005 to 2006.

From 2002 to 2006, chlamydia rates

increased by 17.2% among African

Americans; 23.7% among American

Indian/Alaska Natives; 12.7% among

Hispanics; and 20.6 among whites (Table

11B). Rates decreased by 5.9% among

Asian/Pacific Islanders.

African Americans - In 2006,

approximately 47% of all chlamydia cases

occurred among African Americans (Table

11A). Overall, the rate of chlamydia

among African Americans in the United

States was more than eight times that

among whites. The rate of chlamydia

among African-American women was

more than seven times higher than the rate

STD Surveillance 2006 Special Focus Profiles STDs in Racial and Ethnic Minorities69
among white women (1,760.9 and 237.0

per 100,000 population, respectively)

(Figure O, Table 11B). The chlamydia rate

among African American men was more

than 11 times higher than that among white

men (741.2 and 66.0 per 100,000

population, respectively).

American Indian/Alaska Natives - In

2006, the chlamydia rate among American

Indian/Alaska Natives was 797.3 cases per

100,000 population, over five times higher

than the rate among whites (153.1).

Asian/Pacific Islanders - In 2006, the

chlamydia rate among Asian/Pacific

Islanders was 132.1 cases per 100,000

population, a decrease from the 2005 rate

of 148.4.

Hispanics - In 2006, the chlamydia rate

among Hispanics was 477.0 cases per

100,000 population, three times higher than

the rate among whites (153.1).

Gonorrhea

All racial and ethnic groups except

Asian/Pacific Islanders saw slight increases in

gonorrhea rates from 2005 to 2006. Despite

this slight increase in 2006, between 2002

and 2006, the gonorrhea rate among

African Americans declined by 7.7% (from

713.7 in 2002 to 658.4 cases per 100,000

population in 2006). During the same five

year period, gonorrhea rates increased by

22.9% among American Indian/Alaska

Natives,17.7% among whites, 11.8%

among Hispanics, and decreased by 1.4%

among Asian/Pacific Islanders (Table 21B).

From 2005 to 2006, gonorrhea rates among

15- to 19-year-old African-American women

and men increased for the second

consecutive year (Figures Q and R).

African Americans - In 2006,

approximately 69% of the total number of

reported cases of gonorrhea occurred

among African Americans (Table 21A). In

2006, the rate of gonorrhea among African

Americans was 658.4 cases per 100,000

population. Overall, the rate of gonorrhea

among African Americans in the United

States was 18 times greater than that

among whites.

In 2006, the gonorrhea rate among

African-American men was 25 times higher

than that among white men; the gonorrhea

rate among African-American women was

14 times higher than that among white

women (Figure P).

In 2006, gonorrhea rates were highest for

African Americans aged 15 to 19 and 20

to 24 years among all racial, ethnic, and

age categories. African-American women

aged 15 to 19 years had a gonorrhea rate

of 2,898.1 cases per 100,000 women. This

rate was 14 times greater than the 2006

rate among white women of similar age

(208.7). African-American men in the 15-

to 19-year-old age category had a 2006

gonorrhea rate of 1,503.8 cases per

100,000 men, which was 39 times higher

than the rate among 15- to 19-year-old

white men of 38.4 per 100,000. Among

those aged 20 to 24 years, the gonorrhea

rate among African Americans was 16

times greater than that among whites

(2,560.7 and 165.0 cases per 100,000

population, respectively) (Table 21B).

American Indian/Alaska Natives - In

2006 the gonorrhea rate among American

Indian/Alaska Natives was 138.3 which

was four times higher than the rate among

whites in 2006 of 36.5 cases per 100,000

population.

Asian/Pacific Islanders - In 2006 the

gonorrhea rate among Asian/Pacific

Islanders was 21.1 cases per 100,000

population which was nearly two times

lower than the rate among whites.

Hispanics - In 2006, the gonorrhea rate

among Hispanics was 77.4 which was two

times higher than the rate among whites.

70 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2006
Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s

occurred primarily among heterosexual and

minority populations.3,4 During the 1990s,

the rate of P&S syphilis declined among all

racial and ethnic groups (Figure 32).

Between 2002 and 2006, the rate of P&S

syphilis increased among all racial and

ethnic groups.

African Americans - Between 2005 and

2006, the rate of P&S syphilis among

African Americans increased 16.5% (from

9.7 to 11.3). In 2006, 43.2% of all cases of

P&S syphilis reported to CDC were among

African Americans and 38.4% of all cases

were among non-Hispanic whites (Table

33A). Compared to whites, the overall 2006

rate for African Americans was 5.9 times

higher (Table 33B). In 2006, the P&S rate

among African-American men was more

than five times higher than that among

white men; the rate among AfricanAmerican women was more than 16 times

higher than that among white women. In

some age groups, particularly 15-19 year

old African-American men, disparities have

increased markedly in recent years as rates

of disease have increased (Figure U).

American Indian/Alaska Natives -

Between 2005 and 2006, the rate of P&S

syphilis among American Indian/Alaska

Natives increased 37.5% (from 2.4 to 3.3).

In 2006, 0.8% of all cases of P&S syphilis

reported to CDC were among American

Indian/Alaska Natives (Table 33A).

Compared to whites, the 2006 rate for

American Indian/Alaska Natives was 1.7

times higher (Table 33B).

Asian/Pacific Islanders - Between 2005

and 2006, the rate of P&S syphilis among

Asian/Pacific Islanders increased 18.2%

(from 1.1 to 1.3). In 2006, 1.8% of all

cases of P&S syphilis reported to CDC

were among Asian/Pacific Islanders (Table

33A). Compared to whites, the 2006 rate

for Asian/Pacific Islanders was 0.7 times

higher (Table 33B).

Hispanics - Between 2005 and 2006, the

rate of P&S syphilis among Hispanics

increased 12.5% (from 3.2 to 3.6). In

2006, 15.8% of all cases of P&S syphilis

reported to CDC were among Hispanics

(Table 33A). Compared to whites, the

2006 rate for Hispanics was 1.9 times

higher (Table 33B).

Congenital Syphilis

In 2006, the rate of congenital syphilis

(based on the mother's race/ethnicity) was

24.2 cases per 100,000 live births among

African Americans and 15.4 cases per

100,000 live births among Hispanics.

These rates are 15.1 and 9.6 times higher,

respectively, than the 2005 rate among

whites (1.6 cases per 100,000 live births)

(Figure V, Table 40).

STD Surveillance 2006 Special Focus Profiles STDs in Racial and Ethnic Minorities71

1 Datta SD, Sternberg M, Johnson RE, Berman S,

Papp JR, McQuillan G, et al. Gonorrhea and

chlamydia in the United States among persons

14 to 39 years of age, 1999 to 2002. Ann Intern

Med 2007; 147(2):89-96.

2 Miller WC, Ford CA, Morris M, Handcock MS,

Schmitz JL, Hobbs MM et al. Prevalence of

chlamydial and gonococcal infections among

young adults in the United States. JAMA 2004;

291(18):2229-2236

3 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P,

Greenspan JR. Epidemiology of syphilis in the

United States, 1941 through 1993. Sexually

Transmitted Diseases 1996;23:16-23.

4 Peterman TA, Heffelfinger JD, Swint EB,

Groseclose SL. The changing epidemiology of

syphilis. Sex Transm Dis 2005;32:S4-S10.
72 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2006

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 0 400 800 1200 1600 2000 Race

317.3 1262.3 AI/AN

59.2 201.2 Asian/PI

741.2 Black 1760.9

211.0 761.3 Hispanic

66.0 237.0 White

173.1 516.4 Total

Figure O. Chlamydia — Rates by race/ethnicity and sex: United States, 2006

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 150 300 450 600 750 Race

99.9 175.6 AI/AN

19.6 22.6 Asian/PI

702.7 Black 618.1

70.1 85.3 Hispanic

28.3 44.4 White

117.1 124.6 Total

Figure P. Gonorrhea — Rates by race/ethnicity and sex: United States, 2006
STD Surveillance 2006 Special Focus Profiles STDs in Racial and Ethnic Minorities 73

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

800

1,600

2,400

3,200

4,000

1997 98 99 2000 01 02 03 04 05 06

Figure Q. Gonorrhea — Rates among 15- to 19-year-old females by race/ethnicity:

United States, 1997–2006

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

500

1,000

1,500

2,000

2,500

1997 98 99 2000 01 02 03 04 05 06

Figure R. Gonorrhea — Rates among 15- to 19-year-old males by race/ethnicity:

United States, 1997–2006
74 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2006

Men Rate (per 100,000 population) Women

20 16 12 8 4 0 0 4 8 12 16 20 Race

4.7 1.9 AI/AN

2.5 0.1 Asian/PI

18.3 Black 4.9

6.3 0.8 Hispanic

3.5 0.3 White

5.7 1.0 Total

Figure S. Primary and secondary syphilis — Rates by race/ethnicity and sex: United

States, 2006

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

10

20

30

40

50

1997 98 99 2000 01 02 03 04 05 06

Figure T. Primary and secondary syphilis — Rates among 15- to 19-year-old females by

race/ethnicity: United States, 1997–2006
STD Surveillance 2006 Special Focus Profiles STDs in Racial and Ethnic Minorities 75

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

3

6

9

12

15

1997 98 99 2000 01 02 03 04 05 06

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old males by

race/ethnicity: United States, 1997–2006

Rate (per 100,000 live births)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic

White

0

25

50

75

100

125

1997 98 99 2000 01 02 03 04 05 06

Figure V. Congenital syphilis — Rates among infants < 1 year of age by mother’s

race/ethnicity: United States, 1997–2006

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births.

Less than 5% of cases had missing maternal race/ethnicity information and were excluded.

STDs in Men Who Have Sex with

Men

Public Health Impact

Data from several U.S. cities and projects,

including syphilis outbreak investigations

and the GISP suggest that an increasing

number of MSM are acquiring STDs.1, 2, 3, 4, 5, 6, 7 Data

also suggest that an increasing number of

MSM engage in sexual behaviors that place

them at risk for STDs and HIV infection.8

Several factors may be contributing to this

change, including the availability of highly

active antiretroviral therapy (HAART) for

HIV infection.9 Because STDs and the

behaviors associated with acquiring them

increase the likelihood of acquiring and

transmitting HIV infection,10 the rise in STDs

among MSM may be associated with an

increase in HIV diagnoses among MSM.11

Observations

Most nationally notifiable STD surveillance

data reported to CDC do not include

information regarding sexual behaviors;

therefore, national trends in STDs among

MSM in the United States are not currently

available. Data from enhanced surveillance

projects are presented in this section to

provide information regarding STDs in

MSM.

Monitoring Trends in Prevalence of

STDs, HIV and Risk Behaviors

among Men Who Have Sex with Men

(MSM Prevalence Monitoring

Project), STD Clinics, 1999-2006

From 1999 through 2006, eight U.S. cities

participating in the MSM Prevalence

Monitoring Project submitted syphilis,

gonorrhea, chlamydia, and HIV test data

to CDC from 120,164 MSM visits to STD

clinics; data from 98,866 MSM visits were

submitted from five public STD clinics

(Denver, New York City, Philadelphia, San

Francisco, and Seattle) and data from

21,298 MSM visits were submitted from

three STD clinics in community-based, gay

men's health clinics (Chicago, the District

of Columbia, and Houston).

Changes in testing technology for

gonorrhea and chlamydia have occurred

in recent years with the advent of nucleic

acid amplification tests (NAATs) which

achieve greater sensitivity than traditional

culture methods.12,13 The MSM Prevalence

Monitoring Project includes data from

culture and non-culture tests collected

during routine care and reflects testing

practices at participating clinics. Tests for

gonorrhea included culture, NAATs, or

nucleic acid hybridization tests (DNA

probes). Tests for chlamydia included

culture, NAATs, DNA probes, or direct

fluorescent antibody tests (DFAs).

Nontreponemal syphilis tests included the

Rapid Plasma Reagin (RPR) test and the

Venereal Disease Research Laboratory

(VDRL).

All statistics were based on data collected

from clinic visits and may reflect multiple

visits by a patient rather than individual

patients. City-specific medians and ranges

were calculated for the proportion of tests

done and for STD and HIV test positivity.

STD Surveillance 2006 Special Focus Profiles STDs in Men Who Have Sex with Men 77

1-7
Gonorrhea

Between 1999 and 2006 the number of

gonorrhea tests for all anatomic sites

combined increased in all eight cities. The

trend in the number of positive gonorrhea

tests for all anatomic sites varied by city. For

all cities, the number of symptomatic

positive gonorrhea tests accounts for the

majority of the overall positive tests (Figure

W).

In 2006, 75% (range: 56-94%) of MSM

were tested for urethral gonorrhea, 40%

(range: 3-61%) were tested for rectal

gonorrhea, and 53% (range: 6-87%) were

tested for pharyngeal gonorrhea.

In 2006, median clinic urethral gonorrhea

positivity in MSM was 10% (range: 8-13%),

median rectal gonorrhea positivity was 7%

(range: 2-13%), and median pharyngeal

gonorrhea positivity was 7% (range:

1-15%).

Chlamydia

In 2006, a median of 75% (range: 58-93%)

of MSM visiting participating STD clinics

were tested for urethral chlamydia,

compared to 65% (range: 58-68%) in 1999.

In 2006, the median urethral chlamydia

positivity was 6% (range: 5-8%).

Syphilis

In 2006, 83% (range: 61-94%) of MSM

visiting participating STD clinics had a

nontreponemal serologic test for syphilis

(RPR or VDRL) performed, compared with

69% (range: 54-93%) in 1999 (Figure X).

Overall, median seroreactivity among MSM

tested for syphilis increased from 4% (range:

4-13%) in 1999 to 10% (range: 6-18%) in

2006.

Syphilis seroreactivity is used to estimate

syphilis prevalence and is correlated with

prevalence of P%S syphilis in this

population.14

HIV Infection

Overall, the percent of MSM tested for HIV

in STD clinics increased between 1999 and

2006. In 2006, a median of 73% (range:

28-85%) of MSM visiting STD clinics that

were not previously known to be

HIV-positive were tested for HIV, while

44% (range: 21-55%) were tested in 1999.

In 2006, median HIV positivity in MSM

was 4% (range: 2-7%) (Figure Y).

In 2006, median HIV prevalence among

MSM, including persons previously known

to be HIV-positive and persons testing

HIV-positive at their current visit, was 12%

(range: 10-16%).

HIV/STDs by Race/Ethnicity

HIV positivity varied by race/ethnicity, but

was highest in African-American MSM.

HIV positivity was 3% (range: 1-4%) in

whites, 10% (range: 3-13%) in African

Americans, and 4% (range: 2-6%) in

Hispanics.

HIV prevalence was 11% (range: 7-16%)

in whites, 21% (range: 15-25%) in African

Americans, and 14% (range: 8-19%) in

Hispanics.

In 2006, urethral gonorrhea positivity was

9% (range: 6-12%) in whites, 14% (range:

9-19) in African Americans, and 7%

(range: 4-21%) in Hispanics. Rectal

gonorrhea positivity was 8% (range:

3-11%) in whites, 10% (range: 2-12%) in

African Americans, and 9% (range:

2-11%) in Hispanics. Pharyngeal

gonorrhea positivity was 8% (range:

1-15%) in whites, 6% (range: 1-12%) in

African Americans, and 7% (range:

1-28%) in Hispanics.

Urethral chlamydia was 5% (range: 3-8%)

in whites; 7% (range: 5-13%) in African

Americans, and 6% (range: 4-8%) in

Hispanics.

Median syphilis seroreactivity was 7%

(range: 6-11%) in whites; 15% (range:

78 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2006
8-26%) in African Americans, and 14%

(range: 7-26%) in Hispanics.

STDs by HIV Status, STD Clinics, 2006

In 2006, urethral gonorrhea positivity was

14% (range: 12-31) in HIV-positive MSM

and 8% (range: 7-12%) in MSM who were

HIV-negative or of unknown HIV status;

rectal gonorrhea positivity was 11% (range:

3-18%) in HIV-positive MSM and 6%

(range: 2-14%) in MSM who were

HIV-negative or of unknown HIV status;

pharyngeal gonorrhea positivity was 6%

(range: 1-19%) in HIV-positive MSM and

7% (range: 1-14%) in MSM who were

HIV-negative or of unknown HIV status.

Median urethral chlamydia positivity was

7% (range: 5-9%) in HIV-positive MSM and

6% (range: 4-8%) in MSM who were

HIV-negative or of unknown HIV status.

Median syphilis seroreactivity was 30%

(range: 17-44%) in HIV-positive MSM and

7% (range: 5-13%) in MSM who were

HIV-negative or of unknown HIV status.

Nationally Notifiable Syphilis

Surveillance Data

P&S syphilis increased in the United States

between 2002 and 2006, with a 54.1%

increase in the number of P&S syphilis cases

among men and a 9.1% decrease in the

number of cases among women (Tables 26

and 27). In 2006, the rate of reported P&S

syphilis among men (5.7 cases per 100,000

males) was 5.7 times greater than the rate

among women (1.0 cases per 100,000

females) (Tables 26 and 27). Trends in the

syphilis male-to-female rate ratio, which are

assumed to reflect, in part, syphilis trends

among MSM,7 have been increasing in the

United States during recent years (Figure

33). The overall male-to-female syphilis rate

ratio has risen steadily from 3.4 in 2002 to

5.7 in 2006 (Figure 33, Tables 26 and 27).

The increase in the male-to-female rate

ratio occurred among all racial and ethnic

groups between 2002 and 2006.

In recent years, MSM have accounted for

an increasing number of estimated syphilis

cases in the United States15 and in 2006

accounted for 64% of P&S syphilis cases

in the United States based on information

reported from 29 states and Washington,

D.C.16

Additional information on syphilis can be

found in the Syphilis section (National

Profile).

Gonococcal Isolate Surveillance

Project (GISP)

The GISP, a collaborative project among

selected STD clinics, was established in

1986 to monitor trends in antimicrobial

susceptibilities of strains of Neisseria

gonorrhoeae in the United States.17,18

GISP also reports the percentage of N.

gonorrhoeae isolates obtained from MSM.

Overall, the proportion of isolates from

MSM in GISP clinics increased steadily

from 4% in 1988 to 21.5% in 2006

(Figure Z). Additional information on GISP

may be found in the Gonorrhea section

(National Profile).

The proportion of isolates coming from

MSM varies geographically with the largest

percentage from the West Coast (Figure

AA).

STD Surveillance 2006 Special Focus Profiles STDs in Men Who Have Sex with Men 79
80 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2006

1 Centers for Disease Control and Prevention.

Gonorrhea among men who have sex with men

– selected sexually transmitted disease clinics,

1993–1996. MMWR 1997;46:889-92.

2 Centers for Disease Control and Prevention.

Resurgent bacterial sexually transmitted disease

among men who have sex with men – King

County, Washington, 1997–1999. MMWR

1999;48:773-7.

3 Centers for Disease Control and Prevention.

Outbreak of syphilis among men who have sex

with men – Southern California, 2000. MMWR

2001;50:117-20.

4 Fox KK, del Rio C, Holmes K, et. al. Gonorrhea

in the HIV era: A reversal in trends among men

who have sex with men. Am J Public Health

2001;91:959-964.

5 Centers for Disease Control and Prevention.

Primary and secondary syphilis among men

who have sex with men – New York City, 2001.

MMWR 2002;51:853-6.

6 Centers for Disease Control and Prevention.

Primary and secondary syphilis – United States,

2003–2004. MMWR 2006;55:269-73.

7 Beltrami JF, Shouse RL, Blake PA. Trends in

infectious diseases and the male to female ratio:

possible clues to changes in behavior among

men who have sex with men. AIDS Educ Prev

2005;17:S49-S59.

8 Stall R, Hays R, Waldo C, Ekstrand M,

McFarland W. The gay ‘90s: a review of

research in the 1990s on sexual behavior and

HIV risk among men who have sex with men.

AIDS 2000;14:S1-S14.

9 Scheer S, Chu PL, Klausner JD, Katz MH,

Schwarcz SK. Effect of highly active

antiretroviral therapy on diagnoses of sexually

transmitted diseases in people with AIDS.

Lancet 2001;357:432-5.

10Fleming DT, Wasserheit JN. From

epidemiologic synergy to public health policy

and practice: the contribution of other sexually

transmitted diseases to sexual transmission of

HIV infection. Sex Transm Infect 1999;75:3-17.

11Centers for Disease Control and Prevention.

HIV/AIDS Surveillance Report, 2003, (Vol. 15).

Atlanta: U.S. Department of Health and Human

Services, Centers for Disease Control and

Prevention; 2004.

12Renault CA, Hall C, Kent CK, Klausner JD. Use

of NAATs for STD diagnosis of GC and CT in

non-FDA-cleared anatomic specimens. MLO

Med Lab Obs 2006; 38(7):10, 12-6, 21-2.

13 Jespersen DJ, Flatten KS, Jones MF, Smith TF.

Prospective comparison of cell cultures and

nucleic acid amplification tests for laboratory

diagnosis of Chlamydia trachomatis Infections. J

Clin Microbiol 2005; 43(10):5324-6.

14Helms DJ, Weinstock HS, et. al. Increases in

syphilis among men who have sex with men

attending STD clinics, 2000-2005. In: program

and abstracts of the 17th Biennial meeting of the

ISSTDR, Seattle, WA, July 29-August 1, 2007

[abstract P-608].

15Heffelfinger 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 Public

Health 2007;97:1076-1083

16Beltrami JF, Weinstock HS. Primary and

secondary syphilis among men who have sex

with men in the United States, 2005. In:

program and abstracts of the 17th Biennial

meeting of the ISSTDR, Seattle, WA, July

29-August 1, 2007 [abstract O-069].

17Schwarcz S, Zenilman J, Schnell D, et. al.

National Surveillance of Antimicrobial

Resistance in Neisseria gonorrhoeae. JAMA

1990; 264(11): 1413-1417.

18Centers for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance 2006

Supplement: Gonococcal Isolate Surveillance

Project (GISP) Annual Report 2006. Atlanta,

GA: U.S. Department of Health and Human

Services (available first quarter 2008).
STD Surveillance 2006 Special Focus Profiles STDs in Men Who Have Sex with Men 81

Total GC tests Positives

CHICAGO

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005 2006

0

50

100

150

200

Total GC tests Positives

HOUSTON

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005 2006

0

50

100

150

200

Total GC tests Positives

PHILADELPHIA

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005 2006

0

50

100

150

200

Total GC tests Positives

SAN FRANCISCO

0

2000

4000

6000

8000

1999 2000 2001 2002 2003 2004 2005 2006

0

300

600

900

1200

Total GC tests Positives

DISTRICT OF COLUMBIA

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006

0

125

250

375

500

Total GC tests Positives

NEW YORK CITY

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006

0

125

250

375

500

Total GC tests Positives

DENVER

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006

0

125

250

375

500

Total GC tests Positives

SEATTLE

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006

0

125

250

375

500

Positive GC tests

Positive GC tests in symptomatic men Total tests

Figure W. MSM Prevalence Monitoring Project — Number of gonorrhea tests and number

of positive tests in men who have sex with men, STD clinics, 1999–2006

Note: The bars represent the number of GC tests at all anatomic sites (pharyngeal, rectal, and

urethral) each year. The scales on the left and right axis differ. The bar graphs use the

scale on the left. The line graphs use the scale on the right.
82 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2006

CHICAGO

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

HOUSTON*

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

PHILADELPHIA

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

SAN FRANCISCO

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

DISTRICT OF COLUMBIA

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

NEW YORK CITY

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

DENVER

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

SEATTLE

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006

Seroreactivity

Titer >= 1:16

Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity among men

who have sex with men, STD clinics, 1999–2006

*Data not reported in 2006.Titer data not reported in 2004 or 2005.

Note: Seroreactivity was based on nontreponemal tests results. All sites used the Rapid Plasma

Reagin (RPR) test, with the exception of San Francisco where the Venereal Disease

Research Laboratory (VDRL) test was used and Seattle where the type of test was

changed from VDRL to RPR in 2004.
STD Surveillance 2006 Special Focus Profiles STDs in Men Who Have Sex with Men 83

Median number of tests Median percent positive*

Positivity Number of tests

0

300

600

900

1200

99 2000 01 02 03 04 05 06

0

1

2

3

4

5

6

Figure Y. MSM Prevalence Monitoring Project — City-specific median number of HIV tests

and positivity among men who have sex with men, STD clinics, 1999–2006

*Excludes persons previously known to be HIV-positive.

Note: The bar graph uses the scale on the left. The line graph uses the scale on the right.

Percent

0

5

10

15

20

25

1988 90 92 94 96 98 2000 02 04 06

Figure Z. Gonococcal Isolate Surveillance Project (GISP) — Percent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex with men

attending STD clinics, 1988–2006
84 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2006

0%

50%

100%

'03 '04 '05 '06

% of Isolates

from MSM

BHM PHX

LBC

LAX

ORA

SDG

SFO DEN

MIA

ATL

HON

TRP

CHI

NOR

BAL

DTR

MIN

LVG

ALB

NYC

GRB

CIN

CLE

OKC

POR

PHI

DAL

SEA

Figure AA. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria

gonorrhoeae isolates obtained from men who have sex with men attending

STD clinics, 2003–2006

Note: Not all clinics participated in GISP for the last 4 years. Clinics include: ALB=Albuquerque,

NM; ATL=Atlanta, GA; BAL=Baltimore, MD; BHM=Birmingham, AL; CHI=Chicago, IL;

CIN=Cincinnati, OH; CLE=Cleveland, OH; DAL=Dallas, TX; DEN=Denver, CO;

DTR=Detroit, MI; HON=Honolulu, HI; LAX=Los Angeles, CA; LBC=Long Beach, CA;

LVG=Las Vegas, NV; MIA=Miami, FL; MIN=Minneapolis, MN; GRB=Greensboro, NC;

NOR=New Orleans, LA; NYC=New York City, NY; OKC=Oklahoma City, OK; ORA=Orange

County, CA; PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; SDG=San

Diego, CA; SEA=Seattle, WA; SFO=San Francisco, CA; and TRP=Tripler Army Medical

Center, HI (does not provide sexual risk behavior data).
STDs in Persons Entering

Corrections Facilities

Public Health Impact

Multiple studies and surveillance projects

have demonstrated a high prevalence of

STDs in persons entering jails and juvenile

corrections facilities.1,2,3,4 The prevalence rates

fro chlamydia and gonorrhea in these

settings are consistently among the highest

observed in any venue. Screening for

chlamydia, gonorrhea, and syphilis at intake

offers an opportunity to identify infections,

prevent complications, and reduce

transmission in the general community. For

example, data from one study in a locale

with high syphilis incidence suggested that

screening and treatment of women inmates

for syphilis may result in reduction of

syphilis in the general community.5 In some

locations, a substantial proportion of all

early syphilis cases are reported from

corrections facilities.4 Collecting positivity

data and analyzing trends in STD

prevalence in the inmate population can

provide a tool for monitoring trends in STD

prevalence in the general community.3-4

Description of Population

In 2006, STD screening data from

corrections facilities were reported from 34

states for chlamydia, 30 states for

gonorrhea, and 16 states for syphilis. These

data were reported in response to CDC's

request for data, as part of the Corrections

STD Prevalence Monitoring Project and/or

the Infertility Prevention Project (IPP). IPP

provided CDC with line-listed data for

chlamydia and gonorrhea.

The figures and tables shown in this

section represent 48,445 chlamydia tests in

women and 124,201 in men; 39,688

gonorrhea tests in women and 106,088 in

men; and 36,445 syphilis serologic tests in

women and 155,054 in men entering

corrections facilities during 2006.

Chlamydia

Overall, positivity was higher in women

than in men for almost all age groups.

Adolescent Men - In adolescent men

entering 83 juvenile corrections facilities,

median chlamydia positivity by facility was

5.3% (range: 0.5% to 46.7%) (Table AA).

In men 12 to 18 years of age entering

these juvenile corrections facilities, the

overall chlamydia positivity was 6.4%

(Figure BB). Chlamydia positivity

increased from 0.4% for adolescent men

aged 12 years to 9.5% for those aged 18

years.

Adolescent Women - In adolescent

women entering 57 juvenile corrections

facilities, median chlamydia positivity by

facility was 14.2% (range: 2.8% to 29.4%);

positivity was greater than 10% in almost

all facilities reporting data (Table AA). In

women 12 to 18 years of age entering

these juvenile corrections facilities, the

overall chlamydia positivity was 14.3%

(Figure BB). Positivity in women increased

from 6.6% for those aged 12 years to

15.6% for those aged 16 years and, then,

declined to 11.8% for those aged 18 years.

STD Surveillance 2006 Special Focus Profiles STDs in Persons Entering Corrections Facilities 85

1-4
Men - In men entering 59 adult corrections

facilities, the median chlamydia positivity

by facility was 8.8% (range 0.9% to 26.7%)

(Table BB). Positivity in young adult men

(< 25 years) in these facilities was higher

than that observed in adolescent men

attending juvenile facilities (Figure CC).

Chlamydia positivity decreased with age

from 10.3% for those younger than 20

years of age to 2.5% for those older than

34 years.

Women - In women entering 39 adult

corrections facilities, median positivity for

chlamydia by facility was 8.3% (range: 1.3%

to 22.3%) (Table BB). Overall, in women

entering these adult corrections facilities, the

chlamydia positivity was 9.3% (Figure CC).

Chlamydia positivity decreased with age

from 19.1% for those younger than 20 years

to 3.8% for those older than 34 years.

Chlamydia positivity in women entering

adult correction facilities was significantly

lower than that in women entering juvenile

corrections facilities. However, chlamydia

positivity in women younger than 20 years

of age attending adult corrections facilities

was higher than that in women attending

juvenile corrections facilities.

Gonorrhea

Overall, positivity in women was uniformly

higher than in men for all age groups.

Adolescent Men - The median positivity

for gonorrhea by facility in men entering 62

juvenile corrections facilities was 0.9%

(range: 0.0% to 4.5%) (Table CC). The

overall positivity was 1.3% in men 12 to 18

years of age attending these facilities.

(Figure DD) Gonorrhea positivity increased

with age from 0.5% for those aged 12 years

to 2.0% for those aged 18.

Adolescent Women - The median

positivity for gonorrhea by facility in women

entering 37 juvenile corrections facilities was

3.8% (range: 0.0% to 12.2%) (Table CC). In

women 12 to 18 years of age entering these

juvenile corrections facilities, the overall

gonorrhea positivity was 5.2% (Figure

DD). Gonorrhea positivity did not vary by

age.

Men - In men entering 52 adult

corrections facilities, the median gonorrhea

positivity was 2.3% (range: 0.0% to

18.3%) (Table DD). Overall gonorrhea

positivity for men attending these facilities

was 2.1%. Gonorrhea positivity was

highest in men aged 20 to 24 years at

2.7%, declining with age to 1.4% in men

older than 34 years. Men aged younger

than 20 years attending adult facilities had

higher gonorrhea positivity than men

attending juvenile detention facilities.

Women - In women entering 35 reporting

adult facilities, the median positivity by

facility was 4.2% (range: 0.0% to 10.9%)

(Table DD). Overall, in women entering

adult corrections facilities, the gonorrhea

positivity was 4.5% (Figure EE).

Gonorrhea positivity decreased with age

from 8.4% for those younger than 20

years to 2.4% for those older than 34

years. Women younger than 20 years

attending adult facilities had higher

gonorrhea positivity than women attending

juvenile detention facilities.

Syphilis

Adolescent Men - The median syphilis

serologic positivity by facility was 0.0%

(range: 0.0% to 3.5%) in adolescent men

entering 15 juvenile corrections facilities

(Table EE).

Adolescent Women - The median

syphilis serologic positivity by facility was

1.4% (range: 0.4% to 1.8%) in adolescent

women entering five juvenile corrections

facilities (Table EE).

Men - In men entering 58 adult

corrections facilities, the median syphilis

serologic positivity by facility was 1.4%

(range: 0.0% to 7.8%) (Table FF).

86 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2006
Women - In women entering 32 adult

corrections facilities, the median serologic

positivity by facility was 3.9% (range: 0.0%

to 21.7%) (Table FF).

STD Surveillance 2006 Special Focus Profiles STDs in Persons Entering Corrections Facilities 87

1 Heimberger TS. Chang HG. Birkhead GS.

DiFerdinando GD. Greenberg AJ. Gunn R.

Morse DL. High prevalence of syphilis detected

through a jail screening program. A potential

public health measure to address the syphilis

epidemic. Arch Intern Med

1993;153:1799-1804.

2 Centers for Disease Control and Prevention.

Syphilis screening among women arrestees at

the Cook County Jail – Chicago, 1996. MMWR

1998;47:432-3.

3 Mertz KJ, Schwebke JR, Gaydos CA, Beideinger

HA, Tulloch SD, Levine WC. Screening women

in jails for chlamydial and gonococcal infection

using urine tests: Feasibility, acceptability,

prevalence and treatment rates. Sexually

Transmitted Diseases 2002;29:271-276.

4 Kahn R, Voigt R, Swint E, Weinstock H. Early

syphilis in the United States identified in

corrections facilities, 1999–2002. Sexually

Transmitted Diseases 2004;31:360-364.

5 Blank S, McDonnell DD, Rubin SR et al. New

approaches to syphilis control. Finding

opportunities for syphilis treatment and

congenital syphilis prevention in a women’s

correctional setting. Sexually Transmitted

Diseases 1997; 24:218-26.
88 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2006

Men Positivity Women

20 16 12 8 4 0 0 4 8 12 16 20 Age

0.4 6.6 12

1.3 12.5 13

2.7 14 14.1

5.3 15 14.5

7.3 16 15.6

8.3 17 14.1

9.5 18 11.8

6.4 Total 14.3

Figure BB. Chlamydia — Positivity by age, juvenile corrections facilities, 2006

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

20 16 12 8 4 0 0 4 8 12 16 20 Age

10.3 <20 19.1

9.8 20-24 15.0

6.7 25-29 10.3

5.0 6.2 30-34

2.5 3.8 >=35

7.5 Total 9.3

Figure CC. Chlamydia — Positivity by age, adult corrections facilities, 2006

Note: Percent positivity is presented from facilities reporting > 100 test results.
STD Surveillance 2006 Special Focus Profiles STDs in Persons Entering Corrections Facilities 89

Men Positivity Women

20 16 12 8 4 0 0 4 8 12 16 20 Age

0.5 3.7 12

0.6 5.5 13

0.8 5.0 14

1.1 5.3 15

1.3 5.8 16

1.7 5.0 17

2.0 3.0 18

1.3 5.2 Total

Figure DD. Gonorrhea — Positivity by age, juvenile corrections facilities, 2006

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

20 16 12 8 4 0 0 4 8 12 16 20 Age

2.1 8.4 <20

2.7 6.5 20-24

1.9 4.6 25-29

1.6 3.6 30-34

1.4 2.4 >=35

2.1 4.5 Total

Figure EE. Gonorrhea — Positivity by age, adult corrections facilities, 2006

Note: Percent positivity is presented from facilities reporting > 100 test results.
90 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2006

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 4 4,315 7.8 (5.2-9.6) 4 1,358 18.9 (2.8-20.5)

California* 19 26,939 5.2 (0.5-46.7) 23 11,846 12.2 (4.0-21.2)

Connecticut 2 537 3.2 (2.7-3.8) 1 111 14.4

Hawaii 1 126 7.1 – – –

Idaho 1 201 2.0 – – –

Illinois 4 5,158 8.0 (1.4-9.5) 1 578 20.9

Indiana 1 1,194 7.4 1 374 14.4

Kentucky 8 1,924 4.4 (1.9-9.5) 2 315 18.6 (15.0-22.2)

Maryland 4 2,034 4.2 (2.0-5.1) 2 567 13.9 (12.3-15.5)

Massachusetts 2 977 2.6 (2.6-2.7) 1 362 5.8

Michigan 1 426 8.7 1 159 17.0

Minnesota 1 191 9.4 – – –

Mississippi – – – 1 143 13.3

Missouri 1 431 7.2 1 114 12.3

Nebraska 1 654 6.1 1 234 13.7

Nevada 2 1,404 7.4 (3.8-11.0) 2 374 22.4 (15.4-29.4)

New Jersey 4 3,144 9.8 (5.1-18.0) 1 206 19.9

New York 6 5,122 5.1 (2.0-10.3) 5 1,230 18.4 (13.4-22.0)

North Dakota 1 161 9.3 – – –

Ohio 3 3,132 10.1 (7.2-10.1) 3 789 19.7 (6.5-23.0)

Oregon 3 1,310 5.7 (4.0-12.3) 2 361 9.7 (7.4-12.0)

Pennsylvania 3 471 3.9 (2.3-11.9) – – –

Tennessee 1 1,755 4.0 1 769 10.8

Utah 2 415 6.7 (5.8-7.6) 2 323 16.6 (12.9-20.4)

Virginia 1 728 10.2 – – –

Washington 4 889 4.6 (1.7-9.1) 2 273 13.3 (4.6-22.0)

West Virginia 1 132 3.8 – – –

Wisconsin 2 586 3.7 (2.5-5.0) – – –

Total 83 64,356 5.3 (0.5-46.7) 57 20,486 14.2 (2.8-29.4)

Table AA. Chlamydia — Positivity among men and women in juvenile corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
STD Surveillance 2006 Special Focus Profiles STDs in Persons Entering Corrections Facilities 91

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 6 1,337 14.3 (3.6-17.0) 4 1,736 11.9 (8.9-12.9)

California* 7 4,416 5.5 (3.1-7.9) 5 7,264 10.3 (4.6-18.2)

Delaware 1 776 5.9 2 960 9.2 (7.3-11.1)

Hawaii – – – 2 235 12.3 (4.5-20.0)

Illinois 6 15,688 9.8 (8.5-10.9) 3 8,676 7.8 (4.8-8.3)

Indiana 1 1,928 8.5 1 834 12.6

Iowa 3 986 12.5 (9.7-19.2) 2 657 9.2 (2.8-15.7)

Maryland 1 573 6.3 – – –

Massachusetts 2 2,964 6.4 (5.6-7.1) 2 746 4.7 (3.8-5.6)

Michigan 3 717 12.3 (11.6-21.6) – – –

Missouri 1 3,785 6.6 1 824 4.9

Montana – – – 1 191 2.6

Nebraska 3 1,593 6.6 (5.5-16.7) 1 234 10.3

Nevada 1 297 12.5 1 190 15.8

New Mexico 1 338 9.2 – – –

New York 2 8,866 6.2 (3.7-8.7) 1 317 5.0

North Dakota 1 649 7.1 – – –

Oregon 2 236 17.6 (15.9-19.2) 1 229 3.5

Pennsylvania 5 2,730 12.1 (4.8-23.1) 3 811 7.3 (2.4-9.2)

South Carolina 1 451 10.6 1 211 8.1

Texas 5 4,693 9.1 (1.3-26.7) 4 2,093 18.7 (17.0-22.3)

Utah – – – 1 153 17.6

Washington – – – 1 668 4.9

West Virginia 3 1,133 1.8 (0.9-2.1) – – –

Wisconsin 5 5,897 10.8 (5.1-15.4) 3 1,045 4.8 (1.3-5.8)

Total 60 60,053 8.9 (0.9-26.7) 40 28,074 8.5 (1.3-22.3)

Table BB. Chlamydia — Positivity among men and women in adult corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
92 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2006

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 4 4,313 1.1 (0.6-1.9) 4 1,353 3.8 (1.9-6.2)

California* 7 17,889 0.6 (0.3-1.0) 7 5,313 5.0 (0.7-12.2)

Connecticut 2 538 0.0 1 111 1.8

Hawaii 1 126 0.0 – – –

Idaho 1 198 1.0 – – –

Illinois 4 5,160 2.1 (0.7-2.5) 1 578 9.9

Indiana 1 1,192 2.2 1 374 8.0

Kentucky 8 1,924 0.5 (0.0-3.4) 2 315 5.4 (2.4-8.3)

Maryland 4 2,075 0.2 (0.0-0.8) 2 575 4.3 (2.9-5.7)

Michigan 1 426 1.6 1 159 5.7

Minnesota 1 191 2.6 – – –

Mississippi – – – 1 142 3.5

Missouri 1 432 1.4 1 114 3.5

Nebraska 1 654 1.2 1 234 3.8

Nevada 2 1,404 1.5 (0.5-2.5) 2 373 6.5 (2.9-10.1)

New Jersey 4 3,146 1.6 (0.7-4.5) 1 206 4.4

New York 4 4,511 1.4 (0.2-1.9) 4 1,058 3.4 (0.0-5.3)

Ohio 3 3,132 2.1 (1.1-3.4) 3 789 8.1 (2.2-9.1)

Pennsylvania 3 451 0.0 – – –

Tennessee 1 1,754 1.3 1 769 3.8

Utah 2 415 0.7 (0.0-1.3) 2 323 3.4 (2.4-4.4)

Washington 4 889 0.7 (0.4-1.6) 2 274 1.5 (0.0-3.0)

West Virginia 1 107 3.7 – – –

Wisconsin 2 585 0.5 (0.0-1.0) – – –

Total 62 51,512 0.9 (0.0-4.5) 37 13,060 3.8 (0.0-12.2)

Table CC. Gonorrhea — Positivity among men and women in juvenile corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco.

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 6 1,336 10.3 (0.0-18.3) 4 1,736 7.0 (4.0-7.4)

California* 7 4,420 1.6 (1.3-3.1) 5 7,263 3.8 (1.6-8.6)

Delaware 1 746 1.1 2 923 6.1 (4.4-7.7)

Hawaii – – – 2 235 3.6 (0.0-7.2)

Illinois 6 15,749 3.3 (1.0-6.6) 3 8,717 4.3 (1.0-6.8)

Indiana 1 1,928 2.7 1 834 8.6

Iowa 3 986 2.4 (0.8-3.4) 2 657 1.1 (0.6-1.7)

Maryland 1 578 1.0 – – –

Michigan 3 717 3.7 (2.1-13.8) – – –

Missouri 1 3,786 1.6 1 825 3.2

Montana – – – 1 190 0.0

Nebraska 3 1,593 1.5 (0.3-7.4) 1 234 5.1

Nevada 1 298 3.0 1 190 2.6

New Mexico 1 338 1.2 – – –

New York 1 8,131 0.5 – – –

Pennsylvania 4 2,285 5.2 (0.9-15.0) 3 778 3.1 (0.0-6.4)

South Carolina 1 450 3.1 1 211 3.8

Texas 5 4,691 1.7 (0.0-16.3) 4 2,094 9.0 (6.5-10.9)

Utah – – – 1 152 7.2

Washington – – – 1 667 1.3

West Virginia 3 862 2.2 (0.9-2.5) – – –

Wisconsin 5 5,890 3.3 (0.3-7.0) 3 1,037 0.7 (0.1-3.4)

Total 53 54,784 2.3 (0.0-18.3) 36 26,743 4.1 (0.0-10.9)

Table DD. Gonorrhea — Positivity among men and women in adult corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
STD Surveillance 2006 Special Focus Profiles STDs in Persons Entering Corrections Facilities 93

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 2 2,536 0.4 (0.3-0.4) 1 615 1.5

California* 1 113 3.5 0 – –

Illinois 1 2,895 0.7 1 527 1.3

Kentucky 1 405 0.3 0 – –

Maryland 8 5,316 0.0 (0.0-0.1) 2 605 1.1 (0.4-1.8)

North Carolina 1 417 0.0 0 – –

Texas 1 1,117 0.3 1 363 1.4

Total 15 12,799 0.0 (0.0-3.5) 5 2,110 1.4 (0.4-1.8)

Table EE. Syphilis— Positivity among men and women in juvenile corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes San Francisco project area.

Men Women

State

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

No. of

Facilities

No. of

Tests

Median % Positivity

(Range)

Arizona 1 25,009 2.6 1 5,382 5.6

California* 1 679 5.3 2 3,364 4.0 (2.5-5.4)

Florida 5 6,463 3.4 (2.9-4.3) 1 229 12.2

Illinois 1 320 0.3 1 117 1.7

Indianapolis 1 1,276 1.2 1 605 1.8

Kentucky 1 1,215 0.3 1 360 0.3

Louisiana 0 – – 1 926 21.7

Maryland 10 24,971 1.8 (0.6-3.1) 7 3,540 4.1 (0.0-10.4)

Massachusetts 18 18,773 0.9 (0.0-1.4) 4 3,919 1.8 (1.2-3.1)

Mississippi 3 895 3.4 (2.5-7.8) 0 – –

Missouri 2 5,957 1.6 (1.0-2.1) 2 1,191 4.0 (1.6-6.3)

New York † 2 8,513 1.3 (1.1-1.4) 2 1,023 2.6 (1.6-3.6

North Carolina 5 3,969 1.4 (0.9-4.8) 3 1,544 7.8 (4.3-9.3)

Tennessee 2 9,695 3.3 (2.3-4.2) 1 5,275 9.4

Texas 5 33,863 3.3 (2.0-5.6) 4 6,654 6.9 (3.7-10.6)

Wisconsin 1 657 0.0 1 206 0.0

Total 58 142,255 1.4 (0.0-7.8) 32 34,335 3.9 (0.0-21.7)

Table FF. Syphilis— Positivity among men and women in adult corrections facilities, 2006

Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes San Francisco project area. †New York data is

for confirmatory results.

TABLES
TABLES
STD Surveillance 2006 National Summary Tables 95

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Congenital Chlamydia Gonorrhea Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR . 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR . 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR . 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR . 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR . 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR . 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR . 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR . 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR . 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR . 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR . 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR . 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR . 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 6,676 164.0 NR . 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 5,354 130.7 NR . 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 5,491 130.4 NR . 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 5,288 123.0 NR . 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 4,866 114.6 NR . 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 5,130 119.7 NR . 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 4,416 103.7 NR . 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 4,163 97.5 NR . 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 4,070 97.7 NR . 263,714 143.6 1,344 0.7

1963 124,137 66.5 22,251 11.9 18,235 9.8 78,076 41.8 4,031 98.4 NR . 278,289 149.0 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 3,516 87.3 NR . 300,666 158.9 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 3,564 94.8 NR . 324,925 169.5 982 0.5

1966 105,159 54.2 21,414 11.0 15,950 8.2 63,541 32.7 3,170 87.9 NR . 351,738 181.2 838 0.4

1967 102,581 52.2 21,053 10.7 15,554 7.9 61,975 31.5 2,894 82.2 NR . 404,836 205.9 784 0.4

1968 96,271 48.4 19,019 9.6 15,150 7.6 58,564 29.4 2,381 68.0 NR . 464,543 233.4 845 0.4

1969 92,162 45.7 19,130 9.5 15,402 7.6 54,587 27.1 2,074 57.6 NR . 534,872 265.4 1,104 0.5

1970 91,382 44.8 21,982 10.8 16,311 8.0 50,348 24.7 1,953 52.3 NR . 600,072 294.2 1,416 0.7

1971 95,997 46.4 23,783 11.5 19,417 9.4 49,993 24.2 2,052 57.7 NR . 670,268 324.1 1,320 0.6

1972 91,149 43.6 24,429 11.7 20,784 9.9 43,456 20.8 1,758 54.0 NR . 767,215 366.6 1,414 0.7

1973 87,469 41.4 24,825 11.7 23,584 11.2 37,054 17.5 1,527 48.7 NR . 842,621 398.7 1,165 0.6

1974 83,771 39.3 25,385 11.9 25,124 11.8 31,854 14.9 1,138 36.0 NR . 906,121 424.7 945 0.4

1975 80,356 37.3 25,561 11.9 26,569 12.3 27,096 12.6 916 29.1 NR . 999,937 464.1 700 0.3

1976 71,761 33.0 23,731 10.9 25,363 11.7 21,905 10.1 626 19.8 NR . 1,001,994 460.6 628 0.3

1977 64,621 29.4 20,399 9.3 21,329 9.7 22,313 10.2 463 13.9 NR . 1,002,219 456.0 455 0.2

1978 64,875 29.2 21,656 9.8 19,628 8.8 23,038 10.4 434 13.0 NR . 1,013,436 456.3 521 0.2

1979 67,049 29.9 24,874 11.1 20,459 9.1 21,301 9.5 332 9.5 NR . 1,004,058 447.1 840 0.4

1980 68,832 30.3 27,204 12.0 20,297 8.9 20,979 9.2 277 7.7 NR . 1,004,029 442.1 788 0.3

1981 72,799 31.7 31,266 13.6 21,033 9.2 20,168 8.8 287 7.9 NR . 990,864 431.8 850 0.4

1982 75,579 32.6 33,613 14.5 21,894 9.5 19,799 8.5 259 7.0 NR . 960,633 414.7 1,392 0.6

1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR . 900,435 385.1 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2006
96 National Summary Tables STD Surveillance 2006

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Congenital Chlamydia Gonorrhea Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,358 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,862 47.7 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,715 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,081 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,290 13.9 7,007 2.5 12,696 4.6 17,743 6.4 844 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,383 12.7 6,617 2.4 11,534 4.1 16,653 6.0 579 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,284 11.3 6,103 2.1 8,701 3.0 16,976 5.9 504 12.5 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,422 11.4 7,980 2.7 7,768 2.6 17,300 5.9 374 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,935 12.5 9,756 3.3 9,186 3.1 17,644 6.0 349 8.5 1,030,911 347.8 358,366 120.9 33 0.0

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2006 (continued)

*For 1941-1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for

the calendar year ending December 31. For 1941-1958, data for Alaska and Hawaii were not included.

†

Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical

manifestations other than neurosyphilis.

§

Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hardcopy

and electronic format based on case reporting form CDC 73.126.

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions

through June 22, 2007 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. Cases and

rates shown in this table exclude the outlying areas of Guam, Puerto Rico and Virgin Islands.

NR = No report.
STD Surveillance 2006 Chlamydia Tables 97

Rank* State Cases Rate per 100,000 Population

1 Alaska 4,525 681.8

2 Mississippi 19,002 650.5

3 South Carolina 22,351 525.3

4 New Mexico 9,829 509.7

5 Alabama 22,915 502.8

6 Hawaii 5,548 435.1

7 Georgia 38,972 429.6

8 Delaware 3,615 428.6

9 Tennessee 25,320 424.6

10 Illinois 53,586 419.8

11 Arizona 24,090 405.6

12 Missouri 22,982 396.2

13 Louisiana 17,885 395.4

14 Maryland 21,859 390.3

15 North Carolina 33,615 387.1

16 California 135,827 375.9

17 Oklahoma 12,992 366.2

18 Wisconsin 20,190 364.7

19 Michigan 36,753 363.1

20 New York 68,720 356.9

21 Ohio 40,106 349.8

22 Colorado 16,313 349.7

U.S. TOTAL† 1,030,911 347.8

23 Nevada 8,398 347.8

24 South Dakota 2,633 339.3

25 Texas 75,543 330.5

26 Virginia 24,087 318.3

27 Pennsylvania 39,487 317.7

28 Indiana 19,859 316.6

29 Connecticut 10,946 311.8

30 Nebraska 5,428 308.6

31 Arkansas 8,259 297.2

32 Rhode Island 3,142 292.0

33 North Dakota 1,820 285.9

34 Kansas 7,829 285.2

35 Washington 17,819 283.4

36 Montana 2,650 283.2

37 Iowa 8,390 282.8

38 Wyoming 1,422 279.2

39 Florida 48,955 275.2

40 Oregon 9,577 263.0

41 Minnesota 12,935 252.0

42 Massachusetts 15,394 240.6

43 Idaho 3,345 234.1

44 New Jersey 20,194 231.6

45 Kentucky 8,940 214.2

46 Utah 5,092 206.2

47 Vermont 1,191 191.2

48 Maine 2,306 174.5

49 West Virginia 2,910 160.2

50 New Hampshire 1,997 152.4

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates: United States, 2006

*

States were ranked in descending order by rate, number of cases, and alphabetically by state.

†

Total includes cases reported by the District of Columbia with 3,368 cases and a rate of 611.8, but excludes outlying areas (Guam with 832 cases

and rate of 493.6, Puerto Rico with 5,102 cases and rate of 130.4, and Virgin Islands with 203 cases and rate of 186.7).
98 Chlamydia Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 15,611 14,209 13,314 17,109 22,915 348.0 315.7 293.9 375.4 502.8

Alaska 3,806 3,900 3,954 4,355 4,525 591.2 601.1 603.3 656.2 681.8

Arizona 14,973 12,819 16,786 21,264 24,090 274.4 229.7 292.2 358.0 405.6

Arkansas 7,312 7,856 7,864 8,507 8,259 269.8 288.2 285.7 306.1 297.2

California 110,288 117,428 122,197 130,716 135,827 314.1 330.9 340.4 361.8 375.9

Colorado 14,028 13,039 14,151 15,432 16,313 311.3 286.5 307.5 330.8 349.7

Connecticut 9,808 9,393 9,552 11,039 10,946 283.4 269.7 272.6 314.5 311.8

Delaware 2,649 3,035 2,954 3,392 3,615 328.1 371.3 355.7 402.1 428.6

District of Columbia 3,305 3,168 3,493 3,678 3,368 578.9 561.4 631.0 668.1 611.8

Florida 42,058 42,382 42,554 43,372 48,955 251.6 249.0 244.6 243.8 275.2

Georgia 33,998 35,686 34,280 33,562 38,972 397.2 410.9 388.2 369.9 429.6

Hawaii 4,521 5,480 5,307 5,489 5,548 363.2 435.7 420.2 430.4 435.1

Idaho 2,503 2,366 2,784 2,799 3,345 186.6 173.2 199.8 195.9 234.1

Illinois 48,101 48,294 47,185 50,559 53,586 381.7 381.7 371.1 396.1 419.8

Indiana 17,100 17,075 18,440 20,063 19,859 277.6 275.6 295.6 319.9 316.6

Iowa 6,195 6,491 6,956 7,390 8,390 210.9 220.5 235.4 249.1 282.8

Kansas 6,784 7,249 7,493 7,419 7,829 249.8 266.2 273.9 270.3 285.2

Kentucky 8,756 7,981 6,470 8,351 8,940 213.9 193.8 156.1 200.1 214.2

Louisiana 18,442 20,970 21,837 17,227 17,885 411.4 466.4 483.6 380.8 395.4

Maine 1,805 2,030 2,113 2,254 2,306 139.4 155.5 160.4 170.6 174.5

Maryland 16,891 16,831 19,952 18,291 21,859 309.5 305.5 359.0 326.6 390.3

Massachusetts 10,914 11,301 13,242 14,411 15,394 169.8 175.7 206.4 225.2 240.6

Michigan 32,272 32,572 41,246 38,730 36,753 321.1 323.1 407.9 382.7 363.1

Minnesota 10,107 10,714 11,602 12,189 12,935 201.3 211.8 227.4 237.5 252.0

Mississippi 11,800 12,193 18,863 21,268 19,002 410.9 423.2 649.8 728.1 650.5

Missouri 16,181 18,570 21,319 22,371 22,982 285.2 325.5 370.5 385.7 396.2

Montana 2,475 2,547 2,608 2,400 2,650 272.1 277.6 281.4 256.5 283.2

Nebraska 4,779 4,739 5,238 5,098 5,428 276.4 272.5 299.8 289.9 308.6

Nevada 5,936 5,830 6,690 7,321 8,398 273.1 260.1 286.5 303.2 347.8

New Hampshire 1,557 1,616 1,736 1,842 1,997 122.1 125.5 133.6 140.6 152.4

New Jersey 14,164 16,169 17,448 19,152 20,194 164.9 187.2 200.6 219.7 231.6

New Mexico 7,417 7,480 9,035 8,456 9,829 399.8 399.0 474.7 438.5 509.7

New York 51,123 57,222 59,097 63,966 68,720 266.9 298.2 307.4 332.2 356.9

North Carolina 24,726 26,187 28,967 31,183 33,615 297.2 311.5 339.1 359.1 387.1

North Dakota 1,256 1,655 1,810 1,667 1,820 198.1 261.1 285.3 261.8 285.9

Ohio 38,032 42,522 39,379 43,806 40,106 333.0 371.8 343.7 382.1 349.8

Oklahoma 10,804 11,013 10,366 13,407 12,992 309.2 313.6 294.2 377.9 366.2

Oregon 7,009 7,688 8,690 9,018 9,577 199.0 216.0 241.8 247.7 263.0

Pennsylvania 31,791 37,291 38,025 37,261 39,487 257.7 301.6 306.5 299.8 317.7

Rhode Island 2,832 3,000 3,442 3,269 3,142 264.7 278.8 318.5 303.8 292.0

South Carolina 14,314 14,623 18,423 18,296 22,351 348.5 352.6 438.8 430.0 525.3

South Dakota 2,215 2,608 2,532 2,701 2,633 291.0 341.2 328.5 348.1 339.3

Tennessee 16,042 20,380 22,515 23,084 25,320 276.7 348.9 381.5 387.1 424.6

Texas 69,521 69,200 70,232 71,860 75,543 319.2 312.9 312.3 314.3 330.5

Utah 3,540 3,893 3,857 4,602 5,092 152.8 165.6 161.4 186.3 206.2

Vermont 954 1,060 1,137 957 1,191 154.7 171.2 183.0 153.6 191.2

Virginia 18,518 19,439 21,635 22,668 24,087 253.9 263.2 290.0 299.5 318.3

Washington 14,934 16,797 17,635 18,616 17,819 246.1 273.9 284.3 296.1 283.4

West Virginia 2,464 2,585 2,758 2,944 2,910 136.7 142.8 151.9 162.0 160.2

Wisconsin 17,000 17,942 19,217 20,461 20,190 312.4 327.9 348.8 369.6 364.7

Wyoming 944 960 1,082 1,173 1,422 189.3 191.5 213.6 230.3 279.2

U.S. TOTAL 834,555 877,478 929,462 976,445 1,030,911 289.4 301.7 316.5 329.4 347.8

Northeast 124,948 139,082 145,792 154,151 163,377 230.4 255.7 267.2 282.1 299.0

Midwest 200,022 210,431 222,417 232,454 232,511 307.1 321.7 338.4 352.4 352.4

South 317,211 327,738 346,477 358,199 390,588 306.9 313.5 327.0 333.2 363.3

West 192,374 200,227 214,776 231,641 244,435 293.0 301.2 318.6 339.2 357.9

Guam 550 554 748 807 832 341.5 338.6 450.4 478.7 493.6

Puerto Rico 2,999 2,746 3,588 3,714 5,102 77.7 70.8 92.1 94.9 130.4

Virgin Islands 207 416 303 235 203 188.1 382.3 278.6 216.2 186.7

OUTLYING AREAS 3,756 3,716 4,639 4,756 6,137 90.9 89.5 111.3 113.5 146.5

TOTAL 838,311 881,194 934,101 981,201 1,037,048 286.6 298.7 313.6 326.4 345.0

Table 3. Chlamydia — Reported cases and rates by state/area and region listed in alphabetical order: United

States and outlying areas, 2002–2006
STD Surveillance 2006 Chlamydia Tables 99

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 13,988 12,977 11,685 14,532 17,915 603.6 559.0 500.6 619.4 763.6

Alaska 2,576 2,665 2,671 2,908 3,067 829.2 850.0 843.9 907.4 957.0

Arizona 11,665 10,043 12,896 16,201 18,485 427.2 360.1 449.3 546.2 623.2

Arkansas 5,817 6,284 6,252 6,823 6,604 419.8 451.5 445.3 481.8 466.3

California 81,218 85,967 88,439 93,646 97,170 461.5 483.7 491.9 517.8 537.2

Colorado 10,422 9,843 10,283 11,219 12,037 466.0 436.4 451.0 485.8 521.2

Connecticut 7,738 7,309 7,383 8,383 8,205 434.4 407.8 409.4 464.4 454.5

Delaware 2,034 2,155 2,140 2,493 2,625 490.1 513.9 502.7 576.8 607.3

District of Columbia 2,825 2,695 2,948 2,976 2,510 937.8 903.6 1,010.3 1,028.4 867.4

Florida 33,902 34,581 34,437 34,850 38,536 396.9 398.2 388.1 384.4 425.1

Georgia 27,494 28,992 27,656 26,317 30,546 633.2 659.2 619.5 574.0 666.2

Hawaii 3,445 4,113 4,019 4,093 4,161 554.9 655.9 635.1 640.1 650.7

Idaho 1,862 1,762 2,157 2,162 2,435 278.2 258.5 310.5 303.6 341.9

Illinois 34,154 36,284 35,996 37,672 39,705 531.7 563.1 556.3 580.3 611.6

Indiana 13,151 13,118 14,217 15,263 14,907 419.7 416.6 448.7 479.4 468.2

Iowa 4,680 4,915 5,208 5,400 6,157 313.1 328.5 347.1 358.7 408.9

Kansas 5,653 5,989 6,195 6,054 6,286 412.0 436.1 449.9 438.4 455.2

Kentucky 7,043 6,353 5,027 6,041 6,336 336.8 302.5 238.0 284.5 298.4

Louisiana 14,758 17,046 17,549 13,395 14,290 638.8 736.6 755.8 576.4 614.9

Maine 1,337 1,452 1,532 1,644 1,672 201.3 217.0 227.3 243.2 247.4

Maryland 13,851 13,746 16,108 14,653 17,339 491.3 483.5 561.8 507.5 600.6

Massachusetts 8,177 8,429 9,781 10,587 11,175 245.9 253.7 295.5 321.0 338.9

Michigan 25,129 25,903 32,624 30,079 27,915 491.2 505.1 634.2 584.6 542.6

Minnesota 7,352 7,866 8,521 8,820 9,243 290.3 308.4 331.7 341.3 357.6

Mississippi 10,274 10,536 15,097 16,684 14,853 692.8 709.5 1,010.4 1,110.4 988.6

Missouri 13,253 14,750 16,306 16,580 16,938 455.3 504.8 553.9 559.3 571.4

Montana 1,840 1,865 1,916 1,776 1,932 403.2 405.4 412.4 378.9 412.1

Nebraska 3,609 3,435 3,812 3,713 3,956 412.1 390.3 431.4 417.6 445.0

Nevada 4,365 4,268 4,857 5,362 6,185 409.3 388.3 423.8 452.3 521.8

New Hampshire 1,168 1,196 1,265 1,343 1,484 180.4 183.1 192.1 202.2 223.4

New Jersey 12,183 13,813 14,491 15,826 16,560 275.9 311.5 324.7 354.1 370.6

New Mexico 5,918 5,973 6,876 6,333 7,456 627.6 627.3 710.9 646.2 760.8

New York 41,202 43,907 44,975 45,391 48,568 415.9 442.9 453.3 457.2 489.2

North Carolina 20,384 21,807 23,916 25,702 27,301 480.9 509.9 550.8 582.6 618.8

North Dakota 826 1,087 1,206 1,091 1,231 260.1 342.8 379.6 342.1 386.0

Ohio 29,558 33,549 30,377 33,312 30,483 503.7 571.6 516.8 566.9 518.7

Oklahoma 8,764 8,990 8,237 10,608 9,678 494.1 505.0 461.9 591.1 539.3

Oregon 5,033 5,590 6,090 6,194 6,585 283.8 312.1 336.9 338.4 359.8

Pennsylvania 23,546 27,557 27,740 27,131 28,503 369.7 432.1 433.9 424.0 445.4

Rhode Island 2,057 2,232 2,502 2,396 2,175 370.6 400.2 447.3 430.7 390.9

South Carolina 12,468 12,745 15,925 15,694 19,055 590.4 598.8 739.7 719.6 873.7

South Dakota 1,608 1,864 1,824 1,924 1,923 419.7 484.9 470.5 492.9 492.7

Tennessee 12,625 14,669 16,237 16,453 18,352 424.9 490.7 538.6 540.8 603.2

Texas 57,438 57,549 57,470 58,668 60,327 524.4 518.0 509.1 511.4 525.9

Utah 2,494 2,787 2,720 3,081 3,457 216.0 238.0 228.6 250.6 281.2

Vermont 746 828 861 725 897 237.3 262.8 272.8 229.3 283.7

Virginia 15,102 15,535 16,578 16,805 17,682 406.8 413.8 437.6 437.2 460.0

Washington 11,003 12,341 12,835 13,471 13,021 361.2 401.4 412.8 427.8 413.5

West Virginia 2,072 2,102 2,105 2,272 2,208 224.0 226.6 226.8 244.9 238.0

Wisconsin 12,296 12,838 13,913 14,751 14,606 446.9 464.3 500.1 527.9 522.7

Wyoming 755 717 820 874 1,051 304.7 288.1 326.1 346.0 416.1

U.S. TOTAL 652,858 685,017 716,675 740,371 775,788 445.0 463.6 480.6 492.2 515.8

Northeast 98,154 106,723 110,530 113,426 119,239 350.8 380.7 393.4 403.5 424.2

Midwest 151,269 161,598 170,199 174,659 173,350 455.9 485.6 509.2 521.0 517.1

South 260,839 268,762 279,367 284,966 306,157 495.0 505.0 518.4 521.5 560.3

West 142,596 147,934 156,579 167,320 177,042 434.0 445.1 464.5 490.2 518.7

Guam 463 446 608 667 692 587.4 556.8 747.1 807.0 837.3

Puerto Rico 2,665 2,378 3,240 3,366 4,091 133.1 118.1 160.1 165.6 201.2

Virgin Islands 188 352 232 189 144 317.5 619.0 408.0 332.5 253.4

OUTLYING AREAS 3,316 3,176 4,080 4,222 4,927 154.9 147.6 188.8 194.4 226.8

TOTAL 656,174 688,193 720,755 744,593 780,715 440.8 459.0 476.4 488.0 511.7

Table 4. Chlamydia — Women – Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2002–2006

Note: Cases reported with unknown sex are not included in this table.
100 Chlamydia Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 1,579 1,201 1,603 2,507 4,985 72.8 55.1 73.0 113.4 225.4

Alaska 1,230 1,235 1,283 1,447 1,458 369.2 368.3 378.6 421.6 424.8

Arizona 3,308 2,772 3,884 5,058 5,588 121.4 99.3 135.2 170.1 188.0

Arkansas 1,486 1,567 1,612 1,684 1,655 112.2 117.5 119.5 123.6 121.4

California 28,400 31,238 33,323 36,449 38,003 162.1 176.4 186.0 202.0 210.6

Colorado 3,604 3,196 3,855 4,213 4,276 158.8 139.2 166.1 178.8 181.5

Connecticut 2,070 2,084 2,168 2,656 2,741 123.3 123.2 127.5 155.8 160.8

Delaware 615 880 814 899 990 156.7 221.0 201.1 218.6 240.7

District of Columbia 459 450 529 681 819 170.2 169.1 202.1 260.8 313.6

Florida 8,156 7,801 8,117 8,522 10,410 99.8 93.6 95.2 97.7 119.3

Georgia 6,363 6,509 6,411 6,793 8,089 150.9 151.8 146.9 151.4 180.3

Hawaii 1,076 1,367 1,288 1,396 1,384 172.4 216.8 204.4 219.6 217.7

Idaho 641 604 617 616 895 95.4 88.2 88.3 85.9 124.8

Illinois 13,942 12,009 11,187 12,886 13,881 225.7 193.4 179.2 205.5 221.4

Indiana 3,845 3,803 4,080 4,703 4,849 127.1 124.8 132.9 152.3 157.0

Iowa 1,505 1,561 1,743 1,990 2,233 104.4 107.8 119.9 136.2 152.9

Kansas 1,131 1,260 1,298 1,365 1,543 84.2 93.3 95.6 100.1 113.2

Kentucky 1,706 1,613 1,433 2,285 2,580 85.2 79.9 70.5 111.5 125.8

Louisiana 3,525 3,808 4,016 3,583 3,372 162.3 174.5 183.0 162.9 153.3

Maine 468 577 581 606 634 74.3 90.6 90.3 93.9 98.2

Maryland 3,029 3,068 3,841 3,627 4,439 114.8 115.1 142.7 133.7 163.6

Massachusetts 2,724 2,848 3,449 3,809 4,193 87.8 91.6 111.0 122.8 135.2

Michigan 7,143 6,669 8,622 8,525 8,724 144.8 134.7 173.5 171.3 175.3

Minnesota 2,755 2,848 3,081 3,369 3,692 110.8 113.5 121.7 132.2 144.9

Mississippi 1,526 1,657 3,766 4,584 4,149 109.9 118.7 267.3 323.1 292.5

Missouri 2,928 3,820 5,013 5,791 6,044 106.0 137.3 178.3 204.2 213.1

Montana 625 679 685 619 709 137.9 148.4 148.2 132.6 151.9

Nebraska 1,128 1,244 1,391 1,378 1,401 132.2 144.8 161.1 158.4 161.1

Nevada 1,558 1,552 1,821 1,955 2,211 140.7 135.9 153.2 159.0 179.8

New Hampshire 389 420 471 499 513 62.0 66.2 73.5 77.3 79.4

New Jersey 1,962 2,332 2,945 3,323 3,606 47.0 55.5 69.5 78.2 84.9

New Mexico 1,464 1,485 2,151 2,121 2,368 160.5 161.0 229.8 223.6 249.7

New York 9,885 13,106 14,031 18,547 20,148 106.8 141.3 150.8 198.9 216.0

North Carolina 4,340 4,379 5,051 5,481 6,314 106.3 106.0 120.3 128.3 147.8

North Dakota 429 567 601 574 588 135.5 179.0 189.8 180.6 185.0

Ohio 7,926 8,215 8,189 9,139 9,039 142.7 147.6 146.7 163.6 161.8

Oklahoma 2,040 2,023 2,129 2,799 3,314 118.6 116.8 122.3 159.6 189.0

Oregon 1,976 2,098 2,600 2,824 2,992 113.1 118.6 145.5 155.9 165.2

Pennsylvania 8,244 9,682 10,282 10,128 10,981 138.2 161.7 171.0 168.0 182.1

Rhode Island 775 768 936 868 962 150.6 148.1 179.6 167.0 185.1

South Carolina 1,800 1,813 2,456 2,572 3,272 90.2 89.8 120.1 124.0 157.7

South Dakota 606 742 708 774 709 160.3 195.3 184.7 200.7 183.9

Tennessee 3,417 5,711 6,278 6,619 6,968 120.9 200.2 217.5 226.6 238.6

Texas 11,964 11,594 12,619 13,138 15,178 110.5 105.3 112.7 115.4 133.3

Utah 1,044 1,103 1,137 1,521 1,635 89.9 93.4 94.8 122.6 131.8

Vermont 208 232 276 232 294 68.8 76.3 90.3 75.6 95.8

Virginia 3,416 3,868 5,024 5,823 6,384 95.4 106.5 136.8 156.4 171.5

Washington 3,931 4,456 4,800 5,145 4,798 130.0 145.8 155.1 163.9 152.9

West Virginia 386 472 649 671 698 44.0 53.5 73.1 75.5 78.5

Wisconsin 4,669 5,015 5,290 5,688 5,551 173.6 185.2 194.0 207.5 202.5

Wyoming 189 243 262 299 371 75.3 96.3 102.7 116.5 144.5

U.S. TOTAL 179,585 190,244 210,396 232,781 252,630 126.8 133.0 145.6 159.4 173.0

Northeast 26,725 32,049 35,139 40,668 44,072 101.8 121.6 132.7 153.3 166.1

Midwest 48,007 47,753 51,203 56,182 58,254 150.2 148.6 158.5 173.2 179.5

South 55,807 58,414 66,348 72,268 83,616 110.2 113.8 127.4 136.7 158.2

West 49,046 52,028 57,706 63,663 66,688 149.5 156.6 171.2 186.4 195.2

Guam 87 108 140 140 140 105.8 129.4 165.3 162.9 162.9

Puerto Rico 334 368 348 348 1,007 18.0 19.7 18.6 18.5 53.6

Virgin Islands 19 64 71 46 55 37.4 123.2 136.8 88.7 106.0

OUTLYING AREAS 440 540 559 534 1,202 22.1 27.0 27.8 26.5 59.6

TOTAL 180,025 190,784 210,955 233,315 253,832 125.3 131.5 144.0 157.6 171.5

Table 5. Chlamydia — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2002–2006

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2006 Chlamydia Tables 101

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 42,943 432.2 4

2 Cook County, IL 31,757 598.8 7

3 Philadelphia County, PA 17,199 1,175.4 8

4 Maricopa County, AZ 14,579 401.0 10

5 Kings County, NY 13,915 559.7 11

6 Wayne County, MI 12,213 611.2 12

7 San Diego County, CA 11,980 408.4 14

8 Harris County, TX 11,872 321.5 15

9 Bronx County, NY 10,494 773.0 16

10 Milwaukee County, WI 9,999 1,084.9 17

11 Shelby County, TN 8,795 967.5 18

12 Dallas County, TX 8,521 369.6 18

13 San Bernardino County, CA 8,066 410.8 19

14 Queens County, NY 8,015 357.6 20

15 New York County, NY 7,997 501.9 21

16 Orange County, CA 7,970 266.7 21

17 Sacramento County, CA 7,688 563.9 22

18 Bexar County, TX 7,634 502.8 23

19 Fulton County, GA 6,882 751.6 24

20 Marion County, IN 6,807 788.6 24

21 Clark County, NV 6,592 385.4 25

22 Cuyahoga County, OH 6,573 492.2 26

23 Baltimore (City), MD 6,307 992.0 26

24 Hamilton County, OH 6,114 757.9 27

25 Alameda County, CA 5,922 408.7 27

26 Santa Clara County, CA 5,767 339.4 28

27 Tarrant County, TX 5,482 338.3 28

28 Prince George’s County, MD 5,422 640.8 29

29 Travis County, TX 5,418 610.0 29

30 Fresno County, CA 5,341 608.6 30

31 King County, WA 5,244 292.4 30

32 Franklin County, OH 5,135 470.8 31

33 Miami-Dade County, FL 5,069 213.3 31

34 St Louis County, MO 4,876 485.3 32

35 Broward County, FL 4,870 274.0 32

36 Duval County, FL 4,816 582.7 33

37 Jackson County, MO 4,786 721.9 33

38 Essex County, NJ 4,682 591.9 34

39 De Kalb County, GA 4,676 689.7 34

40 Orange County, FL 4,593 449.0 35

41 St Louis (City), MO 4,581 1,330.3 35

42 Hennepin County, MN 4,576 408.8 36

43 Honolulu County, HI 4,462 492.9 36

44 Jefferson County, AL 4,447 676.6 36

45 Riverside County, CA 4,406 226.4 37

46 Kern County, CA 4,225 558.3 37

47 Erie County, NY 4,199 451.2 38

48 Bernalillo County, NM 4,195 695.0 38

49 Allegheny County, PA 4,193 339.3 39

50 San Francisco County, CA 4,091 553.3 39

51 Suffolk County, MA 4,085 624.2 39

52 Wake County, NC 3,942 526.4 40

53 Hillsborough County, FL 3,835 338.7 40

54 Pima County, AZ 3,744 404.9 40

*Accounting for 40% of reported chlamydia cases.

†

Counties and independent cities were ranked in descending order by number of cases reported in 2006.

Table 6. Chlamydia — Counties and independent cities* ranked by number of reported cases: United States,

2006
102 Chlamydia Tables STD Surveillance 2006

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 16,564 18,135 17,068 16,748 20,979 365.7 393.4 362.5 340.6 426.6

Austin-Round Rock, TX 4,716 4,456 4,580 5,103 7,325 349.5 323.5 324.3 351.3 504.3

Baltimore-Towson, MD 9,598 10,044 10,959 11,071 11,617 368.9 383.9 415.2 416.9 437.4

Birmingham-Hoover, AL 4,173 3,189 3,905 4,720 5,338 390.7 297.3 360.8 433.0 489.7

Boston-Cambridge-Quincy, MA-NH 7,350 7,831 9,006 9,368 9,918 165.3 176.4 203.5 212.3 224.8

Buffalo-Cheektowaga-Tonawanda, NY 3,295 3,513 4,865 5,013 4,992 283.3 303.0 421.4 436.8 435.0

Charlotte-Gastonia-Concord, NC-SC 4,105 4,619 4,832 5,830 5,076 291.1 321.3 327.7 383.2 333.7

Chicago-Naperville-Joliet, IL-IN-WI 38,503 37,017 35,953 38,966 41,521 414.6 396.6 382.8 412.6 439.7

Cincinnati-Middletown, OH-KY-IN 6,408 6,789 6,438 8,516 8,616 314.0 331.6 312.8 411.3 416.1

Cleveland-Elyria-Mentor, OH 7,618 8,489 7,867 8,181 7,462 354.7 396.8 368.1 384.7 350.9

Columbus, OH 5,996 5,758 5,167 5,902 5,843 361.2 343.8 305.0 345.4 342.0

Dallas-Fort Worth-Arlington, TX 15,800 16,828 15,744 18,005 17,035 288.1 301.1 276.2 309.4 292.7

Denver-Aurora, CO 7,952 7,039 7,774 8,534 7,934 348.7 305.9 333.6 361.6 336.2

Detroit-Warren-Livonia, MI 16,518 16,071 21,378 20,497 17,201 368.4 358.4 475.8 456.7 383.2

Hartford-West Hartford-East Hartford, CT 3,535 3,224 3,040 3,815 3,799 302.6 273.7 256.6 321.1 319.7

Houston-Baytown-Sugar Land, TX 14,926 13,530 14,796 13,476 14,641 299.3 266.6 285.6 255.2 277.3

Indianapolis, IN 7,302 7,304 6,922 8,226 7,780 463.7 457.8 426.9 501.4 474.2

Jacksonville, FL 4,430 5,200 5,017 5,246 5,582 376.2 432.3 409.4 420.2 447.1

Kansas City, MO-KS 6,006 7,105 8,003 7,900 7,825 317.9 373.0 415.7 405.6 401.8

Las Vegas-Paradise, NV 4,446 4,379 5,065 5,623 6,592 292.1 277.8 306.8 328.7 385.4

Los Angeles-Long Beach-Santa Ana, CA 43,482 46,342 46,202 50,703 50,913 341.2 361.2 357.5 392.3 394.0

Louisville, KY-IN 2,796 2,775 2,396 3,143 3,319 236.4 233.2 199.5 260.1 274.6

Memphis, TN-MS-AR 6,381 7,362 8,927 9,457 10,224 518.5 594.0 714.0 750.0 810.8

Miami-Fort Lauderdale-Miami Beach, FL 10,867 11,024 11,781 10,403 12,142 207.7 208.4 219.7 191.9 223.9

Milwaukee-Waukesha-West Allis, WI 9,291 9,320 10,070 10,368 10,498 614.3 615.5 664.4 685.3 693.9

Minneapolis-St. Paul-Bloomington, MN-WI 7,678 8,081 8,139 8,513 9,271 251.4 262.1 261.2 270.9 295.0

Nashville-Davidson-Murfreesboro, TN 3,172 3,981 4,243 4,538 4,910 234.4 290.3 304.0 319.0 345.2

New Orleans-Metairie-Kenner, LA 6,258 7,116 6,858 4,761 3,401 475.8 540.1 519.7 360.9 257.8

New York-Newark-Edison, NY-NJ-PA 46,925 51,614 52,266 58,134 62,334 252.2 276.9 279.4 310.1 332.5

Oklahoma City, OK 4,149 4,124 3,939 4,798 4,627 370.0 364.1 344.2 414.8 400.0

Orlando, FL 4,323 4,673 4,888 5,862 6,579 246.7 259.2 262.6 303.2 340.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 20,989 25,347 25,285 24,913 27,417 364.9 439.1 435.9 427.8 470.8

Phoenix-Mesa-Scottsdale, AZ NA 8,084 11,078 11,984 15,278 NA 225.0 298.2 310.1 395.3

Pittsburgh, PA 5,272 5,499 5,539 5,880 5,789 218.0 228.1 230.6 246.4 242.6

Portland-Vancouver-Beaverton, OR-WA 4,363 4,703 5,256 5,636 5,654 216.4 230.5 254.6 268.9 269.8

Providence-New Bedford-Fall River, RI-MA 3,574 3,714 4,269 4,316 4,197 221.6 228.8 262.1 266.0 258.7

Richmond, VA 4,384 4,472 4,923 4,710 5,044 389.3 392.9 426.5 400.6 429.0

Riverside-San Bernardino-Ontario, CA 10,077 10,688 10,913 12,179 12,472 286.7 293.4 287.7 311.5 319.0

Rochester, NY 2,453 4,142 4,040 3,850 4,168 235.2 397.8 387.9 370.5 401.1

Sacramento-Arden-Arcade-Roseville, CA 5,547 6,240 7,294 8,175 9,094 287.4 316.0 361.7 400.3 445.3

Salt Lake City, UT 2,160 2,264 2,223 2,642 2,910 216.6 225.2 218.2 255.4 281.3

San Antonio, TX 6,365 7,212 7,645 8,049 8,338 356.3 396.1 412.3 425.9 441.2

San Diego-Carlsbad-San Marcos, CA 10,286 10,432 10,876 11,520 11,980 353.9 355.9 371.0 392.7 408.4

San Francisco-Oakland-Fremont, CA 12,272 12,774 13,580 13,988 15,565 293.6 307.3 326.9 336.8 374.8

San Jose-Sunnyvale-Santa Clara, CA 4,465 4,796 5,697 5,374 5,898 256.7 276.5 327.1 306.2 336.1

Seattle-Tacoma-Bellevue, WA 8,497 9,457 9,655 10,588 9,778 271.8 301.0 304.9 330.5 305.2

St. Louis, MO-IL 9,218 10,081 11,856 13,328 13,509 337.8 368.5 428.9 479.7 486.2

Tampa-St. Petersburg-Clearwater, FL 6,322 6,002 5,996 6,315 7,475 253.9 237.1 231.7 238.5 282.3

Virginia Beach-Norfolk-Newport News, VA-NC 6,137 6,668 7,601 8,414 9,139 380.5 407.3 462.3 510.8 554.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 11,715 11,230 14,046 12,827 15,456 233.1 220.6 273.3 246.0 296.4

U.S. MSA TOTAL 468,659 500,737 525,860 556,108 584,455 309.6 320.5 333.0 348.7 366.4

Table 7. Chlamydia — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
STD Surveillance 2006 Chlamydia Tables 103

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 13,071 14,519 13,756 12,995 16,165 570.8 624.4 580.4 524.8 652.8

Austin-Round Rock, TX 3,792 3,418 3,405 3,720 5,170 571.4 506.4 492.5 522.7 726.5

Baltimore-Towson, MD 8,091 8,412 9,051 8,927 9,344 599.7 620.5 662.1 649.4 679.8

Birmingham-Hoover, AL 3,321 2,825 3,095 3,709 4,277 599.2 508.3 552.6 657.7 758.4

Boston-Cambridge-Quincy, MA-NH 5,502 5,715 6,549 6,663 7,140 239.7 249.8 287.6 293.8 314.8

Buffalo-Cheektowaga-Tonawanda, NY 2,502 2,677 3,698 3,849 3,762 413.6 444.3 616.7 646.3 631.7

Charlotte-Gastonia-Concord, NC-SC 3,380 3,915 4,059 4,878 4,189 471.2 536.5 541.9 631.9 542.6

Chicago-Naperville-Joliet, IL-IN-WI 26,625 27,419 27,271 28,860 30,600 561.8 576.5 570.2 600.4 636.6

Cincinnati-Middletown, OH-KY-IN 5,244 5,458 5,108 6,580 6,871 500.5 520.2 484.6 621.4 648.9

Cleveland-Elyria-Mentor, OH 5,805 6,548 5,909 6,066 5,458 518.8 588.0 531.6 548.7 493.7

Columbus, OH 4,189 4,525 4,058 4,445 4,549 496.5 532.1 472.8 513.4 525.4

Dallas-Fort Worth-Arlington, TX 12,544 13,633 12,536 14,641 13,466 456.8 488.3 440.7 504.7 464.2

Denver-Aurora, CO 5,777 5,225 5,558 6,122 5,827 507.6 455.8 479.3 521.7 496.6

Detroit-Warren-Livonia, MI 12,883 13,008 17,145 16,172 13,096 559.6 565.6 744.1 703.4 569.6

Hartford-West Hartford-East Hartford, CT 2,749 2,510 2,331 2,842 2,786 456.8 413.6 381.9 464.3 455.1

Houston-Baytown-Sugar Land, TX 12,490 11,325 12,258 11,539 12,178 499.8 446.0 473.1 437.0 461.2

Indianapolis, IN 5,188 5,337 5,167 5,949 5,596 645.7 656.5 625.9 712.5 670.3

Jacksonville, FL 3,403 4,051 3,759 4,021 4,273 564.6 658.1 600.4 630.6 670.1

Kansas City, MO-KS 5,022 5,434 5,993 5,930 5,791 520.3 559.4 611.3 598.8 584.8

Las Vegas-Paradise, NV 3,363 3,318 3,820 4,319 5,014 449.5 428.5 471.0 513.8 596.5

Los Angeles-Long Beach-Santa Ana, CA 31,411 33,124 32,903 36,044 35,826 488.6 511.9 504.6 552.9 549.5

Louisville, KY-IN 2,245 2,144 1,817 2,232 2,344 369.1 351.2 295.1 360.6 378.7

Memphis, TN-MS-AR 5,258 5,650 6,816 7,150 7,935 823.5 880.2 1,053.0 1,098.1 1,218.6

Miami-Fort Lauderdale-Miami Beach, FL 8,647 9,027 9,610 8,492 9,553 320.4 331.4 347.8 304.2 342.2

Milwaukee-Waukesha-West Allis, WI 6,829 6,756 7,358 7,558 7,761 877.5 868.3 945.2 973.0 999.1

Minneapolis-St. Paul-Bloomington, MN-WI 5,441 5,792 5,892 6,022 6,462 352.2 371.9 374.8 380.0 407.7

Nashville-Davidson-Murfreesboro, TN 2,385 2,834 3,018 3,122 3,413 345.9 406.9 426.5 433.4 473.8

New Orleans-Metairie-Kenner, LA 4,870 5,736 5,433 3,563 2,673 710.6 836.7 791.6 519.8 390.0

New York-Newark-Edison, NY-NJ-PA 38,786 40,956 41,039 42,214 45,007 401.5 423.7 423.4 435.0 463.8

Oklahoma City, OK 3,224 3,301 3,057 3,744 3,394 565.2 573.5 527.5 638.7 579.0

Orlando, FL 3,521 3,852 3,993 4,667 5,326 396.6 421.9 424.0 477.4 544.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 15,523 18,707 18,369 18,236 19,813 520.2 625.3 611.6 605.3 657.6

Phoenix-Mesa-Scottsdale, AZ NA 6,303 8,555 9,338 11,859 NA 353.6 464.3 487.7 619.4

Pittsburgh, PA 4,081 4,191 4,185 4,398 4,267 323.7 333.7 334.6 354.2 343.7

Portland-Vancouver-Beaverton, OR-WA 3,036 3,332 3,555 3,816 3,769 299.4 325.2 343.2 363.1 358.6

Providence-New Bedford-Fall River, RI-MA 2,621 2,784 3,138 3,225 2,967 313.0 331.0 372.1 384.3 353.5

Richmond, VA 3,532 3,421 3,573 3,425 3,617 607.0 582.6 601.2 566.7 598.5

Riverside-San Bernardino-Ontario, CA 7,827 8,122 8,252 9,257 9,426 445.7 445.9 435.4 474.3 483.0

Rochester, NY 1,876 2,990 2,869 2,670 2,890 350.2 558.8 536.9 501.5 542.8

Sacramento-Arden-Arcade-Roseville, CA 4,200 4,603 5,326 5,890 6,614 427.6 458.6 519.5 567.4 637.1

Salt Lake City, UT 1,473 1,574 1,501 1,709 1,941 298.1 316.8 298.1 334.4 379.8

San Antonio, TX 5,168 5,985 6,182 6,105 6,232 565.8 644.1 653.1 633.1 646.2

San Diego-Carlsbad-San Marcos, CA 7,285 7,694 7,908 8,210 8,620 504.0 528.8 542.6 565.1 593.3

San Francisco-Oakland-Fremont, CA 8,560 8,824 9,151 9,217 10,418 404.9 420.4 436.4 439.6 496.9

San Jose-Sunnyvale-Santa Clara, CA 3,239 3,465 4,038 3,752 4,128 377.2 406.0 471.7 435.6 479.3

Seattle-Tacoma-Bellevue, WA 5,946 6,606 6,775 7,411 6,915 379.0 419.5 427.2 462.5 431.5

St. Louis, MO-IL 7,411 8,179 9,086 9,804 9,952 524.3 577.7 636.1 683.2 693.5

Tampa-St. Petersburg-Clearwater, FL 5,138 4,846 4,920 5,184 5,936 399.4 371.1 369.1 380.8 436.1

Virginia Beach-Norfolk-Newport News, VA-NC 5,039 5,378 5,862 6,016 6,651 616.7 648.6 704.2 720.5 796.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 9,490 9,065 11,170 10,086 11,722 368.3 347.6 424.8 378.3 439.7

U.S. MSA TOTAL 359,003 384,513 399,877 414,784 432,983 464.7 483.1 497.5 511.3 533.8

Table 8. Chlamydia — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow

MSA-specific case counts and rates to be determined for some jurisdictions for some years.
104 Chlamydia Tables STD Surveillance 2006

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 3,411 3,526 3,187 3,463 4,574 152.3 154.3 136.3 141.8 187.3

Austin-Round Rock, TX 920 1,026 1,093 1,357 2,147 134.2 146.0 151.6 183.2 289.8

Baltimore-Towson, MD 1,505 1,627 1,908 2,139 2,250 120.1 129.1 150.0 167.0 175.6

Birmingham-Hoover, AL 850 361 810 1,005 1,058 165.4 69.8 155.1 191.0 201.1

Boston-Cambridge-Quincy, MA-NH 1,839 2,097 2,449 2,697 2,762 85.5 97.4 114.0 125.8 128.8

Buffalo-Cheektowaga-Tonawanda, NY 793 836 1,167 1,164 1,229 142.1 150.1 210.4 210.8 222.6

Charlotte-Gastonia-Concord, NC-SC 721 700 770 951 887 104.1 98.9 106.1 126.9 118.4

Chicago-Naperville-Joliet, IL-IN-WI 11,860 9,542 8,602 10,075 10,905 260.8 208.5 186.7 217.3 235.2

Cincinnati-Middletown, OH-KY-IN 1,117 1,268 1,239 1,746 1,691 112.5 127.0 123.4 172.6 167.2

Cleveland-Elyria-Mentor, OH 1,758 1,875 1,904 1,986 1,953 170.9 182.8 185.7 194.6 191.3

Columbus, OH 1,730 1,174 1,058 1,377 1,272 212.0 142.5 126.6 163.4 150.9

Dallas-Fort Worth-Arlington, TX 3,178 3,179 3,192 3,346 3,558 116.1 113.6 111.8 114.6 121.9

Denver-Aurora, CO 2,173 1,814 2,210 2,412 2,107 190.2 157.1 188.8 203.3 177.6

Detroit-Warren-Livonia, MI 3,635 3,063 4,233 4,256 4,027 166.6 140.3 193.4 194.4 183.9

Hartford-West Hartford-East Hartford, CT 786 714 708 973 1,013 138.8 125.0 123.3 168.9 175.8

Houston-Baytown-Sugar Land, TX 2,423 2,185 2,504 1,930 2,449 97.4 86.1 96.7 73.1 92.8

Indianapolis, IN 2,053 1,906 1,744 2,242 2,167 266.2 243.6 219.1 278.3 269.0

Jacksonville, FL 1,027 1,149 1,258 1,225 1,309 178.7 195.6 209.9 200.6 214.3

Kansas City, MO-KS 984 1,671 2,010 1,970 2,034 106.5 179.0 212.7 205.8 212.5

Las Vegas-Paradise, NV 1,081 1,051 1,233 1,301 1,576 139.7 131.0 146.9 149.6 181.2

Los Angeles-Long Beach-Santa Ana, CA 12,001 13,161 13,208 14,585 14,921 190.0 207.0 206.2 227.7 233.0

Louisville, KY-IN 546 626 572 909 961 95.0 108.0 97.8 154.2 163.0

Memphis, TN-MS-AR 1,123 1,712 2,111 2,307 2,289 189.7 286.6 350.1 378.3 375.4

Miami-Fort Lauderdale-Miami Beach, FL 2,220 1,997 2,171 1,911 2,588 87.6 77.9 83.5 72.6 98.4

Milwaukee-Waukesha-West Allis, WI 2,441 2,486 2,711 2,804 2,720 332.5 337.7 367.7 380.9 369.5

Minneapolis-St. Paul-Bloomington, MN-WI 2,237 2,289 2,247 2,491 2,809 148.2 150.0 145.5 159.9 180.3

Nashville-Davidson-Murfreesboro, TN 787 1,147 1,225 1,415 1,497 118.6 170.0 178.0 201.5 213.2

New Orleans-Metairie-Kenner, LA 1,317 1,355 1,327 1,100 676 209.1 214.4 209.6 173.5 106.6

New York-Newark-Edison, NY-NJ-PA 8,086 10,437 11,125 15,890 17,301 90.4 116.3 123.4 175.7 191.3

Oklahoma City, OK 925 823 882 1,054 1,233 167.9 147.7 156.2 184.7 216.1

Orlando, FL 802 821 895 1,195 1,252 92.8 92.3 97.3 125.0 131.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,465 6,628 6,915 6,677 7,600 197.5 238.3 247.2 237.6 270.4

Phoenix-Mesa-Scottsdale, AZ NA 1,779 2,521 2,646 3,410 NA 98.2 134.6 135.7 174.8

Pittsburgh, PA 1,191 1,296 1,353 1,482 1,522 102.9 112.3 117.6 129.5 133.0

Portland-Vancouver-Beaverton, OR-WA 1,327 1,371 1,701 1,820 1,885 132.4 135.0 165.4 174.2 180.4

Providence-New Bedford-Fall River, RI-MA 951 930 1,126 1,085 1,223 122.6 118.9 143.3 138.5 156.1

Richmond, VA 852 1,045 1,348 1,281 1,423 156.5 189.6 240.7 224.2 249.1

Riverside-San Bernardino-Ontario, CA 2,248 2,563 2,654 2,913 3,029 127.8 140.7 139.8 148.8 154.7

Rochester, NY 577 1,152 1,171 1,180 1,278 113.8 227.6 230.9 232.9 252.3

Sacramento-Arden-Arcade-Roseville, CA 1,299 1,588 1,901 2,220 2,431 137.0 163.5 191.7 221.1 242.1

Salt Lake City, UT 685 689 722 933 969 136.2 135.5 140.1 178.2 185.1

San Antonio, TX 1,193 1,225 1,460 1,942 2,104 136.6 137.4 160.9 209.8 227.3

San Diego-Carlsbad-San Marcos, CA 2,641 2,715 2,844 3,022 3,134 180.7 184.0 192.9 204.1 211.7

San Francisco-Oakland-Fremont, CA 3,638 3,908 4,370 4,686 5,058 176.2 189.9 212.4 227.9 246.0

San Jose-Sunnyvale-Santa Clara, CA 1,171 1,315 1,628 1,575 1,723 132.9 149.2 183.9 176.2 192.8

Seattle-Tacoma-Bellevue, WA 2,551 2,851 2,880 3,177 2,863 163.8 182.0 182.2 198.5 178.8

St. Louis, MO-IL 1,807 1,902 2,770 3,524 3,557 137.4 144.1 207.4 262.3 264.7

Tampa-St. Petersburg-Clearwater, FL 1,184 1,156 1,076 1,131 1,535 98.3 94.3 85.7 87.9 119.3

Virginia Beach-Norfolk-Newport News, VA-NC 1,098 1,276 1,724 2,375 2,481 138.0 157.9 212.4 292.4 305.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,197 2,120 2,848 2,706 3,637 89.7 85.4 113.5 106.2 142.7

U.S. MSA TOTAL 108,404 115,127 124,765 139,651 150,077 146.3 150.2 160.9 178.2 191.5

Table 9. Chlamydia — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow

MSA-specific case counts and rates to be determined for some jurisdictions for some years.
STD Surveillance 2006 Chlamydia Tables 105

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2002

10-14 15,294 1,076 14,218 72.4 9.9 137.9

15-19 299,863 42,433 257,429 1,471.6 405.2 2,599.0

20-24 305,400 66,991 238,408 1,510.9 647.3 2,417.1

25-29 116,422 32,497 83,925 613.7 337.1 899.3

30-34 50,339 16,847 33,492 240.2 159.5 322.2

35-39 23,411 9,298 14,113 106.8 84.9 128.8

40-44 11,405 5,122 6,283 49.6 44.9 54.2

45-54 7,644 3,652 3,992 19.1 18.6 19.6

55-64 1,451 746 705 5.5 5.8 5.1

65+ 812 296 516 2.3 2.0 2.5

TOTAL 834,503 180,039 654,464 289.4 127.1 446.1

2003

10-14 14,911 1,061 13,849 70.4 9.8 134.0

15-19 310,505 44,331 266,175 1,516.3 421.4 2,672.5

20-24 324,411 71,476 252,936 1,565.1 670.3 2,513.3

25-29 124,890 34,916 89,974 651.6 357.3 957.7

30-34 53,572 17,810 35,762 258.7 170.4 348.7

35-39 24,658 9,772 14,886 115.2 91.1 139.4

40-44 12,287 5,675 6,612 53.5 49.8 57.2

45-54 8,214 4,012 4,202 20.1 20.0 20.2

55-64 1,653 883 770 5.9 6.6 5.3

65+ 776 323 453 2.2 2.2 2.2

TOTAL 877,478 190,723 686,755 301.7 133.3 464.7

2004

10-14 14,817 1,172 13,646 70.1 10.8 132.3

15-19 323,246 48,209 275,036 1,559.3 453.3 2,724.6

20-24 344,159 79,410 264,749 1,641.1 735.1 2,603.7

25-29 137,041 39,374 97,667 700.6 393.9 1,021.0

30-34 56,759 19,353 37,406 277.3 187.1 369.3

35-39 26,486 10,647 15,839 125.8 100.7 151.1

40-44 13,626 6,397 7,229 59.1 55.8 62.4

45-54 9,251 4,602 4,649 22.2 22.5 22.0

55-64 1,885 993 892 6.5 7.1 5.9

65+ 755 335 420 2.1 2.2 2.0

TOTAL 929,462 210,935 718,527 316.5 145.9 481.9

2005

10-14 14,124 1,200 12,924 67.7 11.2 127.0

15-19 336,036 53,734 282,302 1,597.2 498.0 2,754.5

20-24 360,574 86,931 273,643 1,713.9 800.7 2,687.8

25-29 148,059 44,712 103,347 737.9 435.4 1,054.8

30-34 60,065 21,102 38,964 299.2 207.8 392.6

35-39 28,509 11,700 16,809 135.7 110.8 161.0

40-44 14,397 6,940 7,458 63.0 61.0 64.9

45-54 10,105 5,203 4,902 23.8 24.9 22.7

55-64 2,191 1,169 1,021 7.2 8.0 6.5

65+ 885 402 483 2.4 2.6 2.3

TOTAL 976,445 233,553 742,892 329.4 160.0 493.9

2006

10-14 13,601 1,238 12,364 65.2 11.6 121.5

15-19 352,212 58,820 293,392 1,674.1 545.1 2,862.7

20-24 377,798 93,035 284,763 1,795.8 856.9 2,797.0

25-29 161,178 49,369 111,809 803.3 480.8 1,141.2

30-34 63,810 22,558 41,252 317.8 222.2 415.7

35-39 30,947 12,763 18,184 147.4 120.8 174.2

40-44 15,329 7,410 7,919 67.1 65.1 69.0

45-54 11,351 5,818 5,533 26.7 27.8 25.6

55-64 2,411 1,334 1,077 7.9 9.1 6.8

65+ 894 424 469 2.4 2.8 2.2

TOTAL 1,030,911 253,236 777,675 347.8 173.4 517.0

Table 10. Chlamydia — Reported cases and rates per 100,000 population by age group and sex: United

States, 2002–2006

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
106 Chlamydia Tables STD Surveillance 2006

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2002

10-14 3,349 94 3,255 8,245 665 7,580 2,308 234 2,074 160 6 153 291 13 278

15-19 87,116 8,455 78,660 138,051 22,908 115,143 48,145 7,609 40,536 3,927 479 3,448 5,158 698 4,461

20-24 91,120 17,951 73,169 130,338 31,430 98,908 56,493 12,380 44,113 5,821 1,137 4,684 5,089 847 4,242

25-29 29,455 7,780 21,674 47,920 15,117 32,803 27,621 6,808 20,813 2,922 709 2,213 2,175 434 1,741

30-34 11,867 3,978 7,889 20,437 8,111 12,326 12,636 3,259 9,377 1,621 446 1,176 1,067 214 853

35-39 5,723 2,500 3,223 9,450 4,329 5,121 5,554 1,611 3,943 833 224 610 574 146 428

40-44 2,892 1,422 1,469 4,821 2,503 2,319 2,350 740 1,609 446 114 332 332 89 243

45-54 2,129 1,165 964 3,142 1,690 1,452 1,404 435 970 384 130 253 198 57 141

55-64 410 282 128 580 309 271 269 88 182 82 23 59 36 10 26

65+ 226 68 158 376 166 210 141 37 104 20 7 13 10 4 7

TOTAL 234,839 43,913 190,925 364,513 87,744 276,769 157,458 33,453 124,005 16,276 3,300 12,976 14,981 2,538 12,444

2003

10-14 3,336 116 3,219 8,320 721 7,600 2,210 166 2,044 145 7 139 302 19 283

15-19 93,457 8,820 84,637 147,549 25,606 121,944 48,899 7,407 41,493 4,071 445 3,627 5,517 815 4,702

20-24 103,138 20,467 82,671 138,950 34,080 104,871 58,996 12,572 46,424 6,046 1,156 4,890 5,428 1,001 4,427

25-29 33,634 9,219 24,415 52,640 16,408 36,232 28,313 6,876 21,437 3,120 810 2,310 2,385 477 1,908

30-34 13,149 4,309 8,839 22,401 8,645 13,756 13,001 3,502 9,499 1,830 493 1,337 1,066 238 828

35-39 6,091 2,586 3,505 10,340 4,799 5,541 5,728 1,644 4,084 876 252 624 630 158 472

40-44 3,331 1,689 1,642 5,339 2,859 2,480 2,355 733 1,622 434 124 310 339 75 264

45-54 2,420 1,347 1,073 3,440 1,879 1,561 1,418 454 964 378 131 247 210 55 155

55-64 524 326 198 635 361 273 293 113 180 89 33 56 51 15 36

65+ 277 112 165 301 144 158 130 37 93 22 14 8 17 3 14

TOTAL 259,808 49,115 210,693 390,660 95,741 294,918 161,629 33,576 128,053 17,042 3,469 13,573 15,964 2,859 13,105

2004

10-14 3,199 122 3,076 8,504 759 7,745 2,152 222 1,929 135 5 130 266 31 236

15-19 95,195 9,468 85,727 157,398 28,143 129,255 49,457 7,769 41,688 3,900 485 3,415 5,551 776 4,774

20-24 109,590 22,268 87,322 149,743 38,420 111,322 59,885 13,482 46,403 6,232 1,291 4,941 5,820 1,176 4,644

25-29 37,871 10,560 27,311 58,590 18,657 39,933 29,424 7,409 22,014 3,159 802 2,357 2,614 549 2,065

30-34 13,869 4,596 9,273 24,171 9,671 14,499 13,326 3,572 9,754 1,863 502 1,361 1,209 287 922

35-39 6,553 2,748 3,806 11,323 5,277 6,047 5,927 1,777 4,150 967 324 643 646 161 486

40-44 3,815 1,947 1,868 5,900 3,148 2,753 2,532 829 1,703 499 164 335 332 90 242

45-54 2,543 1,360 1,182 4,190 2,322 1,868 1,416 501 915 471 178 294 265 82 183

55-64 593 363 231 790 444 346 292 118 174 88 26 62 40 8 33

65+ 253 116 137 281 140 140 118 37 81 27 9 17 19 7 12

TOTAL 273,854 53,669 220,186 421,608 107,202 314,407 164,762 35,786 128,976 17,358 3,791 13,568 16,787 3,174 13,613

2005

10-14 2,986 126 2,860 7,355 723 6,631 2,069 183 1,886 112 14 98 332 24 309

15-19 93,876 9,636 84,240 153,777 30,214 123,563 52,224 8,526 43,698 3,761 646 3,115 5,964 882 5,082

20-24 114,066 24,303 89,763 142,156 39,355 102,801 64,259 14,772 49,487 6,315 1,416 4,899 6,148 1,295 4,853

25-29 40,477 11,580 28,897 57,704 19,824 37,879 31,795 8,528 23,267 3,107 896 2,211 2,829 715 2,114

30-34 14,600 4,739 9,861 23,142 9,740 13,402 14,349 4,132 10,217 1,849 638 1,211 1,177 270 906

35-39 7,143 3,024 4,119 10,768 5,300 5,468 6,539 2,001 4,538 1,057 337 720 625 181 444

40-44 3,986 2,045 1,941 5,662 3,148 2,515 2,656 908 1,748 559 213 346 345 92 254

45-54 2,875 1,639 1,236 4,032 2,338 1,693 1,674 575 1,100 443 158 286 240 82 158

55-64 657 408 250 791 467 324 334 123 211 148 47 101 50 21 30

65+ 253 123 130 345 168 177 141 53 87 35 18 17 15 4 12

TOTAL 281,268 57,709 223,559 406,423 111,513 294,910 176,271 39,885 136,386 17,408 4,388 13,020 17,762 3,571 14,191

2006

10-14 2,732 84 2,648 8,187 891 7,296 2,088 233 1,856 98 3 95 309 18 290

15-19 97,442 10,379 87,063 180,893 36,692 144,201 58,312 9,483 48,829 3,387 413 2,974 6,259 1,016 5,243

20-24 120,835 26,260 94,575 164,045 45,448 118,597 71,991 16,675 55,316 5,836 1,129 4,707 6,646 1,309 5,337

25-29 46,643 13,506 33,137 67,691 23,107 44,584 36,568 9,968 26,600 3,206 826 2,381 3,103 708 2,395

30-34 16,327 5,518 10,809 26,296 11,044 15,253 16,281 4,596 11,685 1,876 523 1,354 1,421 329 1,092

35-39 8,102 3,265 4,837 12,686 6,367 6,319 7,570 2,319 5,251 998 292 706 709 171 538

40-44 4,253 2,131 2,122 6,436 3,639 2,797 3,211 1,157 2,054 633 197 437 413 106 307

45-54 3,296 1,792 1,504 5,049 2,901 2,148 1,938 695 1,242 486 190 296 271 82 189

55-64 796 474 322 943 588 355 392 157 234 133 47 86 64 16 48

65+ 285 147 139 337 177 161 176 56 119 26 14 12 28 6 22

TOTAL 301,064 63,675 237,389 473,235 131,077 342,159 198,783 45,432 153,351 16,701 3,640 13,061 19,267 3,773 15,493

Table 11A. Chlamydia — Reported cases by race/ethnicity, age group and sex: United States, 2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded: 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI). Differences between total

cases from this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not shown

because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2006 Chlamydia Tables 107

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 27.4 1.5 54.7 266.2 42.3 496.7 67.9 13.5 125.0 20.2 1.6 39.7 128.8 11.3 249.7

2002

15-19 715.7 135.2 1,329.6 4,887.6 1,595.0 8,294.0 1,566.1 475.4 2,751.1 489.7 117.4 875.6 2,356.2 624.1 4,164.2

20-24 772.3 300.6 1,255.8 4,847.2 2,371.6 7,252.9 1,626.9 645.4 2,838.4 647.3 255.0 1,033.5 2,665.7 874.5 4,512.4

25-29 274.7 144.0 407.6 2,066.4 1,365.9 2,706.0 765.5 343.7 1,278.6 281.0 141.1 411.8 1,346.7 534.8 2,167.7

30-34 95.4 63.5 127.7 831.5 697.2 952.2 368.7 177.3 590.3 144.0 81.7 202.5 647.3 260.2 1,032.3

35-39 41.9 36.5 47.3 367.6 358.1 376.1 184.3 101.5 276.4 81.9 45.4 116.3 329.7 171.2 482.5

40-44 19.0 18.7 19.3 185.2 205.0 167.6 92.7 56.7 131.0 47.6 25.6 67.6 183.8 102.2 259.6

45-54 7.6 8.4 6.9 75.3 87.7 64.7 40.2 24.9 55.4 24.4 17.9 30.0 66.5 39.6 91.2

55-64 2.1 3.0 1.3 24.5 29.4 20.6 14.3 9.8 18.3 9.0 5.4 12.1 20.5 11.6 28.7

65+ 0.8 0.6 1.0 13.9 16.1 12.6 7.5 4.6 9.6 2.2 1.8 2.4 6.6 5.6 7.4

TOTAL 126.9 48.4 202.2 1,087.8 550.3 1,575.9 423.4 174.3 688.8 140.4 59.1 216.0 644.8 221.6 1,056.2

10-14 26.8 1.8 53.1 257.1 43.8 477.2 63.5 9.3 120.3 18.1 1.6 35.6 132.8 16.1 252.4

2003

15-19 747.8 137.3 1,393.3 5,004.5 1,711.0 8,399.4 1,586.1 463.0 2,797.2 502.0 106.7 919.6 2,472.4 717.0 4,295.6

20-24 836.7 327.1 1,362.2 4,926.4 2,426.8 7,405.0 1,662.2 640.1 2,928.8 641.0 243.0 1,046.1 2,692.8 977.9 4,462.0

25-29 305.2 165.7 447.3 2,176.4 1,414.5 2,878.6 788.7 347.7 1,329.4 293.1 154.6 427.0 1,440.8 573.2 2,318.3

30-34 105.8 68.9 143.3 888.2 723.6 1,036.4 384.8 192.9 607.5 155.2 85.5 222.0 642.5 288.1 995.1

35-39 45.0 38.1 52.0 400.5 395.1 405.2 191.4 103.6 290.4 84.2 49.7 116.9 369.1 188.7 543.4

40-44 21.6 22.0 21.3 199.9 228.9 174.4 91.2 54.8 130.3 44.7 26.5 61.6 185.1 84.6 279.1

45-54 8.4 9.4 7.4 77.8 92.0 65.6 39.4 25.2 53.6 23.0 17.2 28.1 67.8 37.3 95.8

55-64 2.5 3.2 1.8 25.0 31.9 19.4 14.9 12.2 17.4 9.0 7.2 10.6 27.4 16.9 37.0

65+ 1.0 0.9 1.0 10.8 13.4 9.1 6.7 4.5 8.3 2.2 3.2 1.4 10.6 4.9 14.9

TOTAL 136.7 52.7 217.4 1,122.3 577.4 1,617.9 428.2 172.3 701.5 141.6 59.4 219.1 672.2 244.4 1,087.2

10-14 26.0 1.9 51.5 263.3 46.3 487.3 59.8 12.1 109.8 16.6 1.2 32.9 119.7 27.2 214.2

2004

15-19 757.4 146.7 1,402.3 5,217.4 1,840.6 8,687.4 1,562.2 474.9 2,725.0 475.0 114.9 856.3 2,467.3 677.8 4,323.7

20-24 878.2 350.5 1,425.4 5,215.0 2,673.0 7,762.9 1,677.8 686.3 2,891.6 658.5 269.6 1,056.5 2,790.5 1,113.2 4,512.3

25-29 337.6 186.4 491.8 2,351.1 1,553.3 3,093.3 794.8 361.4 1,332.5 294.5 152.1 432.4 1,541.8 641.3 2,459.7

30-34 114.9 75.6 154.7 963.4 813.6 1,098.2 381.1 189.7 604.4 153.2 84.3 219.2 734.2 350.3 1,115.4

35-39 49.9 41.7 58.2 447.4 442.3 452.0 191.9 108.1 287.2 89.7 61.7 116.4 389.7 196.4 578.0

40-44 24.9 25.5 24.4 219.1 249.9 192.0 93.0 58.5 130.3 49.4 33.7 64.1 180.0 100.9 254.4

45-54 8.7 9.4 8.0 92.2 110.6 76.4 37.3 26.3 48.4 27.7 22.3 32.4 83.8 54.0 111.0

55-64 2.7 3.4 2.1 29.6 37.3 23.4 14.0 11.8 15.9 8.3 5.2 11.0 20.5 8.0 31.9

65+ 0.9 1.0 0.8 9.9 12.9 8.0 5.8 4.3 6.8 2.5 2.1 2.9 11.1 9.9 11.9

TOTAL 143.6 57.4 226.7 1,196.6 638.4 1,704.8 421.4 177.1 682.4 139.8 62.9 212.3 699.9 268.8 1,117.9

10-14 25.6 2.1 50.5 251.4 48.7 460.9 57.2 9.9 106.8 14.8 3.6 26.7 157.4 22.1 295.9

2005

15-19 766.1 153.2 1,412.8 5,348.8 2,073.2 8,716.3 1,613.2 511.2 2,784.1 492.4 164.2 840.9 2,665.3 775.9 4,617.5

20-24 938.3 391.5 1,508.7 5,324.4 2,927.8 7,754.4 1,854.2 782.9 3,134.6 727.6 321.8 1,144.8 2,920.5 1,215.3 4,669.1

25-29 364.1 206.5 524.5 2,432.2 1,722.3 3,101.1 855.5 414.0 1,404.5 307.6 180.5 430.5 1,635.7 817.9 2,472.6

30-34 130.1 83.9 176.8 1,028.3 911.8 1,133.5 409.4 219.0 631.4 159.6 112.7 204.4 738.5 340.3 1,135.0

35-39 57.1 48.1 66.2 467.7 487.3 450.1 208.5 119.9 309.5 100.7 65.9 133.7 390.9 229.4 548.5

40-44 27.4 28.2 26.7 229.3 272.4 191.5 95.5 62.6 131.2 58.6 46.1 70.2 193.8 106.0 276.6

45-54 10.0 11.5 8.5 93.1 116.9 72.8 42.2 28.7 55.9 27.5 20.9 33.4 75.5 54.2 94.9

55-64 3.0 3.8 2.2 30.1 39.8 22.3 15.1 11.7 18.2 14.4 10.0 18.2 24.8 21.2 28.1

65+ 0.9 1.0 0.8 12.6 16.0 10.5 6.6 5.9 7.1 3.6 4.4 3.0 8.8 4.8 11.8

TOTAL 151.7 63.4 236.7 1,234.3 709.9 1,712.6 444.5 194.9 710.5 148.4 77.0 215.9 747.0 305.3 1,174.6

10-14 22.1 1.3 44.0 249.2 53.4 451.2 55.4 12.1 100.8 12.0 0.7 23.9 144.2 17.0 274.5

2006

15-19 750.5 155.7 1,378.4 5,617.5 2,249.7 9,073.9 1,725.0 544.1 2,981.6 413.1 97.8 748.3 2,759.8 881.1 4,703.1

20-24 941.6 400.7 1,506.3 5,477.3 3,014.8 7,973.0 1,977.5 839.0 3,346.6 629.8 240.1 1,031.2 3,113.2 1,209.8 5,067.9

25-29 397.0 227.9 569.1 2,515.0 1,772.2 3,212.8 930.8 456.3 1,525.5 295.6 154.9 431.4 1,765.0 795.5 2,758.1

30-34 136.8 91.9 182.2 1,024.2 908.1 1,128.8 439.5 229.8 685.7 149.1 84.9 210.4 875.7 405.5 1,344.5

35-39 60.8 48.7 72.9 483.9 515.1 456.1 228.4 131.1 339.6 87.4 52.5 120.8 434.9 212.0 652.8

40-44 27.5 27.6 27.4 229.8 278.1 187.5 109.3 75.5 146.3 61.1 39.1 81.8 227.6 119.8 329.3

45-54 10.8 11.8 9.8 103.6 129.0 81.9 46.4 33.0 60.1 28.0 23.3 32.1 83.6 53.2 111.3

55-64 3.4 4.2 2.7 31.9 44.6 21.7 16.8 14.2 19.3 12.1 9.2 14.6 31.1 16.2 44.6

65+ 1.0 1.2 0.8 11.0 15.1 8.5 7.9 5.9 9.3 2.6 3.2 2.1 15.6 7.7 21.6

TOTAL 153.1 66.0 237.0 1,275.0 741.2 1,760.9 477.0 211.0 761.3 132.1 59.2 201.2 797.3 317.3 1,262.3

Table 11B. Chlamydia — Rates per 100,000 population by race/ethnicity, age group and sex: United States,

2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded: 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI). Differences between total rates from this table and others

in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not shown because some of these cases may not be due

to sexual transmission; however, they are included in the totals.
108 Gonorrhea Tables STD Surveillance 2006

Rank* State/Area Cases Rate per 100,000 Population

1 Mississippi 7,511 257.1

2 South Carolina 10,320 242.5

3 Louisiana 10,883 240.6

4 Alabama 10,665 234.0

5 Georgia 19,669 216.8

6 North Carolina 17,312 199.4

7 Delaware 1,485 176.0

8 Missouri 10,204 175.9

9 Ohio 19,190 167.4

10 Tennessee 9,694 162.6

11 Illinois 20,186 158.2

12 Arkansas 4,306 154.9

13 Michigan 15,677 154.9

14 Oklahoma 4,951 139.5

15 Indiana 8,732 139.2

16 Florida 23,976 134.8

17 Texas 30,449 133.2

18 Maryland 7,328 130.8

19 Wisconsin 6,927 125.1

U.S. TOTAL† 358,366 120.9

20 Nevada 2,791 115.6

21 Arizona 5,949 100.2

22 Alaska 630 94.9

23 California 33,740 93.4

24 Pennsylvania 11,466 92.2

25 New York 17,459 90.7

26 New Mexico 1,733 89.9

27 Virginia 6,476 85.6

28 Nebraska 1,433 81.5

29 Kansas 2,210 80.5

30 Colorado 3,695 79.2

31 Kentucky 3,277 78.5

32 Connecticut 2,610 74.4

33 Hawaii 885 69.4

34 Washington 4,231 67.3

35 Iowa 1,966 66.3

36 Minnesota 3,303 64.4

37 New Jersey 5,492 63.0

38 West Virginia 953 52.5

39 South Dakota 367 47.3

40 Rhode Island 508 47.2

41 Oregon 1,461 40.1

42 Massachusetts 2,429 38.0

43 Utah 888 36.0

44 North Dakota 153 24.0

45 Wyoming 120 23.6

46 Montana 194 20.7

YEAR 2010 TARGET 19.0

47 Idaho 206 14.4

48 New Hampshire 180 13.7

49 Vermont 72 11.6

50 Maine 137 10.4

Table 12. Gonorrhea — Reported cases and rates by state/area, ranked by rates: United States, 2006

*States were ranked in descending order by rate, number of cases, and alphabetically by state.

†

Total includes cases reported by the District of Columbia with 1,887 cases and a rate of 342.8, but excludes outlying areas (Guam with 98 cases and

rate of 58.1, Puerto Rico with 302 cases and rate of 7.7, and Virgin Islands with 34 cases and rate of 31.3).
STD Surveillance 2006 Gonorrhea Tables 109

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 10,118 9,303 8,206 9,406 10,665 225.5 206.7 181.1 206.4 234.0

Alaska 641 573 567 600 630 99.6 88.3 86.5 90.4 94.9

Arizona 3,795 3,580 4,065 4,951 5,949 69.6 64.1 70.8 83.4 100.2

Arkansas 4,584 4,251 4,137 4,476 4,306 169.1 156.0 150.3 161.1 154.9

California 24,606 25,963 30,155 34,338 33,740 70.1 73.2 84.0 95.0 93.4

Colorado 3,511 2,854 3,054 3,224 3,695 77.9 62.7 66.4 69.1 79.2

Connecticut 3,241 3,114 2,862 2,750 2,610 93.7 89.4 81.7 78.3 74.4

Delaware 1,576 1,128 894 913 1,485 195.2 138.0 107.7 108.2 176.0

District of Columbia 2,669 2,508 2,568 2,146 1,887 467.5 444.4 463.9 389.8 342.8

Florida 21,348 18,974 18,580 20,225 23,976 127.7 111.5 106.8 113.7 134.8

Georgia 18,383 17,686 15,783 15,860 19,669 214.7 203.6 178.8 174.8 216.8

Hawaii 740 1,263 1,193 1,024 885 59.4 100.4 94.5 80.3 69.4

Idaho 94 68 103 119 206 7.0 5.0 7.4 8.3 14.4

Illinois 24,026 21,817 20,597 20,019 20,186 190.7 172.4 162.0 156.8 158.2

Indiana 7,395 6,681 6,851 8,094 8,732 120.1 107.8 109.8 129.1 139.2

Iowa 1,480 1,554 1,249 1,606 1,966 50.4 52.8 42.3 54.1 66.3

Kansas 2,744 2,647 2,542 2,605 2,210 101.0 97.2 92.9 94.9 80.5

Kentucky 3,772 3,578 2,758 2,935 3,277 92.2 86.9 66.5 70.3 78.5

Louisiana 11,387 11,850 10,538 9,572 10,883 254.0 263.5 233.4 211.6 240.6

Maine 142 233 210 142 137 11.0 17.8 15.9 10.7 10.4

Maryland 9,355 8,032 8,297 7,035 7,328 171.4 145.8 149.3 125.6 130.8

Massachusetts 3,242 2,901 3,057 2,537 2,429 50.4 45.1 47.6 39.6 38.0

Michigan 14,770 13,965 17,376 17,684 15,677 147.0 138.5 171.8 174.7 154.9

Minnesota 3,049 3,202 2,957 3,482 3,303 60.7 63.3 58.0 67.8 64.4

Mississippi 6,875 6,328 7,163 7,171 7,511 239.4 219.6 246.7 245.5 257.1

Missouri 8,952 8,792 9,218 9,455 10,204 157.8 154.1 160.2 163.0 175.9

Montana 123 122 88 158 194 13.5 13.3 9.5 16.9 20.7

Nebraska 1,564 1,623 1,147 1,158 1,433 90.4 93.3 65.6 65.8 81.5

Nevada 1,988 2,221 3,078 2,880 2,791 91.5 99.1 131.8 119.3 115.6

New Hampshire 120 125 133 177 180 9.4 9.7 10.2 13.5 13.7

New Jersey 7,894 7,944 6,696 5,722 5,492 91.9 92.0 77.0 65.6 63.0

New Mexico 1,462 1,169 1,306 1,552 1,733 78.8 62.4 68.6 80.5 89.9

New York 21,841 22,166 18,737 17,717 17,459 114.0 115.5 97.5 92.0 90.7

North Carolina 15,531 15,116 15,194 15,072 17,312 186.7 179.8 177.9 173.6 199.4

North Dakota 72 103 110 128 153 11.4 16.3 17.3 20.1 24.0

Ohio 22,008 22,537 20,467 20,985 19,190 192.7 197.1 178.6 183.1 167.4

Oklahoma 4,661 4,552 4,453 5,228 4,951 133.4 129.6 126.4 147.4 139.5

Oregon 909 1,000 1,302 1,562 1,461 25.8 28.1 36.2 42.9 40.1

Pennsylvania 13,294 11,866 11,236 11,222 11,466 107.8 96.0 90.6 90.3 92.2

Rhode Island 900 973 816 438 508 84.1 90.4 75.5 40.7 47.2

South Carolina 9,152 8,518 9,171 8,561 10,320 222.8 205.4 218.5 201.2 242.5

South Dakota 263 226 304 351 367 34.6 29.6 39.4 45.2 47.3

Tennessee 9,348 8,519 8,475 8,605 9,694 161.2 145.8 143.6 144.3 162.6

Texas 26,988 24,595 24,371 26,110 30,449 123.9 111.2 108.4 114.2 133.2

Utah 374 412 603 727 888 16.1 17.5 25.2 29.4 36.0

Vermont 98 97 86 60 72 15.9 15.7 13.8 9.6 11.6

Virginia 10,462 9,066 8,565 8,346 6,476 143.4 122.7 114.8 110.3 85.6

Washington 2,925 2,753 2,810 3,739 4,231 48.2 44.9 45.3 59.5 67.3

West Virginia 974 847 892 770 953 54.1 46.8 49.1 42.4 52.5

Wisconsin 6,341 5,663 5,053 5,869 6,927 116.5 103.5 91.7 106.0 125.1

Wyoming 65 46 59 87 120 13.0 9.2 11.6 17.1 23.6

U.S. TOTAL 351,852 335,104 330,132 339,593 358,366 122.0 115.2 112.4 114.6 120.9

Northeast 50,772 49,419 43,833 40,765 40,353 93.6 90.8 80.3 74.6 73.8

Midwest 92,664 88,810 87,871 91,436 90,348 142.2 135.8 133.7 138.6 136.9

South 167,183 154,851 150,045 152,431 171,142 161.8 148.1 141.6 141.8 159.2

West 41,233 42,024 48,383 54,961 56,523 62.8 63.2 71.8 80.5 82.8

Guam 49 65 114 106 98 30.4 39.7 68.6 62.9 58.1

Puerto Rico 411 276 267 328 302 10.6 7.1 6.9 8.4 7.7

Virgin Islands 49 91 75 30 34 44.5 83.6 68.9 27.6 31.3

OUTLYING AREAS 509 432 456 464 434 12.3 10.4 10.9 11.1 10.4

TOTAL 352,361 335,536 330,588 340,057 358,800 120.5 113.8 111.0 113.1 119.4

Table 13. Gonorrhea — Reported cases and rates by state/area and region listed in alphabetical order: United

States and outlying areas, 2002–2006
110 Gonorrhea Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 4,974 4,583 3,673 4,494 5,983 214.6 197.4 157.4 191.5 255.0

Alaska 353 339 337 349 356 113.6 108.1 106.5 108.9 111.1

Arizona 1,659 1,636 1,787 2,338 2,847 60.8 58.7 62.3 78.8 96.0

Arkansas 2,388 2,108 2,032 2,252 2,182 172.4 151.5 144.7 159.0 154.1

California 10,857 11,912 13,620 15,827 15,688 61.7 67.0 75.8 87.5 86.7

Colorado 1,643 1,529 1,656 1,619 1,879 73.5 67.8 72.6 70.1 81.4

Connecticut 1,910 1,910 1,756 1,590 1,478 107.2 106.6 97.4 88.1 81.9

Delaware 858 602 508 515 829 206.7 143.5 119.3 119.2 191.8

District of Columbia 1,224 1,137 1,293 1,029 808 406.3 381.2 443.1 355.6 279.2

Florida 10,373 9,419 9,371 10,204 12,427 121.4 108.5 105.6 112.6 137.1

Georgia 9,306 9,137 8,119 7,819 10,002 214.3 207.8 181.9 170.5 218.1

Hawaii 394 723 680 619 476 63.5 115.3 107.5 96.8 74.4

Idaho 49 18 42 57 113 7.3 2.6 6.0 8.0 15.9

Illinois 12,273 11,624 11,510 10,998 10,926 191.1 180.4 177.9 169.4 168.3

Indiana 3,996 3,610 3,550 4,453 4,806 127.5 114.6 112.0 139.9 151.0

Iowa 821 869 736 885 1,179 54.9 58.1 49.1 58.8 78.3

Kansas 1,556 1,522 1,565 1,645 1,327 113.4 110.8 113.6 119.1 96.1

Kentucky 1,936 1,845 1,415 1,530 1,709 92.6 87.8 67.0 72.1 80.5

Louisiana 5,861 6,076 5,450 4,761 5,605 253.7 262.6 234.7 204.9 241.2

Maine 44 84 84 61 54 6.6 12.6 12.5 9.0 8.0

Maryland 4,592 4,166 4,327 3,620 3,850 162.9 146.5 150.9 125.4 133.4

Massachusetts 1,579 1,342 1,531 1,320 1,214 47.5 40.4 46.3 40.0 36.8

Michigan 7,974 7,823 9,614 10,161 8,900 155.9 152.5 186.9 197.5 173.0

Minnesota 1,688 1,784 1,712 1,909 1,814 66.7 70.0 66.6 73.9 70.2

Mississippi 4,201 3,757 4,362 4,234 4,400 283.3 253.0 291.9 281.8 292.9

Missouri 4,810 4,794 5,139 5,334 5,752 165.2 164.1 174.6 179.9 194.0

Montana 75 74 54 102 123 16.4 16.1 11.6 21.8 26.2

Nebraska 909 924 656 688 865 103.8 105.0 74.2 77.4 97.3

Nevada 965 1,062 1,417 1,343 1,257 90.5 96.6 123.7 113.3 106.0

New Hampshire 51 57 54 97 97 7.9 8.7 8.2 14.6 14.6

New Jersey 3,958 4,550 3,607 3,077 2,829 89.6 102.6 80.8 68.9 63.3

New Mexico 740 598 749 884 1,003 78.5 62.8 77.4 90.2 102.3

New York 11,141 11,296 9,720 9,031 8,479 112.5 113.9 98.0 91.0 85.4

North Carolina 7,585 7,383 7,384 7,545 8,718 178.9 172.6 170.0 171.0 197.6

North Dakota 40 59 72 76 86 12.6 18.6 22.7 23.8 27.0

Ohio 11,944 12,390 11,144 11,592 10,508 203.5 211.1 189.6 197.3 178.8

Oklahoma 2,566 2,562 2,471 3,018 2,780 144.7 143.9 138.6 168.2 154.9

Oregon 357 389 567 661 609 20.1 21.7 31.4 36.1 33.3

Pennsylvania 7,200 6,644 6,295 6,271 6,219 113.0 104.2 98.5 98.0 97.2

Rhode Island 484 517 478 227 273 87.2 92.7 85.4 40.8 49.1

South Carolina 4,357 4,369 5,007 4,601 5,406 206.3 205.3 232.6 211.0 247.9

South Dakota 148 133 178 196 215 38.6 34.6 45.9 50.2 55.1

Tennessee 4,564 4,263 4,327 4,395 5,104 153.6 142.6 143.5 144.5 167.8

Texas 14,075 12,643 12,433 13,827 15,619 128.5 113.8 110.1 120.5 136.2

Utah 150 153 266 319 369 13.0 13.1 22.4 25.9 30.0

Vermont 56 48 53 26 39 17.8 15.2 16.8 8.2 12.3

Virginia 5,445 4,809 4,650 4,402 3,287 146.7 128.1 122.7 114.5 85.5

Washington 1,197 1,167 1,229 1,622 1,938 39.3 38.0 39.5 51.5 61.5

West Virginia 567 464 470 427 488 61.3 50.0 50.6 46.0 52.6

Wisconsin 3,717 3,299 2,953 3,433 4,047 135.1 119.3 106.1 122.9 144.8

Wyoming 38 28 39 54 71 15.3 11.2 15.5 21.4 28.1

U.S. TOTAL 179,648 174,230 172,142 177,537 187,033 122.5 117.9 115.4 118.0 124.3

Northeast 26,423 26,448 23,578 21,700 20,682 94.4 94.3 83.9 77.2 73.6

Midwest 49,876 48,831 48,829 51,370 50,425 150.3 146.7 146.1 153.2 150.4

South 84,872 79,323 77,292 78,673 89,197 161.1 149.0 143.4 144.0 163.2

West 18,477 19,628 22,443 25,794 26,729 56.2 59.1 66.6 75.6 78.3

Guam 26 39 70 71 49 33.0 48.7 86.0 85.9 59.3

Puerto Rico 230 121 150 194 152 11.5 6.0 7.4 9.5 7.5

Virgin Islands 38 65 48 18 23 64.2 114.3 84.4 31.7 40.5

OUTLYING AREAS 294 225 268 283 224 13.7 10.5 12.4 13.0 10.3

TOTAL 179,942 174,455 172,410 177,820 187,257 120.9 116.4 114.0 116.5 122.7

Table 14. Gonorrhea — Women – Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2002–2006

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2006 Gonorrhea Tables 111

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 5,131 4,705 4,526 4,892 4,678 236.5 215.9 206.1 221.2 211.5

Alaska 288 234 230 251 274 86.5 69.8 67.9 73.1 79.8

Arizona 2,136 1,942 2,274 2,610 3,097 78.4 69.6 79.1 87.8 104.2

Arkansas 2,194 2,141 2,104 2,223 2,122 165.6 160.5 156.0 163.1 155.7

California 13,586 13,965 16,440 18,348 17,856 77.6 78.8 91.8 101.7 99.0

Colorado 1,868 1,325 1,398 1,605 1,816 82.3 57.7 60.2 68.1 77.1

Connecticut 1,331 1,204 1,106 1,160 1,132 79.3 71.2 65.1 68.0 66.4

Delaware 718 526 386 398 656 183.0 132.1 95.4 96.8 159.5

District of Columbia 1,436 1,361 1,269 1,113 1,072 532.5 511.5 484.9 426.2 410.5

Florida 10,975 9,555 9,209 10,021 11,546 134.3 114.6 108.0 114.9 132.3

Georgia 9,013 8,487 7,596 7,885 9,510 213.7 198.0 174.0 175.7 211.9

Hawaii 346 540 513 405 409 55.4 85.6 81.4 63.7 64.3

Idaho 45 50 60 60 92 6.7 7.3 8.6 8.4 12.8

Illinois 11,750 10,192 9,087 9,020 9,260 190.2 164.1 145.5 143.8 147.7

Indiana 3,372 3,040 3,270 3,616 3,895 111.5 99.8 106.6 117.1 126.1

Iowa 658 680 511 721 787 45.6 47.0 35.1 49.4 53.9

Kansas 1,188 1,125 977 960 883 88.4 83.3 71.9 70.4 64.8

Kentucky 1,834 1,727 1,338 1,399 1,561 91.6 85.6 65.8 68.2 76.1

Louisiana 5,466 5,710 5,029 4,744 5,186 251.6 261.6 229.2 215.7 235.8

Maine 98 149 126 81 83 15.6 23.4 19.6 12.5 12.9

Maryland 4,756 3,858 3,969 3,410 3,461 180.2 144.7 147.5 125.7 127.6

Massachusetts 1,663 1,552 1,524 1,216 1,212 53.6 49.9 49.1 39.2 39.1

Michigan 6,796 6,141 7,762 7,468 6,738 137.7 124.0 156.2 150.1 135.4

Minnesota 1,361 1,418 1,245 1,573 1,489 54.7 56.5 49.2 61.7 58.4

Mississippi 2,674 2,571 2,801 2,937 3,111 192.5 184.1 198.8 207.0 219.3

Missouri 4,142 3,998 4,079 4,121 4,452 150.0 143.7 145.1 145.3 157.0

Montana 47 47 33 56 71 10.4 10.3 7.1 12.0 15.2

Nebraska 653 695 488 467 552 76.5 80.9 56.5 53.7 63.5

Nevada 1,022 1,158 1,658 1,535 1,533 92.3 101.4 139.5 124.9 124.7

New Hampshire 69 68 79 80 83 11.0 10.7 12.3 12.4 12.9

New Jersey 3,930 3,389 3,089 2,645 2,657 94.2 80.6 72.9 62.3 62.5

New Mexico 716 567 557 668 730 78.5 61.5 59.5 70.4 77.0

New York 10,688 10,813 8,985 8,680 8,976 115.5 116.6 96.6 93.1 96.2

North Carolina 7,942 7,733 7,810 7,527 8,594 194.6 187.2 186.0 176.2 201.2

North Dakota 32 44 38 52 67 10.1 13.9 12.0 16.4 21.1

Ohio 9,819 9,856 9,046 9,035 8,493 176.8 177.1 162.1 161.7 152.0

Oklahoma 2,095 1,990 1,982 2,210 2,171 121.8 114.9 113.9 126.0 123.8

Oregon 552 611 735 901 852 31.6 34.5 41.1 49.8 47.0

Pennsylvania 6,094 5,214 4,941 4,950 5,247 102.1 87.1 82.2 82.1 87.0

Rhode Island 416 456 338 211 235 80.8 88.0 64.8 40.6 45.2

South Carolina 4,766 4,118 4,136 3,925 4,899 238.9 204.0 202.2 189.2 236.2

South Dakota 115 93 126 155 152 30.4 24.5 32.9 40.2 39.4

Tennessee 4,784 4,256 4,148 4,209 4,590 169.3 149.2 143.7 144.1 157.2

Texas 12,884 11,932 11,902 12,269 14,812 119.0 108.4 106.3 107.7 130.1

Utah 223 259 337 408 519 19.2 21.9 28.1 32.9 41.8

Vermont 42 49 33 34 33 13.9 16.1 10.8 11.1 10.8

Virginia 5,017 4,237 3,904 3,939 3,187 140.1 116.7 106.3 105.8 85.6

Washington 1,728 1,586 1,581 2,117 2,293 57.2 51.9 51.1 67.4 73.0

West Virginia 406 380 421 343 465 46.3 43.0 47.4 38.6 52.3

Wisconsin 2,612 2,341 2,087 2,431 2,870 97.1 86.5 76.5 88.7 104.7

Wyoming 27 18 20 33 49 10.8 7.1 7.8 12.9 19.1

U.S. TOTAL 171,504 160,106 157,303 161,117 170,508 121.1 111.9 108.8 110.4 116.8

Northeast 24,331 22,894 20,221 19,057 19,658 92.7 86.8 76.4 71.8 74.1

Midwest 42,498 39,623 38,716 39,619 39,638 133.0 123.3 119.8 122.1 122.2

South 82,091 75,287 72,530 73,444 81,621 162.1 146.7 139.3 138.9 154.4

West 22,584 22,302 25,836 28,997 29,591 68.9 67.1 76.7 84.9 86.6

Guam 23 26 44 35 49 28.0 31.1 51.9 40.7 57.0

Puerto Rico 181 155 117 134 150 9.7 8.3 6.3 7.1 8.0

Virgin Islands 11 26 27 12 11 21.6 50.0 52.0 23.1 21.2

OUTLYING AREAS 215 207 188 181 210 10.8 10.3 9.4 9.0 10.4

TOTAL 171,719 160,313 157,491 161,298 170,718 119.5 110.5 107.5 109.0 115.3

Table 15. Gonorrhea — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2002–2006

NOTE: Cases reported with unknown sex are not included in this table.
112 Gonorrhea Tables STD Surveillance 2006

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Cook County, IL 12,605 237.7 3

2 Los Angeles County, CA 11,162 112.3 6

3 Wayne County, MI 6,851 342.9 8

4 Harris County, TX 6,193 167.7 10

5 Philadelphia County, PA 5,218 356.6 11

6 Milwaukee County, WI 4,917 533.5 13

7 Dallas County, TX 4,649 201.7 14

8 Cuyahoga County, OH 4,347 325.5 15

9 Fulton County, GA 4,240 463.1 16

10 Marion County, IN 4,157 481.6 17

11 Shelby County, TN 4,113 452.5 19

12 Maricopa County, AZ 3,997 109.9 20

13 Kings County, NY 3,871 155.7 21

14 Baltimore (City), MD 3,332 524.1 22

15 Franklin County, OH 3,105 284.7 23

16 Hamilton County, OH 2,973 368.6 23

17 St Louis (City), MO 2,828 821.2 24

18 San Diego County, CA 2,767 94.3 25

19 Jackson County, MO 2,764 416.9 26

20 Tarrant County, TX 2,760 170.3 27

21 Duval County, FL 2,632 318.5 27

22 Bexar County, TX 2,572 169.4 28

23 De Kalb County, GA 2,571 379.2 29

24 San Francisco County, CA 2,500 338.1 29

25 Clark County, NV 2,478 144.9 30

26 Orange County, FL 2,450 239.5 31

27 New York County, NY 2,405 151.0 31

28 Broward County, FL 2,387 134.3 32

29 Alameda County, CA 2,269 156.6 33

30 St Louis County, MO 2,218 220.8 33

31 Bronx County, NY 2,135 157.3 34

32 Jefferson County, AL 2,122 322.9 35

33 San Bernardino County, CA 2,115 107.7 35

34 Sacramento County, CA 2,087 153.1 36

35 Mecklenburg County, NC 2,073 260.3 36

36 Oklahoma County, OK 2,042 298.3 37

37 Travis County, TX 2,018 227.2 37

38 King County, WA 1,937 108.0 38

39 Miami-Dade County, FL 1,892 79.6 38

40 Washington, DC 1,887 342.8 39

41 Mobile County, AL 1,808 450.4 40

42 Erie County, NY 1,791 192.4 40

43 Hillsborough County, FL 1,759 155.4 41

44 Queens County, NY 1,719 76.7 41

45 Hennepin County, MN 1,688 150.8 41

46 Pinellas County, FL 1,643 177.0 42

47 Genesee County, MI 1,619 364.7 42

48 Allegheny County, PA 1,619 131.0 43

49 Wake County, NC 1,615 215.7 43

50 East Baton Rouge County, LA 1,603 389.6 44

51 Essex County, NJ 1,556 196.7 44

52 Montgomery County, OH 1,510 275.8 45

53 Jefferson County, KY 1,489 212.8 45

54 Prince George’s County, MD 1,486 175.6 45

55 Fresno County, CA 1,485 169.2 46

56 Caddo County, LA 1,435 571.0 46

57 Richland County, SC 1,415 416.1 47

58 Monroe County, NY 1,367 186.4 47

59 Davidson County, TN 1,312 228.1 47

60 Hinds County, MS 1,307 524.2 48

61 Kern County, CA 1,307 172.7 48

62 Kent County, MI 1,302 218.2 48

63 Montgomery County, AL 1,300 586.6 49

64 Charleston County, SC 1,295 392.0 49

65 Denver County, CO 1,281 229.6 50

66 Guilford County, NC 1,085 244.6 50

67 Pulaski County, AR 1,077 293.9 50

68 Palm Beach County, FL 1,077 84.9 50

Table 16. Gonorrhea — Counties and independent cities* ranked by number of reported cases:

United States, 2006

*Accounting for 50% of reported gonorrhea cases.

†

Counties and independent cities were ranked in descending order by number of cases reported in 2006.
STD Surveillance 2006 Gonorrhea Tables 113

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 8,731 8,825 7,355 7,838 10,223 192.8 191.4 156.2 159.4 207.9

Austin-Round Rock, TX 1,656 1,458 1,472 1,706 2,446 122.7 105.8 104.2 117.5 168.4

Baltimore-Towson, MD 6,213 5,382 5,256 4,779 4,653 238.8 205.7 199.2 180.0 175.2

Birmingham-Hoover, AL 2,693 2,212 2,377 2,381 2,444 252.1 206.2 219.6 218.4 224.2

Boston-Cambridge-Quincy, MA-NH 2,191 1,818 1,998 1,684 1,542 49.3 40.9 45.2 38.2 35.0

Buffalo-Cheektowaga-Tonawanda, NY 2,224 1,809 1,670 1,926 2,068 191.2 156.0 144.7 167.8 180.2

Charlotte-Gastonia-Concord, NC-SC 3,146 3,130 2,998 3,330 3,388 223.1 217.8 203.3 218.9 222.7

Chicago-Naperville-Joliet, IL-IN-WI 19,312 17,080 15,684 14,857 15,127 208.0 183.0 167.0 157.3 160.2

Cincinnati-Middletown, OH-KY-IN 4,065 4,206 3,455 3,927 3,862 199.2 205.4 167.9 189.7 186.5

Cleveland-Elyria-Mentor, OH 5,489 5,338 4,472 4,641 4,663 255.6 249.5 209.3 218.3 219.3

Columbus, OH 3,268 2,963 3,004 3,445 3,303 196.9 176.9 177.3 201.6 193.3

Dallas-Fort Worth-Arlington, TX 7,896 7,570 7,119 8,416 8,365 144.0 135.4 124.9 144.6 143.7

Denver-Aurora, CO 2,783 2,136 2,232 2,147 2,253 122.0 92.8 95.8 91.0 95.5

Detroit-Warren-Livonia, MI 8,622 7,173 9,299 10,766 8,535 192.3 160.0 207.0 239.9 190.2

Hartford-West Hartford-East Hartford, CT 1,281 1,030 933 993 988 109.7 87.4 78.8 83.6 83.1

Houston-Baytown-Sugar Land, TX 6,337 5,191 5,525 5,213 7,318 127.1 102.3 106.7 98.7 138.6

Indianapolis, IN 3,660 3,349 3,510 4,142 4,410 232.4 209.9 216.5 252.5 268.8

Jacksonville, FL 3,078 2,574 2,197 2,578 2,954 261.4 214.0 179.3 206.5 236.6

Kansas City, MO-KS 3,827 3,694 3,832 3,769 3,822 202.6 193.9 199.0 193.5 196.2

Las Vegas-Paradise, NV 1,757 1,968 2,645 2,487 2,478 115.4 124.8 160.2 145.4 144.9

Los Angeles-Long Beach-Santa Ana, CA 9,073 9,753 11,103 12,697 12,210 71.2 76.0 85.9 98.2 94.5

Louisville, KY-IN 1,517 1,617 1,484 1,551 1,749 128.3 135.9 123.6 128.3 144.7

Memphis, TN-MS-AR 4,623 3,764 3,832 3,782 4,665 375.7 303.7 306.5 299.9 370.0

Miami-Fort Lauderdale-Miami Beach, FL 4,816 4,455 4,622 4,497 5,356 92.0 84.2 86.2 82.9 98.8

Milwaukee-Waukesha-West Allis, WI 4,687 3,998 3,311 4,031 5,006 309.9 264.0 218.4 266.4 330.9

Minneapolis-St. Paul-Bloomington, MN-WI 2,738 2,781 2,439 2,920 2,780 89.6 90.2 78.3 92.9 88.5

Nashville-Davidson-Murfreesboro, TN 1,764 1,888 1,602 1,474 1,734 130.4 137.7 114.8 103.6 121.9

New Orleans-Metairie-Kenner, LA 3,679 3,956 3,316 2,609 1,962 279.7 300.3 251.3 197.7 148.7

New York-Newark-Edison, NY-NJ-PA 19,507 20,480 16,915 15,533 14,949 104.9 109.9 90.4 82.9 79.7

Oklahoma City, OK 2,090 2,050 2,153 2,548 2,315 186.4 181.0 188.1 220.3 200.1

Orlando, FL 2,502 2,165 2,285 2,848 3,393 142.8 120.1 122.7 147.3 175.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 10,087 8,502 7,818 7,719 8,163 175.4 147.3 134.8 132.6 140.2

Phoenix-Mesa-Scottsdale, AZ NA 2,795 3,161 3,133 4,260 NA 77.8 85.1 81.1 110.2

Pittsburgh, PA 2,472 2,035 1,799 2,157 2,057 102.2 84.4 74.9 90.4 86.2

Portland-Vancouver-Beaverton, OR-WA 818 858 1,173 1,393 1,128 40.6 42.1 56.8 66.5 53.8

Providence-New Bedford-Fall River, RI-MA 1,052 1,136 1,048 650 693 65.2 70.0 64.3 40.1 42.7

Richmond, VA 2,746 2,319 2,160 2,361 1,778 243.8 203.7 187.1 200.8 151.2

Riverside-San Bernardino-Ontario, CA 2,245 2,512 2,631 3,012 2,994 63.9 69.0 69.4 77.0 76.6

Rochester, NY 1,821 1,897 1,900 1,899 1,457 174.6 182.2 182.4 182.8 140.2

Sacramento-Arden-Arcade-Roseville, CA 1,514 1,859 2,066 2,450 2,235 78.4 94.1 102.4 120.0 109.4

Salt Lake City, UT 261 276 371 460 623 26.2 27.5 36.4 44.5 60.2

San Antonio, TX 2,078 2,333 2,183 2,300 2,701 116.3 128.1 117.7 121.7 142.9

San Diego-Carlsbad-San Marcos, CA 2,132 2,007 2,379 2,695 2,767 73.3 68.5 81.1 91.9 94.3

San Francisco-Oakland-Fremont, CA 5,070 4,394 4,967 5,713 6,029 121.3 105.7 119.6 137.6 145.2

San Jose-Sunnyvale-Santa Clara, CA 516 740 1,084 1,055 1,065 29.7 42.7 62.2 60.1 60.7

Seattle-Tacoma-Bellevue, WA 2,288 2,027 1,883 2,704 3,079 73.2 64.5 59.5 84.4 96.1

St. Louis, MO-IL 5,797 5,600 5,719 6,391 6,547 212.4 204.7 206.9 230.0 235.6

Tampa-St. Petersburg-Clearwater, FL 3,679 3,160 2,801 2,910 3,667 147.7 124.8 108.2 109.9 138.5

Virginia Beach-Norfolk-Newport News, VA-NC 4,812 4,201 3,812 3,355 2,544 298.3 256.6 231.8 203.7 154.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,977 5,262 5,803 4,497 4,358 118.9 103.4 112.9 86.2 83.6

U.S. MSA TOTAL 210,590 199,726 194,853 202,369 209,106 139.1 127.8 123.4 126.9 131.1

Table 17. Gonorrhea — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
114 Gonorrhea Tables STD Surveillance 2006

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 3,967 4,177 3,563 3,567 5,026 173.2 179.6 150.3 144.1 203.0

Austin-Round Rock, TX 815 644 692 830 1,134 122.8 95.4 100.1 116.6 159.4

Baltimore-Towson, MD 3,063 2,793 2,710 2,426 2,470 227.0 206.0 198.2 176.5 179.7

Birmingham-Hoover, AL 1,354 1,100 1,060 1,133 1,511 244.3 197.9 189.2 200.9 267.9

Boston-Cambridge-Quincy, MA-NH 1,017 771 937 793 728 44.3 33.7 41.2 35.0 32.1

Buffalo-Cheektowaga-Tonawanda, NY 1,167 974 920 1,079 1,153 192.9 161.7 153.4 181.2 193.6

Charlotte-Gastonia-Concord, NC-SC 1,461 1,492 1,413 1,604 1,584 203.7 204.4 188.6 207.8 205.2

Chicago-Naperville-Joliet, IL-IN-WI 9,585 8,804 8,546 7,948 7,853 202.3 185.1 178.7 165.3 163.4

Cincinnati-Middletown, OH-KY-IN 2,274 2,371 2,038 2,274 2,465 217.0 226.0 193.3 214.8 232.8

Cleveland-Elyria-Mentor, OH 2,688 2,620 2,192 2,264 2,277 240.2 235.3 197.2 204.8 206.0

Columbus, OH 1,746 1,569 1,475 1,896 1,758 206.9 184.5 171.8 219.0 203.1

Dallas-Fort Worth-Arlington, TX 3,979 3,822 3,547 4,135 4,129 144.9 136.9 124.7 142.6 142.3

Denver-Aurora, CO 1,251 1,091 1,144 996 1,044 109.9 95.2 98.7 84.9 89.0

Detroit-Warren-Livonia, MI 4,524 3,807 4,850 6,079 4,613 196.5 165.5 210.5 264.4 200.7

Hartford-West Hartford-East Hartford, CT 749 614 533 520 521 124.5 101.2 87.3 85.0 85.1

Houston-Baytown-Sugar Land, TX 3,189 2,509 2,813 3,016 3,806 127.6 98.8 108.6 114.2 144.1

Indianapolis, IN 1,847 1,659 1,698 2,163 2,297 229.9 204.1 205.7 259.1 275.1

Jacksonville, FL 1,413 1,201 1,083 1,240 1,506 234.4 195.1 173.0 194.5 236.2

Kansas City, MO-KS 1,917 1,890 2,027 2,035 2,099 198.6 194.6 206.8 205.5 212.0

Las Vegas-Paradise, NV 848 931 1,206 1,163 1,123 113.4 120.2 148.7 138.4 133.6

Los Angeles-Long Beach-Santa Ana, CA 3,879 4,371 4,997 5,687 5,657 60.3 67.6 76.6 87.2 86.8

Louisville, KY-IN 722 767 720 740 887 118.7 125.6 116.9 119.6 143.3

Memphis, TN-MS-AR 2,273 1,860 1,926 1,990 2,548 356.0 289.8 297.6 305.6 391.3

Miami-Fort Lauderdale-Miami Beach, FL 2,205 2,114 2,307 2,317 2,708 81.7 77.6 83.5 83.0 97.0

Milwaukee-Waukesha-West Allis, WI 2,713 2,295 1,906 2,298 2,923 348.6 295.0 244.9 295.8 376.3

Minneapolis-St. Paul-Bloomington, MN-WI 1,499 1,508 1,373 1,548 1,486 97.0 96.8 87.3 97.7 93.8

Nashville-Davidson-Murfreesboro, TN 781 873 742 661 794 113.3 125.4 104.9 91.8 110.2

New Orleans-Metairie-Kenner, LA 1,721 1,961 1,606 1,287 965 251.1 286.0 234.0 187.8 140.8

New York-Newark-Edison, NY-NJ-PA 9,755 10,650 8,821 7,784 7,015 101.0 110.2 91.0 80.2 72.3

Oklahoma City, OK 1,142 1,138 1,181 1,486 1,275 200.2 197.7 203.8 253.5 217.5

Orlando, FL 1,212 1,039 1,063 1,286 1,688 136.5 113.8 112.9 131.6 172.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,288 4,593 4,189 4,219 4,257 177.2 153.5 139.5 140.0 141.3

Phoenix-Mesa-Scottsdale, AZ NA 1,254 1,373 1,456 2,014 NA 70.3 74.5 76.0 105.2

Pittsburgh, PA 1,454 1,192 1,063 1,216 1,174 115.3 94.9 85.0 97.9 94.6

Portland-Vancouver-Beaverton, OR-WA 315 331 491 551 436 31.1 32.3 47.4 52.4 41.5

Providence-New Bedford-Fall River, RI-MA 570 603 607 365 374 68.1 71.7 72.0 43.5 44.6

Richmond, VA 1,573 1,260 1,187 1,256 824 270.3 214.6 199.7 207.8 136.3

Riverside-San Bernardino-Ontario, CA 1,129 1,289 1,323 1,572 1,602 64.3 70.8 69.8 80.5 82.1

Rochester, NY 929 982 919 1,006 748 173.4 183.5 172.0 188.9 140.5

Sacramento-Arden-Arcade-Roseville, CA 811 942 1,049 1,307 1,164 82.6 93.9 102.3 125.9 112.1

Salt Lake City, UT 86 91 143 183 246 17.4 18.3 28.4 35.8 48.1

San Antonio, TX 1,083 1,152 1,109 1,155 1,412 118.6 124.0 117.2 119.8 146.4

San Diego-Carlsbad-San Marcos, CA 718 739 936 1,108 1,158 49.7 50.8 64.2 76.3 79.7

San Francisco-Oakland-Fremont, CA 1,857 1,578 1,580 2,052 2,122 87.8 75.2 75.4 97.9 101.2

San Jose-Sunnyvale-Santa Clara, CA 196 328 467 457 488 22.8 38.4 54.6 53.1 56.7

Seattle-Tacoma-Bellevue, WA 853 732 717 1,060 1,300 54.4 46.5 45.2 66.1 81.1

St. Louis, MO-IL 3,174 3,037 3,213 3,638 3,718 224.5 214.5 225.0 253.5 259.1

Tampa-St. Petersburg-Clearwater, FL 1,767 1,498 1,474 1,542 2,064 137.4 114.7 110.6 113.3 151.6

Virginia Beach-Norfolk-Newport News, VA-NC 2,287 2,111 1,990 1,717 1,305 279.9 254.6 239.1 205.6 156.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,762 2,520 2,973 2,269 2,048 107.2 96.6 113.1 85.1 76.8

U.S. MSA TOTAL 103,608 99,647 97,892 102,374 105,497 134.1 125.2 121.8 126.2 130.1

Table 18. Gonorrhea — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
STD Surveillance 2006 Gonorrhea Tables 115

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 4,729 4,616 3,750 4,183 5,083 211.2 202.0 160.4 171.3 208.2

Austin-Round Rock, TX 841 811 768 870 1,310 122.7 115.4 106.5 117.4 176.8

Baltimore-Towson, MD 3,148 2,588 2,546 2,352 2,180 251.3 205.3 200.1 183.6 170.2

Birmingham-Hoover, AL 1,338 1,108 1,316 1,243 932 260.4 214.4 252.1 236.2 177.1

Boston-Cambridge-Quincy, MA-NH 1,174 1,045 1,060 890 812 54.6 48.6 49.4 41.5 37.9

Buffalo-Cheektowaga-Tonawanda, NY 1,057 835 750 847 913 189.3 149.9 135.2 153.4 165.3

Charlotte-Gastonia-Concord, NC-SC 1,682 1,638 1,583 1,726 1,804 242.7 231.5 218.1 230.4 240.8

Chicago-Naperville-Joliet, IL-IN-WI 9,719 8,265 7,122 6,900 7,267 213.7 180.6 154.5 148.8 156.7

Cincinnati-Middletown, OH-KY-IN 1,759 1,804 1,375 1,616 1,373 177.1 180.8 136.9 159.7 135.7

Cleveland-Elyria-Mentor, OH 2,762 2,683 2,236 2,329 2,366 268.4 261.5 218.0 228.2 231.8

Columbus, OH 1,493 1,380 1,509 1,531 1,537 182.9 167.4 180.6 181.6 182.3

Dallas-Fort Worth-Arlington, TX 3,899 3,742 3,560 4,276 4,230 142.4 133.7 124.7 146.5 144.9

Denver-Aurora, CO 1,532 1,045 1,088 1,151 1,209 134.1 90.5 92.9 97.0 101.9

Detroit-Warren-Livonia, MI 4,098 3,365 4,449 4,657 3,890 187.8 154.1 203.2 212.7 177.7

Hartford-West Hartford-East Hartford, CT 532 416 400 473 467 93.9 72.8 69.7 82.1 81.1

Houston-Baytown-Sugar Land, TX 3,144 2,672 2,707 2,194 3,504 126.4 105.3 104.5 83.1 132.7

Indianapolis, IN 1,798 1,680 1,808 1,972 2,106 233.1 214.7 227.1 244.8 261.4

Jacksonville, FL 1,665 1,373 1,114 1,338 1,448 289.6 233.8 185.9 219.1 237.1

Kansas City, MO-KS 1,910 1,804 1,805 1,734 1,723 206.7 193.3 191.0 181.1 180.0

Las Vegas-Paradise, NV 909 1,036 1,436 1,322 1,354 117.4 129.1 171.0 152.0 155.6

Los Angeles-Long Beach-Santa Ana, CA 5,174 5,364 6,084 6,985 6,505 81.9 84.4 95.0 109.1 101.6

Louisville, KY-IN 794 848 761 811 858 138.2 146.3 130.0 137.6 145.5

Memphis, TN-MS-AR 2,350 1,904 1,906 1,792 2,117 396.9 318.7 316.1 293.9 347.2

Miami-Fort Lauderdale-Miami Beach, FL 2,611 2,341 2,315 2,180 2,648 103.1 91.3 89.1 82.9 100.7

Milwaukee-Waukesha-West Allis, WI 1,966 1,682 1,405 1,731 2,080 267.8 228.5 190.6 235.2 282.6

Minneapolis-St. Paul-Bloomington, MN-WI 1,239 1,273 1,066 1,372 1,294 82.1 83.4 69.0 88.1 83.1

Nashville-Davidson-Murfreesboro, TN 983 1,015 860 813 940 148.1 150.4 125.0 115.8 133.9

New Orleans-Metairie-Kenner, LA 1,946 1,988 1,684 1,299 981 308.9 314.6 265.9 204.9 154.8

New York-Newark-Edison, NY-NJ-PA 9,736 9,769 8,063 7,744 7,929 108.9 108.9 89.4 85.6 87.7

Oklahoma City, OK 948 912 972 1,062 1,040 172.1 163.7 172.1 186.1 182.3

Orlando, FL 1,290 1,126 1,222 1,562 1,704 149.2 126.5 132.8 163.4 178.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,799 3,907 3,629 3,500 3,904 173.4 140.5 129.7 124.5 138.9

Phoenix-Mesa-Scottsdale, AZ NA 1,539 1,787 1,676 2,242 NA 85.0 95.4 85.9 114.9

Pittsburgh, PA 1,018 841 736 941 883 88.0 72.8 63.9 82.2 77.2

Portland-Vancouver-Beaverton, OR-WA 503 527 682 842 692 50.2 51.9 66.3 80.6 66.2

Providence-New Bedford-Fall River, RI-MA 482 532 441 285 318 62.1 68.0 56.1 36.4 40.6

Richmond, VA 1,173 1,054 971 1,105 954 215.5 191.3 173.4 193.4 167.0

Riverside-San Bernardino-Ontario, CA 1,116 1,221 1,308 1,440 1,390 63.4 67.1 68.9 73.5 71.0

Rochester, NY 892 915 981 893 709 175.9 180.8 193.4 176.3 140.0

Sacramento-Arden-Arcade-Roseville, CA 698 897 1,002 1,123 1,046 73.6 92.4 101.1 111.8 104.2

Salt Lake City, UT 174 185 228 277 377 34.6 36.4 44.2 52.9 72.0

San Antonio, TX 995 1,181 1,073 1,145 1,289 113.9 132.5 118.2 123.7 139.3

San Diego-Carlsbad-San Marcos, CA 1,336 1,256 1,417 1,500 1,531 91.4 85.1 96.1 101.3 103.4

San Francisco-Oakland-Fremont, CA 3,184 2,797 3,367 3,644 3,882 154.2 135.9 163.7 177.2 188.8

San Jose-Sunnyvale-Santa Clara, CA 310 408 617 597 570 35.2 46.3 69.7 66.8 63.8

Seattle-Tacoma-Bellevue, WA 1,435 1,295 1,166 1,644 1,779 92.2 82.6 73.8 102.7 111.1

St. Louis, MO-IL 2,623 2,563 2,506 2,753 2,829 199.4 194.1 187.6 204.9 210.6

Tampa-St. Petersburg-Clearwater, FL 1,912 1,662 1,327 1,368 1,602 158.8 135.5 105.7 106.3 124.5

Virginia Beach-Norfolk-Newport News, VA-NC 2,525 2,077 1,816 1,636 1,237 317.3 257.0 223.7 201.4 152.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 3,200 2,724 2,822 2,220 2,291 130.7 109.7 112.4 87.1 89.9

U.S. MSA TOTAL 106,601 99,709 96,596 99,544 103,129 143.8 130.1 124.6 127.0 131.6

Table 19. Gonorrhea — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
116 Gonorrhea Tables STD Surveillance 2006

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2002

10-14 5,449 784 4,665 25.8 7.2 45.2

15-19 96,325 29,921 66,404 472.7 285.7 670.4

20-24 112,449 52,130 60,318 556.3 503.7 611.5

25-29 55,480 31,391 24,089 292.4 325.6 258.1

30-34 32,081 20,560 11,521 153.1 194.6 110.8

35-39 21,419 14,878 6,541 97.7 135.8 59.7

40-44 13,791 10,254 3,536 60.0 89.8 30.5

45-54 10,927 8,891 2,036 27.3 45.2 10.0

55-64 2,284 2,019 266 8.6 15.8 1.9

65+ 791 631 159 2.2 4.3 0.8

TOTAL 351,836 171,839 179,997 122.0 121.3 122.7

2003

10-14 4,929 725 4,204 23.3 6.7 40.7

15-19 90,340 27,473 62,867 441.1 261.2 631.2

20-24 106,930 48,222 58,709 515.9 452.2 583.4

25-29 53,692 29,368 24,325 280.1 300.5 258.9

30-34 30,528 19,004 11,524 147.4 181.9 112.4

35-39 20,212 13,824 6,388 94.4 128.9 59.8

40-44 13,722 10,079 3,644 59.8 88.4 31.5

45-54 11,018 8,905 2,113 27.0 44.4 10.2

55-64 2,316 2,012 303 8.3 15.0 2.1

65+ 745 617 128 2.1 4.1 0.6

TOTAL 335,104 160,459 174,645 115.2 112.2 118.2

2004

10-14 4,447 630 3,817 21.0 5.8 37.0

15-19 87,454 26,607 60,847 421.9 250.2 602.8

20-24 103,187 45,917 57,269 492.0 425.0 563.2

25-29 54,857 29,520 25,337 280.4 295.4 264.9

30-34 30,372 18,664 11,708 148.4 180.5 115.6

35-39 19,793 13,350 6,443 94.0 126.3 61.5

40-44 14,026 10,220 3,806 60.8 89.2 32.8

45-54 12,078 9,645 2,433 29.0 47.2 11.5

55-64 2,653 2,286 367 9.1 16.3 2.4

65+ 745 615 130 2.1 4.1 0.6

TOTAL 330,132 157,623 172,509 112.4 109.1 115.7

2005

10-14 4,278 646 3,631 20.5 6.0 35.7

15-19 90,840 27,781 63,060 431.8 257.5 615.3

20-24 106,280 47,187 59,093 505.2 434.6 580.4

25-29 57,195 30,631 26,565 285.0 298.3 271.1

30-34 30,044 18,244 11,800 149.6 179.7 118.9

35-39 19,948 13,413 6,535 95.0 127.0 62.6

40-44 14,346 10,406 3,940 62.8 91.5 34.3

45-54 12,636 10,063 2,573 29.7 48.2 11.9

55-64 2,777 2,399 378 9.1 16.4 2.4

65+ 763 631 132 2.1 4.1 0.6

TOTAL 339,593 161,557 178,036 114.6 110.7 118.4

2006

10-14 4,250 675 3,574 20.4 6.3 35.1

15-19 96,524 30,119 66,405 458.8 279.1 647.9

20-24 110,969 49,304 61,665 527.5 454.1 605.7

25-29 61,843 32,946 28,897 308.2 320.9 294.9

30-34 31,313 18,858 12,455 156.0 185.7 125.5

35-39 20,674 13,813 6,861 98.4 130.8 65.7

40-44 14,534 10,636 3,898 63.6 93.5 33.9

45-54 13,847 11,064 2,782 32.6 53.0 12.9

55-64 3,137 2,686 451 10.3 18.4 2.9

65+ 800 648 152 2.2 4.2 0.7

TOTAL 358,366 170,902 187,464 120.9 117.1 124.6

Table 20. Gonorrhea — Reported cases and rates per 100,000 population by age group and sex: United

States, 2002–2006

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
This page intentionally left blank.
118 Gonorrhea Tables STD Surveillance 2006

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2002

10-14 786 50 736 4,181 665 3,516 412 57 355 28 4 24 41 7 34

15-19 15,055 2,521 12,534 73,130 24,995 48,134 6,809 2,111 4,699 547 122 425 785 170 615

20-24 18,044 5,714 12,330 84,159 41,703 42,456 8,648 4,176 4,473 772 304 468 843 244 599

25-29 9,168 3,917 5,251 40,777 24,593 16,184 4,647 2,470 2,177 501 263 238 390 157 233

30-34 6,450 3,628 2,822 22,223 14,951 7,271 2,820 1,656 1,164 322 207 115 260 117 143

35-39 5,067 3,336 1,731 14,263 10,190 4,073 1,695 1,132 562 214 130 84 175 87 88

40-44 3,386 2,393 993 9,226 7,098 2,128 957 637 320 109 66 44 109 58 51

45-54 2,706 2,089 617 7,460 6,268 1,192 573 408 165 105 74 31 80 51 29

55-64 664 574 90 1,467 1,336 132 125 95 29 23 10 13 4 3 2

65+ 196 155 41 523 428 95 50 35 15 18 11 7 3 3 0

TOTAL 61,671 24,429 37,243 257,986 132,498 125,488 26,829 12,822 14,007 2,646 1,196 1,450 2,704 905 1,800

2003

10-14 789 51 739 3,662 594 3,068 390 71 320 31 3 28 55 7 49

15-19 15,541 2,532 13,009 66,553 22,572 43,980 7,011 2,086 4,924 533 116 417 700 163 537

20-24 19,132 6,097 13,035 77,129 37,552 39,577 9,080 4,085 4,994 840 270 570 767 229 539

25-29 9,891 4,159 5,732 38,142 22,275 15,866 4,787 2,544 2,243 499 250 249 375 146 229

30-34 6,648 3,512 3,136 20,459 13,498 6,961 2,821 1,704 1,117 381 206 175 214 83 131

35-39 5,126 3,314 1,812 12,840 9,130 3,710 1,823 1,160 663 244 139 105 174 80 94

40-44 3,835 2,634 1,201 8,642 6,626 2,016 981 654 327 145 95 49 118 70 48

45-54 2,917 2,169 748 7,268 6,172 1,096 660 467 192 105 64 41 66 32 33

55-64 713 588 125 1,439 1,301 138 123 98 25 31 19 13 8 7 2

65+ 239 196 43 443 379 64 44 29 15 11 7 4 8 6 2

TOTAL 64,961 25,288 39,673 237,038 120,266 116,771 27,793 12,922 14,872 2,823 1,171 1,652 2,489 823 1,666

2004

10-14 678 44 634 3,336 526 2,811 366 48 318 28 5 23 38 7 31

15-19 15,369 2,546 12,822 63,917 21,682 42,234 6,908 2,101 4,807 475 115 359 785 159 626

20-24 19,129 5,909 13,220 73,374 35,351 38,023 8,891 4,017 4,874 868 329 538 939 319 620

25-29 10,539 4,237 6,301 38,013 21,985 16,028 5,387 2,882 2,505 497 262 234 424 159 265

30-34 6,751 3,459 3,293 20,027 13,180 6,847 2,956 1,726 1,230 384 200 184 249 99 150

35-39 5,276 3,277 1,998 12,243 8,667 3,576 1,883 1,178 706 214 143 72 172 84 88

40-44 4,021 2,713 1,307 8,710 6,653 2,058 1,060 736 324 116 75 40 116 40 76

45-54 3,341 2,487 855 7,777 6,523 1,253 746 511 235 103 61 42 110 63 46

55-64 831 695 136 1,615 1,457 158 159 116 43 35 12 23 12 7 5

65+ 219 174 45 472 404 68 42 29 14 3 1 2 8 6 2

TOTAL 66,250 25,585 40,665 229,843 116,537 113,306 28,455 13,360 15,096 2,726 1,205 1,521 2,858 946 1,912

2005

10-14 691 35 655 3,154 549 2,604 355 52 304 25 1 23 45 8 37

15-19 15,758 2,679 13,079 66,165 22,563 43,602 7,299 2,134 5,165 606 176 430 845 196 650

20-24 20,892 6,509 14,383 73,365 35,373 37,991 9,742 4,438 5,303 960 418 542 1,012 344 668

25-29 11,681 4,667 7,013 38,213 22,200 16,013 5,915 3,126 2,790 633 341 293 569 216 353

30-34 6,790 3,405 3,385 19,172 12,540 6,632 3,248 1,830 1,418 405 281 124 314 137 177

35-39 5,384 3,256 2,127 12,004 8,570 3,433 2,009 1,270 739 268 180 88 193 97 97

40-44 4,255 2,863 1,392 8,606 6,593 2,012 1,153 776 377 146 93 53 119 44 75

45-54 3,535 2,668 867 7,993 6,667 1,325 831 561 270 118 79 39 93 46 46

55-64 853 721 132 1,653 1,490 163 191 134 57 44 28 16 24 17 6

65+ 242 203 39 452 386 66 55 36 19 8 4 4 3 1 2

TOTAL 70,209 27,050 43,159 231,076 117,025 114,050 30,845 14,374 16,471 3,214 1,602 1,612 3,225 1,112 2,113

2006

10-14 596 53 543 3,227 549 2,678 367 70 297 23 1 21 36 1 34

15-19 16,038 2,612 13,426 70,992 24,675 46,317 8,055 2,451 5,603 556 125 431 877 251 626

20-24 21,590 6,684 14,906 77,200 37,200 40,000 10,340 4,739 5,601 809 335 474 1,045 356 689

25-29 12,907 5,147 7,760 41,339 23,863 17,477 6,408 3,424 2,985 558 278 280 634 238 396

30-34 6,948 3,313 3,636 20,334 13,363 6,971 3,340 1,861 1,478 365 207 157 325 114 211

35-39 5,570 3,281 2,289 12,565 9,018 3,547 2,097 1,270 827 246 154 93 193 89 103

40-44 4,231 2,800 1,432 8,798 6,831 1,967 1,241 843 398 144 102 42 117 59 59

45-54 3,952 2,875 1,077 8,744 7,427 1,317 896 619 277 125 69 56 128 74 55

55-64 1,019 836 183 1,886 1,699 187 172 116 55 32 14 18 27 19 8

65+ 269 226 44 450 370 80 65 44 21 8 3 5 8 6 2

TOTAL 73,200 27,848 45,353 245,855 125,102 120,753 33,044 15,460 17,584 2,869 1,290 1,579 3,398 1,208 2,189

Table 21A. Gonorrhea — Reported cases by race/ethnicity, age group and sex: United States, 2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. In 2005, HI did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not shown because some of these

cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2006 Gonorrhea Tables 119

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 6.0 0.7 11.5 124.9 39.1 213.2 11.6 3.1 20.6 3.4 1.0 5.9 17.4 5.9 29.2

2002

15-19 115.2 37.5 197.3 2,410.6 1,621.2 3,226.2 213.0 126.8 306.6 64.2 28.1 101.6 346.9 147.5 555.1

20-24 143.4 89.7 198.3 2,927.7 2,942.8 2,913.0 239.8 209.6 277.0 81.4 64.7 97.9 427.4 244.0 616.6

25-29 80.1 67.9 92.6 1,631.8 2,062.7 1,238.6 123.8 119.9 128.5 45.1 49.0 41.5 233.3 186.1 281.2

30-34 48.4 54.1 42.6 834.8 1,187.4 518.3 78.8 86.3 70.2 26.6 35.3 18.4 152.3 137.3 167.3

35-39 34.4 45.3 23.6 514.3 781.9 277.1 53.7 68.2 37.6 19.5 24.4 14.9 96.9 97.9 96.0

40-44 20.7 29.3 12.1 329.1 540.7 142.7 36.1 46.7 24.9 10.9 13.7 8.3 58.0 64.4 52.0

45-54 9.0 14.1 4.1 165.7 301.7 49.2 15.7 22.4 9.0 6.3 9.6 3.4 26.0 34.4 18.1

55-64 3.2 5.6 0.8 57.2 116.9 9.2 6.3 10.2 2.8 2.3 2.1 2.5 2.4 3.2 1.7

65+ 0.7 1.3 0.2 17.9 38.3 5.3 2.5 4.2 1.3 1.8 2.5 1.3 1.9 4.4 0.0

TOTAL 31.0 25.1 36.7 713.7 770.7 662.1 69.2 64.1 74.6 21.4 20.0 22.6 112.5 76.3 147.6

10-14 6.0 0.8 11.6 108.3 34.6 184.4 10.7 3.8 17.9 3.7 0.6 6.9 23.9 5.7 42.7

2003

15-19 118.9 37.7 204.7 2,165.6 1,447.2 2,905.9 215.9 123.8 315.1 62.2 26.3 100.1 307.6 140.7 481.1

20-24 149.1 93.5 206.3 2,614.5 2,558.2 2,670.3 242.4 197.0 298.6 84.8 54.0 116.2 372.7 218.5 532.1

25-29 85.8 71.4 100.4 1,504.2 1,831.3 1,202.6 126.0 121.6 131.5 44.2 45.1 43.4 220.8 170.4 272.0

30-34 51.0 53.5 48.4 771.9 1,074.6 499.2 78.8 88.6 67.4 30.3 33.4 27.3 125.6 98.0 153.2

35-39 36.0 46.4 25.5 472.6 713.9 258.0 57.4 69.0 44.4 22.0 25.8 18.4 99.4 92.8 105.8

40-44 23.7 32.6 14.8 308.0 504.5 135.1 35.8 46.0 24.7 14.0 19.2 9.2 62.8 76.8 49.7

45-54 9.6 14.4 4.9 156.6 287.9 43.9 17.3 24.5 10.1 6.0 7.8 4.4 20.7 21.4 20.0

55-64 3.3 5.5 1.1 53.6 108.9 9.3 5.9 9.8 2.3 3.0 3.9 2.3 4.4 7.3 1.8

65+ 0.8 1.6 0.2 15.0 33.5 3.5 2.2 3.4 1.3 1.1 1.6 0.6 4.6 8.1 2.0

TOTAL 32.6 25.9 39.1 649.3 691.8 610.6 69.7 62.7 77.1 22.1 18.9 25.2 102.5 68.8 135.2

10-14 5.3 0.7 10.1 98.8 30.7 169.2 9.7 2.5 17.2 3.3 1.2 5.5 16.6 5.8 27.7

2004

15-19 116.8 37.7 200.4 2,032.9 1,360.8 2,723.6 207.3 122.0 298.4 54.7 25.8 85.3 342.3 136.3 556.1

20-24 147.1 89.3 207.1 2,449.7 2,357.1 2,542.6 236.2 193.8 288.0 87.2 65.4 109.4 440.7 295.1 590.4

25-29 89.9 71.6 108.6 1,457.9 1,748.9 1,187.0 137.6 132.9 143.4 43.7 47.0 40.5 243.5 180.3 308.0

30-34 53.3 54.2 52.3 761.0 1,056.8 494.6 79.9 86.6 72.0 29.5 31.4 27.7 147.4 117.7 177.0

35-39 38.2 47.3 29.1 460.3 690.9 254.4 57.6 67.7 46.1 18.6 25.4 12.1 101.3 100.0 102.5

40-44 25.0 33.8 16.2 308.0 502.7 136.7 36.7 49.1 23.3 10.7 14.5 7.2 61.5 44.2 77.7

45-54 10.9 16.3 5.5 163.2 296.5 48.9 18.5 25.3 11.7 5.7 7.2 4.3 33.8 40.8 27.3

55-64 3.7 6.3 1.2 57.4 116.2 10.1 7.2 11.0 3.7 3.1 2.3 3.9 5.7 6.8 4.7

65+ 0.7 1.4 0.3 15.7 35.1 3.7 2.0 3.1 1.1 0.3 0.3 0.3 4.4 7.6 2.0

TOTAL 33.2 26.1 40.0 622.5 662.5 586.2 68.9 62.6 75.6 20.7 18.8 22.4 116.5 78.3 153.6

10-14 5.5 0.5 10.7 95.5 32.8 160.2 9.2 2.6 16.1 3.0 0.3 5.8 20.9 7.4 34.7

2005

15-19 119.3 39.5 203.6 2,044.5 1,376.4 2,730.3 211.5 119.9 308.9 73.1 41.2 107.1 367.8 167.5 575.2

20-24 160.0 97.6 225.1 2,437.0 2,333.5 2,542.0 261.7 218.3 314.0 102.5 88.0 117.4 466.7 312.9 625.0

25-29 97.5 77.2 118.1 1,412.1 1,692.4 1,148.5 147.1 139.7 156.5 57.7 63.1 52.4 317.6 238.4 398.8

30-34 55.7 55.5 55.9 742.3 1,024.0 488.3 85.7 89.3 81.4 31.8 45.1 19.0 189.8 165.9 213.7

35-39 39.7 47.7 31.5 455.3 688.7 246.6 59.4 70.3 46.9 23.2 31.9 14.9 116.5 117.7 115.3

40-44 27.1 36.5 17.7 305.6 500.6 134.3 38.5 49.6 26.3 13.9 18.3 9.9 64.6 49.5 79.0

45-54 11.4 17.3 5.5 163.3 294.9 50.3 19.5 26.1 12.8 6.7 9.6 4.2 28.2 29.5 26.9

55-64 3.6 6.3 1.1 55.7 112.7 9.9 8.1 11.9 4.6 3.9 5.4 2.6 11.3 17.2 5.8

65+ 0.8 1.6 0.2 14.7 32.8 3.5 2.4 3.7 1.5 0.8 1.0 0.7 1.9 1.8 1.9

TOTAL 35.1 27.6 42.4 619.4 658.0 584.2 72.4 65.3 80.1 25.2 25.8 24.6 131.5 92.1 169.7

10-14 4.7 0.8 8.9 97.6 32.7 164.6 9.5 3.5 15.8 2.6 0.3 5.0 16.5 1.3 32.1

2006

15-19 121.2 38.4 208.7 2,191.8 1,503.8 2,898.1 232.7 137.4 334.2 63.1 27.6 100.8 381.0 214.6 553.3

20-24 165.0 99.9 232.9 2,560.7 2,449.5 2,673.6 277.1 232.5 330.7 82.0 66.9 97.6 481.2 323.5 643.7

25-29 107.5 85.0 130.5 1,525.7 1,816.4 1,252.1 159.1 152.7 167.0 48.8 49.5 48.2 353.6 262.3 447.4

30-34 56.9 53.9 60.0 786.3 1,089.4 512.8 87.9 90.7 84.7 27.6 32.1 23.3 196.2 137.8 254.6

35-39 41.0 48.0 33.8 476.0 723.6 254.6 61.9 70.2 52.4 20.4 26.1 15.0 115.9 108.6 123.0

40-44 26.9 35.6 18.2 312.2 518.1 131.1 41.3 53.8 27.7 13.0 19.0 7.3 63.4 65.3 61.7

45-54 12.7 18.6 6.9 178.5 328.2 50.0 21.0 28.7 13.1 6.7 7.8 5.7 38.9 46.8 31.7

55-64 4.3 7.3 1.5 63.5 128.4 11.4 7.2 10.2 4.5 2.6 2.4 2.8 13.0 19.1 7.4

65+ 0.9 1.8 0.3 14.6 31.4 4.2 2.8 4.5 1.6 0.6 0.6 0.7 4.5 7.5 2.2

TOTAL 36.5 28.3 44.4 658.4 702.7 618.1 77.4 70.1 85.3 21.1 19.6 22.6 138.3 99.9 175.6

Table 21B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age group and sex: United States,

2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for total

and sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these

variables were specified. In 2005, HI did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded.

Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not shown because

some of these cases may not be due to sexual transmission; however, they are included in the totals.
120 Syphilis Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 700 567 639 551 931 15.6 12.6 14.1 12.1 20.4

Alaska 9 8 15 22 25 1.4 1.2 2.3 3.3 3.8

Arizona 1,086 1,106 974 792 926 19.9 19.8 17.0 13.3 15.6

Arkansas 219 296 249 231 243 8.1 10.9 9.0 8.3 8.7

California 3,917 4,207 4,589 5,340 6,043 11.2 11.9 12.8 14.8 16.7

Colorado 174 144 179 144 182 3.9 3.2 3.9 3.1 3.9

Connecticut 188 207 169 166 197 5.4 5.9 4.8 4.7 5.6

Delaware 62 47 61 35 74 7.7 5.7 7.3 4.1 8.8

District of Columbia 431 330 357 365 314 75.5 58.5 64.5 66.3 57.0

Florida 3,280 3,283 2,964 2,888 2,945 19.6 19.3 17.0 16.2 16.6

Georgia 1,896 2,152 1,589 1,924 1,933 22.1 24.8 18.0 21.2 21.3

Hawaii 59 61 36 57 66 4.7 4.9 2.9 4.5 5.2

Idaho 23 45 78 54 12 1.7 3.3 5.6 3.8 0.8

Illinois 1,593 1,377 1,348 1,608 1,473 12.6 10.9 10.6 12.6 11.5

Indiana 320 367 273 288 250 5.2 5.9 4.4 4.6 4.0

Iowa 54 46 36 28 68 1.8 1.6 1.2 0.9 2.3

Kansas 77 77 87 88 87 2.8 2.8 3.2 3.2 3.2

Kentucky 212 160 151 129 188 5.2 3.9 3.6 3.1 4.5

Louisiana 776 1,581 1,646 1,239 1,387 17.3 35.2 36.5 27.4 30.7

Maine 9 21 7 6 22 0.7 1.6 0.5 0.5 1.7

Maryland 843 975 1,002 1,005 1,038 15.4 17.7 18.0 17.9 18.5

Massachusetts 541 644 517 398 378 8.4 10.0 8.1 6.2 5.9

Michigan 1,184 860 806 488 384 11.8 8.5 8.0 4.8 3.8

Minnesota 148 195 145 208 189 2.9 3.9 2.8 4.1 3.7

Mississippi 451 435 404 371 520 15.7 15.1 13.9 12.7 17.8

Missouri 204 207 269 372 430 3.6 3.6 4.7 6.4 7.4

Montana 5 0 4 7 2 0.5 0.0 0.4 0.7 0.2

Nebraska 25 27 15 18 34 1.4 1.6 0.9 1.0 1.9

Nevada 113 149 254 343 388 5.2 6.6 10.9 14.2 16.1

New Hampshire 24 37 26 33 35 1.9 2.9 2.0 2.5 2.7

New Jersey 1,062 1,089 826 813 799 12.4 12.6 9.5 9.3 9.2

New Mexico 117 205 251 183 237 6.3 10.9 13.2 9.5 12.3

New York 3,885 4,360 4,472 3,853 4,577 20.3 22.7 23.3 20.0 23.8

North Carolina 1,052 850 747 713 961 12.6 10.1 8.7 8.2 11.1

North Dakota 0 2 0 1 3 0.0 0.3 0.0 0.2 0.5

Ohio 351 481 571 502 491 3.1 4.2 5.0 4.4 4.3

Oklahoma 287 353 168 159 251 8.2 10.1 4.8 4.5 7.1

Oregon 75 118 108 109 99 2.1 3.3 3.0 3.0 2.7

Pennsylvania 689 706 574 712 885 5.6 5.7 4.6 5.7 7.1

Rhode Island 67 90 104 64 71 6.3 8.4 9.6 5.9 6.6

South Carolina 620 552 524 549 397 15.1 13.3 12.5 12.9 9.3

South Dakota 0 5 0 4 29 0.0 0.7 0.0 0.5 3.7

Tennessee 1,082 881 804 917 1,015 18.7 15.1 13.6 15.4 17.0

Texas 4,109 3,996 4,205 4,289 4,956 18.9 18.1 18.7 18.8 21.7

Utah 71 72 78 50 68 3.1 3.1 3.3 2.0 2.8

Vermont 2 1 3 1 7 0.3 0.2 0.5 0.2 1.1

Virginia 528 552 610 655 701 7.2 7.5 8.2 8.7 9.3

Washington 158 239 336 359 423 2.6 3.9 5.4 5.7 6.7

West Virginia 5 11 18 18 30 0.3 0.6 1.0 1.0 1.7

Wisconsin 135 111 128 138 170 2.5 2.0 2.3 2.5 3.1

Wyoming 1 4 6 1 1 0.2 0.8 1.2 0.2 0.2

U.S. TOTAL 32,919 34,289 33,422 33,288 36,935 11.4 11.8 11.4 11.2 12.5

Northeast 6,467 7,155 6,698 6,046 6,971 11.9 13.2 12.3 11.1 12.8

Midwest 4,091 3,755 3,678 3,743 3,608 6.3 5.7 5.6 5.7 5.5

South 16,553 17,021 16,138 16,038 17,884 16.0 16.3 15.2 14.9 16.6

West 5,808 6,358 6,908 7,461 8,472 8.8 9.6 10.2 10.9 12.4

Guam 19 16 13 19 13 11.8 9.8 7.8 11.3 7.7

Puerto Rico 1,394 1,357 1,154 1,223 1,066 36.1 35.0 29.6 31.3 27.2

Virgin Islands 4 14 17 13 5 3.6 12.9 15.6 12.0 4.6

OUTLYING AREAS 1,417 1,387 1,184 1,255 1,084 34.3 33.4 28.4 30.0 25.9

TOTAL 34,336 35,676 34,606 34,543 38,019 11.7 12.1 11.6 11.5 12.6

Table 22. All stages of syphilis* — Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2002–2006

*See Appendix (Syphilis Morbidity Reporting) for definition.
STD Surveillance 2006 Syphilis Tables 121

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 1,430 1,702 1,315 1,626 1,641 31.6 36.9 27.9 33.1 33.4

Austin-Round Rock, TX 111 152 200 193 212 8.2 11.0 14.2 13.3 14.6

Baltimore-Towson, MD 549 648 647 679 642 21.1 24.8 24.5 25.6 24.2

Birmingham-Hoover, AL 147 122 117 243 561 13.8 11.4 10.8 22.3 51.5

Boston-Cambridge-Quincy, MA-NH 478 568 410 339 329 10.8 12.8 9.3 7.7 7.5

Buffalo-Cheektowaga-Tonawanda, NY 12 11 24 14 40 1.0 0.9 2.1 1.2 3.5

Charlotte-Gastonia-Concord, NC-SC 163 167 154 235 303 11.6 11.6 10.4 15.4 19.9

Chicago-Naperville-Joliet, IL-IN-WI 1,493 1,341 1,296 1,541 1,386 16.1 14.4 13.8 16.3 14.7

Cincinnati-Middletown, OH-KY-IN 35 18 54 55 58 1.7 0.9 2.6 2.7 2.8

Cleveland-Elyria-Mentor, OH 39 62 84 52 53 1.8 2.9 3.9 2.4 2.5

Columbus, OH 214 266 254 227 229 12.9 15.9 15.0 13.3 13.4

Dallas-Fort Worth-Arlington, TX 1,515 1,505 1,374 1,495 1,678 27.6 26.9 24.1 25.7 28.8

Denver-Aurora, CO 141 116 135 111 141 6.2 5.0 5.8 4.7 6.0

Detroit-Warren-Livonia, MI 1,083 751 679 390 284 24.2 16.7 15.1 8.7 6.3

Hartford-West Hartford-East Hartford, CT 68 70 46 57 65 5.8 5.9 3.9 4.8 5.5

Houston-Baytown-Sugar Land, TX 1,158 1,256 1,289 1,188 1,570 23.2 24.7 24.9 22.5 29.7

Indianapolis, IN 148 142 128 134 121 9.4 8.9 7.9 8.2 7.4

Jacksonville, FL 81 135 218 151 165 6.9 11.2 17.8 12.1 13.2

Kansas City, MO-KS 74 118 101 193 228 3.9 6.2 5.2 9.9 11.7

Las Vegas-Paradise, NV 81 123 225 300 354 5.3 7.8 13.6 17.5 20.7

Los Angeles-Long Beach-Santa Ana, CA 2,104 2,166 2,482 3,159 3,594 16.5 16.9 19.2 24.4 27.8

Louisville, KY-IN 161 126 115 102 101 13.6 10.6 9.6 8.4 8.4

Memphis, TN-MS-AR 632 547 519 585 612 51.4 44.1 41.5 46.4 48.5

Miami-Fort Lauderdale-Miami Beach, FL 1,933 1,911 1,687 1,444 1,455 36.9 36.1 31.5 26.6 26.8

Milwaukee-Waukesha-West Allis, WI 100 74 85 77 100 6.6 4.9 5.6 5.1 6.6

Minneapolis-St. Paul-Bloomington, MN-WI 131 173 125 187 161 4.3 5.6 4.0 6.0 5.1

Nashville-Davidson-Murfreesboro, TN 338 220 194 189 194 25.0 16.0 13.9 13.3 13.6

New Orleans-Metairie-Kenner, LA 130 264 449 350 352 9.9 20.0 34.0 26.5 26.7

New York-Newark-Edison, NY-NJ-PA 4,672 5,101 4,918 4,318 4,917 25.1 27.4 26.3 23.0 26.2

Oklahoma City, OK 210 253 110 87 116 18.7 22.3 9.6 7.5 10.0

Orlando, FL 402 318 267 413 403 22.9 17.6 14.3 21.4 20.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 721 785 678 583 771 12.5 13.6 11.7 10.0 13.2

Phoenix-Mesa-Scottsdale, AZ NA 914 754 595 757 NA 25.4 20.3 15.4 19.6

Pittsburgh, PA 52 57 32 112 152 2.2 2.4 1.3 4.7 6.4

Portland-Vancouver-Beaverton, OR-WA 66 103 84 94 74 3.3 5.0 4.1 4.5 3.5

Providence-New Bedford-Fall River, RI-MA 90 127 137 75 92 5.6 7.8 8.4 4.6 5.7

Richmond, VA 85 114 85 87 106 7.5 10.0 7.4 7.4 9.0

Riverside-San Bernardino-Ontario, CA 275 313 319 399 376 7.8 8.6 8.4 10.2 9.6

Rochester, NY 19 33 41 36 90 1.8 3.2 3.9 3.5 8.7

Sacramento-Arden-Arcade-Roseville, CA 48 35 64 39 136 2.5 1.8 3.2 1.9 6.7

Salt Lake City, UT 50 43 53 35 41 5.0 4.3 5.2 3.4 4.0

San Antonio, TX 322 231 361 458 473 18.0 12.7 19.5 24.2 25.0

San Diego-Carlsbad-San Marcos, CA 162 299 356 448 571 5.6 10.2 12.1 15.3 19.5

San Francisco-Oakland-Fremont, CA 870 901 917 719 740 20.8 21.7 22.1 17.3 17.8

San Jose-Sunnyvale-Santa Clara, CA 94 137 113 121 94 5.4 7.9 6.5 6.9 5.4

Seattle-Tacoma-Bellevue, WA 127 174 273 285 356 4.1 5.5 8.6 8.9 11.1

St. Louis, MO-IL 160 150 189 173 186 5.9 5.5 6.8 6.2 6.7

Tampa-St. Petersburg-Clearwater, FL 316 407 303 326 428 12.7 16.1 11.7 12.3 16.2

Virginia Beach-Norfolk-Newport News, VA-NC 185 148 198 246 245 11.5 9.0 12.0 14.9 14.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 871 836 896 894 928 17.3 16.4 17.4 17.1 17.8

U.S. MSA TOTAL 24,346 26,233 25,554 25,859 28,681 16.1 16.8 16.2 16.2 18.0

Table 23. All stages of syphilis* — Reported cases and rates in selected metropolitan statistical areas†

(MSAs) listed in alphabetical order: United States, 2002–2006

*See Appendix (Reporting of Syphilis Cases) for definition.

†

Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
122 Syphilis Tables STD Surveillance 2006

Rank* State Cases Rate per 100,000 Population

1 Louisiana 342 7.6

2 Alabama 319 7.0

3 Georgia 581 6.4

4 Nevada 137 5.7

5 Maryland 300 5.4

6 California 1,835 5.1

7 Texas 1,064 4.7

8 Tennessee 249 4.2

9 New Mexico 79 4.1

10 Florida 719 4.0

11 New York 736 3.8

12 North Carolina 309 3.6

13 Arizona 203 3.4

14 Illinois 431 3.4

U.S. TOTAL† 9,756 3.3

15 Mississippi 86 2.9

16 Missouri 168 2.9

17 Washington 182 2.9

18 Arkansas 77 2.8

19 Virginia 190 2.5

20 Delaware 20 2.4

21 Pennsylvania 264 2.1

22 New Jersey 173 2.0

23 Oklahoma 70 2.0

24 Massachusetts 124 1.9

25 Connecticut 64 1.8

26 Kentucky 73 1.7

27 South Dakota 13 1.7

28 Alaska 11 1.7

29 Ohio 184 1.6

30 South Carolina 66 1.6

31 Indiana 93 1.5

32 Colorado 69 1.5

33 Hawaii 18 1.4

34 Rhode Island 14 1.3

35 Wisconsin 68 1.2

36 Michigan 118 1.2

37 New Hampshire 13 1.0

38 Kansas 27 1.0

39 Minnesota 47 0.9

40 Utah 21 0.9

41 Oregon 29 0.8

42 Maine 9 0.7

43 Iowa 19 0.6

44 West Virginia 11 0.6

45 Vermont 3 0.5

46 Nebraska 7 0.4

47 Idaho 3 0.2

YEAR 2010 TARGET 0.2

48 North Dakota 1 0.2

49 Montana 1 0.1

Wyoming 0 0.0

Table 24. Primary and secondary syphilis — Reported cases and rates by state, ranked by rates:

United States, 2006

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Total includes cases reported by the District of Columbia with 116 cases and a rate of 21.1, but excludes outlying areas (Guam with 3 cases and rate

of 1.8, Puerto Rico with 150 cases and rate of 3.8, and Virgin Islands with 1 case and rate of 0.9).
STD Surveillance 2006 Syphilis Tables 123

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 149 114 165 169 319 3.3 2.5 3.6 3.7 7.0

Alaska 0 1 8 9 11 0.0 0.2 1.2 1.4 1.7

Arizona 200 186 157 175 203 3.7 3.3 2.7 2.9 3.4

Arkansas 34 51 47 52 77 1.3 1.9 1.7 1.9 2.8

California 1,033 1,299 1,356 1,585 1,835 2.9 3.7 3.8 4.4 5.1

Colorado 64 39 63 46 69 1.4 0.9 1.4 1.0 1.5

Connecticut 28 30 45 58 64 0.8 0.9 1.3 1.7 1.8

Delaware 11 7 9 11 20 1.4 0.9 1.1 1.3 2.4

District of Columbia 58 48 69 114 116 10.2 8.5 12.5 20.7 21.1

Florida 617 658 728 724 719 3.7 3.9 4.2 4.1 4.0

Georgia 439 585 549 645 581 5.1 6.7 6.2 7.1 6.4

Hawaii 11 14 8 11 18 0.9 1.1 0.6 0.9 1.4

Idaho 8 15 24 20 3 0.6 1.1 1.7 1.4 0.2

Illinois 479 374 386 525 431 3.8 3.0 3.0 4.1 3.4

Indiana 62 50 60 62 93 1.0 0.8 1.0 1.0 1.5

Iowa 8 12 5 9 19 0.3 0.4 0.2 0.3 0.6

Kansas 20 25 24 19 27 0.7 0.9 0.9 0.7 1.0

Kentucky 88 33 47 52 73 2.2 0.8 1.1 1.2 1.7

Louisiana 152 183 332 278 342 3.4 4.1 7.4 6.1 7.6

Maine 2 8 2 1 9 0.2 0.6 0.2 0.1 0.7

Maryland 228 312 380 313 300 4.2 5.7 6.8 5.6 5.4

Massachusetts 99 133 114 125 124 1.5 2.1 1.8 2.0 1.9

Michigan 486 249 192 105 118 4.8 2.5 1.9 1.0 1.2

Minnesota 59 47 27 70 47 1.2 0.9 0.5 1.4 0.9

Mississippi 49 40 59 49 86 1.7 1.4 2.0 1.7 2.9

Missouri 34 61 94 147 168 0.6 1.1 1.6 2.5 2.9

Montana 0 0 4 7 1 0.0 0.0 0.4 0.7 0.1

Nebraska 6 10 7 4 7 0.3 0.6 0.4 0.2 0.4

Nevada 15 12 40 109 137 0.7 0.5 1.7 4.5 5.7

New Hampshire 8 19 5 16 13 0.6 1.5 0.4 1.2 1.0

New Jersey 169 170 150 133 173 2.0 2.0 1.7 1.5 2.0

New Mexico 39 71 82 56 79 2.1 3.8 4.3 2.9 4.1

New York 478 584 727 705 736 2.5 3.0 3.8 3.7 3.8

North Carolina 279 152 192 274 309 3.4 1.8 2.2 3.2 3.6

North Dakota 0 2 0 1 1 0.0 0.3 0.0 0.2 0.2

Ohio 159 197 237 211 184 1.4 1.7 2.1 1.8 1.6

Oklahoma 72 64 25 44 70 2.1 1.8 0.7 1.2 2.0

Oregon 28 48 29 41 29 0.8 1.3 0.8 1.1 0.8

Pennsylvania 105 159 118 199 264 0.9 1.3 1.0 1.6 2.1

Rhode Island 13 33 26 24 14 1.2 3.1 2.4 2.2 1.3

South Carolina 134 94 116 84 66 3.3 2.3 2.8 2.0 1.6

South Dakota 0 2 0 2 13 0.0 0.3 0.0 0.3 1.7

Tennessee 168 135 130 217 249 2.9 2.3 2.2 3.6 4.2

Texas 589 654 827 873 1,064 2.7 3.0 3.7 3.8 4.7

Utah 7 14 13 10 21 0.3 0.6 0.5 0.4 0.9

Vermont 2 1 1 1 3 0.3 0.2 0.2 0.2 0.5

Virginia 71 82 116 143 190 1.0 1.1 1.6 1.9 2.5

Washington 70 82 150 152 182 1.2 1.3 2.4 2.4 2.9

West Virginia 2 2 3 3 11 0.1 0.1 0.2 0.2 0.6

Wisconsin 30 16 29 41 68 0.6 0.3 0.5 0.7 1.2

Wyoming 0 0 3 0 0 0.0 0.0 0.6 0.0 0.0

U.S. TOTAL 6,862 7,177 7,980 8,724 9,756 2.4 2.5 2.7 2.9 3.3

Northeast 904 1,137 1,188 1,262 1,400 1.7 2.1 2.2 2.3 2.6

Midwest 1,343 1,045 1,061 1,196 1,176 2.1 1.6 1.6 1.8 1.8

South 3,140 3,214 3,794 4,045 4,592 3.0 3.1 3.6 3.8 4.3

West 1,475 1,781 1,937 2,221 2,588 2.2 2.7 2.9 3.3 3.8

Guam 6 1 0 2 3 3.7 0.6 0.0 1.2 1.8

Puerto Rico 270 202 182 224 150 7.0 5.2 4.7 5.7 3.8

Virgin Islands 1 3 5 1 1 0.9 2.8 4.6 0.9 0.9

OUTLYING AREAS 277 206 187 227 154 6.7 5.0 4.5 5.4 3.7

TOTAL 7,139 7,383 8,167 8,951 9,910 2.4 2.5 2.7 3.0 3.3

Table 25. Primary and secondary syphilis — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2002–2006
124 Syphilis Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 63 49 52 69 116 2.7 2.1 2.2 2.9 4.9

Alaska 0 0 0 1 2 0.0 0.0 0.0 0.3 0.6

Arizona 74 66 42 49 33 2.7 2.4 1.5 1.7 1.1

Arkansas 18 16 18 21 35 1.3 1.1 1.3 1.5 2.5

California 39 52 63 121 128 0.2 0.3 0.4 0.7 0.7

Colorado 2 5 7 2 5 0.1 0.2 0.3 0.1 0.2

Connecticut 3 3 3 2 2 0.2 0.2 0.2 0.1 0.1

Delaware 4 2 1 2 4 1.0 0.5 0.2 0.5 0.9

District of Columbia 9 3 4 11 6 3.0 1.0 1.4 3.8 2.1

Florida 108 73 98 100 98 1.3 0.8 1.1 1.1 1.1

Georgia 98 68 45 47 41 2.3 1.5 1.0 1.0 0.9

Hawaii 2 0 0 0 1 0.3 0.0 0.0 0.0 0.2

Idaho 4 5 11 6 2 0.6 0.7 1.6 0.8 0.3

Illinois 81 48 55 47 37 1.3 0.7 0.9 0.7 0.6

Indiana 18 16 6 10 10 0.6 0.5 0.2 0.3 0.3

Iowa 4 2 1 1 6 0.3 0.1 0.1 0.1 0.4

Kansas 6 13 7 2 2 0.4 0.9 0.5 0.1 0.1

Kentucky 43 13 6 3 7 2.1 0.6 0.3 0.1 0.3

Louisiana 76 79 123 112 123 3.3 3.4 5.3 4.8 5.3

Maine 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Maryland 53 74 92 88 61 1.9 2.6 3.2 3.0 2.1

Massachusetts 12 3 5 4 7 0.4 0.1 0.2 0.1 0.2

Michigan 192 93 61 20 26 3.8 1.8 1.2 0.4 0.5

Minnesota 4 4 3 2 4 0.2 0.2 0.1 0.1 0.2

Mississippi 31 20 19 12 36 2.1 1.3 1.3 0.8 2.4

Missouri 10 14 12 12 19 0.3 0.5 0.4 0.4 0.6

Montana 0 0 1 1 0 0.0 0.0 0.2 0.2 0.0

Nebraska 2 1 4 0 1 0.2 0.1 0.5 0.0 0.1

Nevada 1 3 8 24 34 0.1 0.3 0.7 2.0 2.9

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 48 49 38 17 12 1.1 1.1 0.9 0.4 0.3

New Mexico 12 23 36 16 22 1.3 2.4 3.7 1.6 2.2

New York 26 26 32 28 29 0.3 0.3 0.3 0.3 0.3

North Carolina 115 47 48 58 67 2.7 1.1 1.1 1.3 1.5

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 27 40 61 40 43 0.5 0.7 1.0 0.7 0.7

Oklahoma 20 20 9 17 19 1.1 1.1 0.5 0.9 1.1

Oregon 8 3 1 2 0 0.5 0.2 0.1 0.1 0.0

Pennsylvania 22 33 16 34 34 0.3 0.5 0.3 0.5 0.5

Rhode Island 2 8 10 6 0 0.4 1.4 1.8 1.1 0.0

South Carolina 58 24 25 17 11 2.7 1.1 1.2 0.8 0.5

South Dakota 0 0 0 0 5 0.0 0.0 0.0 0.0 1.3

Tennessee 82 40 34 64 73 2.8 1.3 1.1 2.1 2.4

Texas 192 162 179 243 261 1.8 1.5 1.6 2.1 2.3

Utah 0 3 3 1 3 0.0 0.3 0.3 0.1 0.2

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 17 7 6 19 23 0.5 0.2 0.2 0.5 0.6

Washington 1 4 6 5 4 0.0 0.1 0.2 0.2 0.1

West Virginia 1 2 1 0 1 0.1 0.2 0.1 0.0 0.1

Wisconsin 6 1 2 3 3 0.2 0.0 0.1 0.1 0.1

Wyoming 0 0 1 0 0 0.0 0.0 0.4 0.0 0.0

U.S. TOTAL 1,594 1,217 1,255 1,339 1,458 1.1 0.8 0.8 0.9 1.0

Northeast 113 122 104 91 86 0.4 0.4 0.4 0.3 0.3

Midwest 350 232 212 137 156 1.1 0.7 0.6 0.4 0.5

South 988 699 760 883 982 1.9 1.3 1.4 1.6 1.8

West 143 164 179 228 234 0.4 0.5 0.5 0.7 0.7

Guam 2 0 0 1 1 2.5 0.0 0.0 1.2 1.2

Puerto Rico 123 93 62 81 46 6.1 4.6 3.1 4.0 2.3

Virgin Islands 0 2 3 0 0 0.0 3.5 5.3 0.0 0.0

OUTLYING AREAS 125 95 65 82 47 5.8 4.4 3.0 3.8 2.2

TOTAL 1,719 1,312 1,320 1,421 1,505 1.2 0.9 0.9 0.9 1.0

Table 26. Primary and secondary syphilis — Women – Reported cases and rates by state/area and region

listed in alphabetical order: United States and outlying areas, 2002–2006

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2006 Syphilis Tables 125

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 86 65 113 100 203 4.0 3.0 5.1 4.5 9.2

Alaska 0 1 8 8 9 0.0 0.3 2.4 2.3 2.6

Arizona 126 120 115 125 166 4.6 4.3 4.0 4.2 5.6

Arkansas 16 35 29 31 42 1.2 2.6 2.2 2.3 3.1

California 994 1,245 1,291 1,463 1,706 5.7 7.0 7.2 8.1 9.5

Colorado 62 34 56 44 64 2.7 1.5 2.4 1.9 2.7

Connecticut 25 27 42 56 62 1.5 1.6 2.5 3.3 3.6

Delaware 7 5 8 9 16 1.8 1.3 2.0 2.2 3.9

District of Columbia 49 45 65 103 110 18.2 16.9 24.8 39.4 42.1

Florida 509 585 630 624 621 6.2 7.0 7.4 7.2 7.1

Georgia 340 517 504 598 540 8.1 12.1 11.5 13.3 12.0

Hawaii 9 14 8 11 17 1.4 2.2 1.3 1.7 2.7

Idaho 4 10 13 14 1 0.6 1.5 1.9 2.0 0.1

Illinois 398 326 331 478 394 6.4 5.2 5.3 7.6 6.3

Indiana 44 34 54 52 83 1.5 1.1 1.8 1.7 2.7

Iowa 4 10 3 8 13 0.3 0.7 0.2 0.5 0.9

Kansas 14 12 17 17 25 1.0 0.9 1.3 1.2 1.8

Kentucky 45 19 41 49 66 2.2 0.9 2.0 2.4 3.2

Louisiana 76 104 209 166 219 3.5 4.8 9.5 7.5 10.0

Maine 2 8 2 1 7 0.3 1.3 0.3 0.2 1.1

Maryland 175 238 288 225 239 6.6 8.9 10.7 8.3 8.8

Massachusetts 87 129 109 121 117 2.8 4.1 3.5 3.9 3.8

Michigan 294 156 131 85 92 6.0 3.2 2.6 1.7 1.8

Minnesota 55 43 24 68 43 2.2 1.7 0.9 2.7 1.7

Mississippi 18 20 40 37 50 1.3 1.4 2.8 2.6 3.5

Missouri 24 47 82 135 149 0.9 1.7 2.9 4.8 5.3

Montana 0 0 3 6 1 0.0 0.0 0.6 1.3 0.2

Nebraska 4 9 3 4 6 0.5 1.0 0.3 0.5 0.7

Nevada 14 9 32 85 103 1.3 0.8 2.7 6.9 8.4

New Hampshire 8 19 5 16 13 1.3 3.0 0.8 2.5 2.0

New Jersey 121 121 112 116 161 2.9 2.9 2.6 2.7 3.8

New Mexico 27 48 46 40 57 3.0 5.2 4.9 4.2 6.0

New York 452 558 695 677 707 4.9 6.0 7.5 7.3 7.6

North Carolina 164 105 144 216 242 4.0 2.5 3.4 5.1 5.7

North Dakota 0 2 0 1 1 0.0 0.6 0.0 0.3 0.3

Ohio 132 157 176 171 141 2.4 2.8 3.2 3.1 2.5

Oklahoma 52 44 16 27 51 3.0 2.5 0.9 1.5 2.9

Oregon 20 45 28 39 29 1.1 2.5 1.6 2.2 1.6

Pennsylvania 83 126 102 165 230 1.4 2.1 1.7 2.7 3.8

Rhode Island 11 25 16 18 14 2.1 4.8 3.1 3.5 2.7

South Carolina 76 70 91 67 55 3.8 3.5 4.4 3.2 2.7

South Dakota 0 2 0 2 8 0.0 0.5 0.0 0.5 2.1

Tennessee 86 95 96 153 176 3.0 3.3 3.3 5.2 6.0

Texas 397 492 648 630 803 3.7 4.5 5.8 5.5 7.1

Utah 7 11 10 9 18 0.6 0.9 0.8 0.7 1.5

Vermont 2 1 1 1 3 0.7 0.3 0.3 0.3 1.0

Virginia 54 75 110 124 167 1.5 2.1 3.0 3.3 4.5

Washington 69 78 144 147 178 2.3 2.6 4.7 4.7 5.7

West Virginia 1 0 2 3 10 0.1 0.0 0.2 0.3 1.1

Wisconsin 24 15 27 38 65 0.9 0.6 1.0 1.4 2.4

Wyoming 0 0 2 0 0 0.0 0.0 0.8 0.0 0.0

U.S. TOTAL 5,267 5,956 6,722 7,383 8,293 3.7 4.2 4.7 5.1 5.7

Northeast 791 1,014 1,084 1,171 1,314 3.0 3.8 4.1 4.4 5.0

Midwest 993 813 848 1,059 1,020 3.1 2.5 2.6 3.3 3.1

South 2,151 2,514 3,034 3,162 3,610 4.2 4.9 5.8 6.0 6.8

West 1,332 1,615 1,756 1,991 2,349 4.1 4.9 5.2 5.8 6.9

Guam 4 1 0 1 2 4.9 1.2 0.0 1.2 2.3

Puerto Rico 147 109 120 143 104 7.9 5.8 6.4 7.6 5.5

Virgin Islands 1 1 2 1 1 2.0 1.9 3.9 1.9 1.9

OUTLYING AREAS 152 111 122 145 107 7.6 5.5 6.1 7.2 5.3

TOTAL 5,419 6,067 6,844 7,528 8,400 3.8 4.2 4.7 5.1 5.7

Table 27. Primary and secondary syphilis — Men – Reported cases and rates by state/area and region listed

in alphabetical order: United States and outlying areas, 2002–2006

NOTE: Cases reported with unknown sex are not included in this table.
126 Syphilis Tables STD Surveillance 2006

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 866 8.7 8

2 Harris County, TX 374 10.1 12

3 Cook County, IL 349 6.6 16

4 San Francisco County, CA 244 33.0 18

5 Fulton County, GA 242 26.4 21

6 New York County, NY 240 15.1 23

7 Jefferson County, AL 238 36.2 26

8 San Diego County, CA 235 8.0 28

9 Dallas County, TX 206 8.9 30

10 Miami-Dade County, FL 203 8.5 32

11 De Kalb County, GA 182 26.8 34

12 Baltimore (City), MD 159 25.0 36

13 Kings County, NY 159 6.4 37

14 Maricopa County, AZ 156 4.3 39

15 Broward County, FL 155 8.7 41

16 King County, WA 147 8.2 42

17 Shelby County, TN 132 14.5 43

18 Clark County, NV 132 7.7 45

19 Bexar County, TX 131 8.6 46

20 Philadelphia County, PA 125 8.5 47

21 Washington, DC 116 21.1 49

22 Mecklenburg County, NC 104 13.1 50

23 Bronx County, NY 101 7.4 51

24 Franklin County, OH 100 9.2 52

25 East Baton Rouge County, LA 97 23.6 53

26 Jackson County, MO 85 12.8 54

27 Tarrant County, TX 84 5.2 54

28 Travis County, TX 81 9.1 55

29 Orange County, FL 81 7.9 56

30 Riverside County, CA 80 4.1 57

31 Orange County, CA 79 2.6 58

32 Queens County, NY 77 3.4 59

33 Allegheny County, PA 71 5.7 59

34 Alameda County, CA 71 4.9 60

35 Wayne County, MI 69 3.5 61

36 Hillsborough County, FL 68 6.0 61

37 Suffolk County, MA 66 10.1 62

38 Prince George’s County, MD 60 7.1 63

39 Hudson County, NJ 55 9.1 63

40 Orleans County, LA 54 11.9 64

41 Santa Clara County, CA 52 3.1 64

42 Essex County, NJ 44 5.6 65

43 Marion County, IN 43 5.0 65

44 Pinellas County, FL 38 4.1 66

45 Denver County, CO 37 6.6 66

46 Milwaukee County, WI 37 4.0 66

47 St Louis (City), MO 36 10.5 67

48 Jefferson County, KY 35 5.0 67

49 Gwinnett County, GA 35 4.8 67

50 Wake County, NC 35 4.7 68

51 Duval County, FL 35 4.2 68

52 Pima County, AZ 35 3.8 69

53 Hennepin County, MN 35 3.1 69

54 Davidson County, TN 34 5.9 69

55 Cobb County, GA 34 5.1 70

56 Knox County, TN 33 8.1 70

57 Norfolk (City), VA 32 13.8 70

Table 28. Primary and secondary syphilis — Counties and independent cities* ranked by number of reported

cases: United States, 2006

*Accounting for 70% of reported primary and secondary syphilis cases.

†

Counties and independent cities were ranked in descending order by number of cases reported in 2006.
STD Surveillance 2006 Syphilis Tables 127

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 378 516 508 598 529 8.3 11.2 10.8 12.2 10.8

Austin-Round Rock, TX 23 31 56 44 84 1.7 2.3 4.0 3.0 5.8

Baltimore-Towson, MD 163 224 276 244 213 6.3 8.6 10.5 9.2 8.0

Birmingham-Hoover, AL 13 23 33 101 244 1.2 2.1 3.0 9.3 22.4

Boston-Cambridge-Quincy, MA-NH 84 121 84 106 117 1.9 2.7 1.9 2.4 2.7

Buffalo-Cheektowaga-Tonawanda, NY 3 2 9 7 18 0.3 0.2 0.8 0.6 1.6

Charlotte-Gastonia-Concord, NC-SC 45 23 46 103 121 3.2 1.6 3.1 6.8 8.0

Chicago-Naperville-Joliet, IL-IN-WI 433 346 373 510 416 4.7 3.7 4.0 5.4 4.4

Cincinnati-Middletown, OH-KY-IN 7 2 22 24 13 0.3 0.1 1.1 1.2 0.6

Cleveland-Elyria-Mentor, OH 14 32 40 22 18 0.7 1.5 1.9 1.0 0.8

Columbus, OH 107 120 109 109 107 6.4 7.2 6.4 6.4 6.3

Dallas-Fort Worth-Arlington, TX 309 265 279 305 320 5.6 4.7 4.9 5.2 5.5

Denver-Aurora, CO 55 32 55 38 56 2.4 1.4 2.4 1.6 2.4

Detroit-Warren-Livonia, MI 466 218 153 77 82 10.4 4.9 3.4 1.7 1.8

Hartford-West Hartford-East Hartford, CT 11 16 13 14 23 0.9 1.4 1.1 1.2 1.9

Houston-Baytown-Sugar Land, TX 124 227 235 279 396 2.5 4.5 4.5 5.3 7.5

Indianapolis, IN 39 25 34 35 47 2.5 1.6 2.1 2.1 2.9

Jacksonville, FL 18 21 72 50 41 1.5 1.7 5.9 4.0 3.3

Kansas City, MO-KS 17 43 35 89 112 0.9 2.3 1.8 4.6 5.8

Las Vegas-Paradise, NV 7 8 38 103 132 0.5 0.5 2.3 6.0 7.7

Los Angeles-Long Beach-Santa Ana, CA 433 562 551 806 945 3.4 4.4 4.3 6.2 7.3

Louisville, KY-IN 83 28 38 46 41 7.0 2.4 3.2 3.8 3.4

Memphis, TN-MS-AR 111 90 99 138 145 9.0 7.3 7.9 10.9 11.5

Miami-Fort Lauderdale-Miami Beach, FL 391 409 434 395 369 7.5 7.7 8.1 7.3 6.8

Milwaukee-Waukesha-West Allis, WI 23 11 19 22 38 1.5 0.7 1.3 1.5 2.5

Minneapolis-St. Paul-Bloomington, MN-WI 55 43 26 68 43 1.8 1.4 0.8 2.2 1.4

Nashville-Davidson-Murfreesboro, TN 33 26 17 34 40 2.4 1.9 1.2 2.4 2.8

New Orleans-Metairie-Kenner, LA 13 28 101 88 90 1.0 2.1 7.7 6.7 6.8

New York-Newark-Edison, NY-NJ-PA 602 709 816 773 811 3.2 3.8 4.4 4.1 4.3

Oklahoma City, OK 65 56 20 23 24 5.8 4.9 1.7 2.0 2.1

Orlando, FL 67 70 69 106 94 3.8 3.9 3.7 5.5 4.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 103 135 95 127 173 1.8 2.3 1.6 2.2 3.0

Phoenix-Mesa-Scottsdale, AZ NA 134 106 113 157 NA 3.7 2.9 2.9 4.1

Pittsburgh, PA 24 38 22 69 91 1.0 1.6 0.9 2.9 3.8

Portland-Vancouver-Beaverton, OR-WA 28 47 26 39 25 1.4 2.3 1.3 1.9 1.2

Providence-New Bedford-Fall River, RI-MA 20 42 30 28 18 1.2 2.6 1.8 1.7 1.1

Richmond, VA 9 12 11 13 28 0.8 1.1 1.0 1.1 2.4

Riverside-San Bernardino-Ontario, CA 64 91 103 121 108 1.8 2.5 2.7 3.1 2.8

Rochester, NY 6 7 12 6 14 0.6 0.7 1.2 0.6 1.3

Sacramento-Arden-Arcade-Roseville, CA 14 19 19 16 32 0.7 1.0 0.9 0.8 1.6

Salt Lake City, UT 7 6 5 9 15 0.7 0.6 0.5 0.9 1.4

San Antonio, TX 48 52 116 129 136 2.7 2.9 6.3 6.8 7.2

San Diego-Carlsbad-San Marcos, CA 37 111 138 194 235 1.3 3.8 4.7 6.6 8.0

San Francisco-Oakland-Fremont, CA 399 406 422 331 363 9.5 9.8 10.2 8.0 8.7

San Jose-Sunnyvale-Santa Clara, CA 30 56 56 44 52 1.7 3.2 3.2 2.5 3.0

Seattle-Tacoma-Bellevue, WA 59 70 138 125 160 1.9 2.2 4.4 3.9 5.0

St. Louis, MO-IL 32 51 71 50 65 1.2 1.9 2.6 1.8 2.3

Tampa-St. Petersburg-Clearwater, FL 57 96 89 85 110 2.3 3.8 3.4 3.2 4.2

Virginia Beach-Norfolk-Newport News, VA-NC 31 23 50 60 84 1.9 1.4 3.0 3.6 5.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 139 168 199 233 250 2.8 3.3 3.9 4.5 4.8

U.S. MSA TOTAL 5,299 5,891 6,368 7,149 7,845 3.5 3.8 4.0 4.5 4.9

Table 29. Primary and secondary syphilis — Reported cases and rates in selected metropolitan statistical

areas* (MSAs) listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
128 Syphilis Tables STD Surveillance 2006

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 74 57 36 36 33 3.2 2.5 1.5 1.5 1.3

Austin-Round Rock, TX 3 2 3 3 11 0.5 0.3 0.4 0.4 1.5

Baltimore-Towson, MD 47 63 70 84 53 3.5 4.6 5.1 6.1 3.9

Birmingham-Hoover, AL 7 4 11 35 94 1.3 0.7 2.0 6.2 16.7

Boston-Cambridge-Quincy, MA-NH 8 2 5 1 7 0.3 0.1 0.2 0.0 0.3

Buffalo-Cheektowaga-Tonawanda, NY 0 1 1 0 2 0.0 0.2 0.2 0.0 0.3

Charlotte-Gastonia-Concord, NC-SC 22 3 12 20 28 3.1 0.4 1.6 2.6 3.6

Chicago-Naperville-Joliet, IL-IN-WI 62 44 55 50 43 1.3 0.9 1.1 1.0 0.9

Cincinnati-Middletown, OH-KY-IN 2 0 2 0 5 0.2 0.0 0.2 0.0 0.5

Cleveland-Elyria-Mentor, OH 4 13 3 1 2 0.4 1.2 0.3 0.1 0.2

Columbus, OH 11 17 31 22 30 1.3 2.0 3.6 2.5 3.5

Dallas-Fort Worth-Arlington, TX 123 99 73 100 112 4.5 3.5 2.6 3.4 3.9

Denver-Aurora, CO 0 3 6 1 3 0.0 0.3 0.5 0.1 0.3

Detroit-Warren-Livonia, MI 188 81 49 17 20 8.2 3.5 2.1 0.7 0.9

Hartford-West Hartford-East Hartford, CT 1 3 0 0 1 0.2 0.5 0.0 0.0 0.2

Houston-Baytown-Sugar Land, TX 19 26 39 61 65 0.8 1.0 1.5 2.3 2.5

Indianapolis, IN 11 7 2 4 1 1.4 0.9 0.2 0.5 0.1

Jacksonville, FL 8 9 32 20 11 1.3 1.5 5.1 3.1 1.7

Kansas City, MO-KS 3 20 5 5 17 0.3 2.1 0.5 0.5 1.7

Las Vegas-Paradise, NV 0 1 8 21 32 0.0 0.1 1.0 2.5 3.8

Los Angeles-Long Beach-Santa Ana, CA 19 28 40 63 72 0.3 0.4 0.6 1.0 1.1

Louisville, KY-IN 42 13 6 3 3 6.9 2.1 1.0 0.5 0.5

Memphis, TN-MS-AR 62 30 33 50 52 9.7 4.7 5.1 7.7 8.0

Miami-Fort Lauderdale-Miami Beach, FL 48 33 41 43 40 1.8 1.2 1.5 1.5 1.4

Milwaukee-Waukesha-West Allis, WI 5 1 1 1 2 0.6 0.1 0.1 0.1 0.3

Minneapolis-St. Paul-Bloomington, MN-WI 3 3 3 3 3 0.2 0.2 0.2 0.2 0.2

Nashville-Davidson-Murfreesboro, TN 13 6 2 2 2 1.9 0.9 0.3 0.3 0.3

New Orleans-Metairie-Kenner, LA 4 10 27 23 25 0.6 1.5 3.9 3.4 3.6

New York-Newark-Edison, NY-NJ-PA 65 65 58 37 31 0.7 0.7 0.6 0.4 0.3

Oklahoma City, OK 15 19 7 9 6 2.6 3.3 1.2 1.5 1.0

Orlando, FL 22 17 10 14 14 2.5 1.9 1.1 1.4 1.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 22 23 16 13 6 0.7 0.8 0.5 0.4 0.2

Phoenix-Mesa-Scottsdale, AZ NA 45 25 23 18 NA 2.5 1.4 1.2 0.9

Pittsburgh, PA 8 17 7 25 28 0.6 1.4 0.6 2.0 2.3

Portland-Vancouver-Beaverton, OR-WA 8 2 0 0 0 0.8 0.2 0.0 0.0 0.0

Providence-New Bedford-Fall River, RI-MA 5 9 10 7 0 0.6 1.1 1.2 0.8 0.0

Richmond, VA 2 2 1 1 1 0.3 0.3 0.2 0.2 0.2

Riverside-San Bernardino-Ontario, CA 2 5 1 12 10 0.1 0.3 0.1 0.6 0.5

Rochester, NY 1 1 0 1 0 0.2 0.2 0.0 0.2 0.0

Sacramento-Arden-Arcade-Roseville, CA 0 1 0 0 3 0.0 0.1 0.0 0.0 0.3

Salt Lake City, UT 0 1 1 1 1 0.0 0.2 0.2 0.2 0.2

San Antonio, TX 12 6 20 34 32 1.3 0.6 2.1 3.5 3.3

San Diego-Carlsbad-San Marcos, CA 6 4 10 25 12 0.4 0.3 0.7 1.7 0.8

San Francisco-Oakland-Fremont, CA 6 4 2 8 7 0.3 0.2 0.1 0.4 0.3

San Jose-Sunnyvale-Santa Clara, CA 1 4 4 2 7 0.1 0.5 0.5 0.2 0.8

Seattle-Tacoma-Bellevue, WA 0 2 6 4 2 0.0 0.1 0.4 0.2 0.1

St. Louis, MO-IL 12 12 9 5 3 0.8 0.8 0.6 0.3 0.2

Tampa-St. Petersburg-Clearwater, FL 10 6 3 8 15 0.8 0.5 0.2 0.6 1.1

Virginia Beach-Norfolk-Newport News, VA-NC 12 3 4 15 18 1.5 0.4 0.5 1.8 2.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 15 13 16 13 11 0.6 0.5 0.6 0.5 0.4

U.S. MSA TOTAL 1,013 840 806 926 994 1.3 1.1 1.0 1.1 1.2

Table 30. Primary and secondary syphilis — Women – Reported cases and rates in selected metropolitan

statistical areas* (MSAs) listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow

MSA-specific case counts and rates to be determined for some jurisdictions for some years.
STD Surveillance 2006 Syphilis Tables 129

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 303 459 472 562 496 13.5 20.1 20.2 23.0 20.3

Austin-Round Rock, TX 20 29 53 41 73 2.9 4.1 7.4 5.5 9.9

Baltimore-Towson, MD 116 161 206 160 160 9.3 12.8 16.2 12.5 12.5

Birmingham-Hoover, AL 6 19 22 66 150 1.2 3.7 4.2 12.5 28.5

Boston-Cambridge-Quincy, MA-NH 76 119 79 105 110 3.5 5.5 3.7 4.9 5.1

Buffalo-Cheektowaga-Tonawanda, NY 3 1 8 7 16 0.5 0.2 1.4 1.3 2.9

Charlotte-Gastonia-Concord, NC-SC 23 20 34 83 93 3.3 2.8 4.7 11.1 12.4

Chicago-Naperville-Joliet, IL-IN-WI 371 302 318 460 373 8.2 6.6 6.9 9.9 8.0

Cincinnati-Middletown, OH-KY-IN 5 2 20 24 8 0.5 0.2 2.0 2.4 0.8

Cleveland-Elyria-Mentor, OH 10 19 37 21 16 1.0 1.9 3.6 2.1 1.6

Columbus, OH 96 103 78 87 77 11.8 12.5 9.3 10.3 9.1

Dallas-Fort Worth-Arlington, TX 186 166 206 205 208 6.8 5.9 7.2 7.0 7.1

Denver-Aurora, CO 55 29 49 37 53 4.8 2.5 4.2 3.1 4.5

Detroit-Warren-Livonia, MI 278 137 104 60 62 12.7 6.3 4.8 2.7 2.8

Hartford-West Hartford-East Hartford, CT 10 13 13 14 22 1.8 2.3 2.3 2.4 3.8

Houston-Baytown-Sugar Land, TX 105 201 196 218 331 4.2 7.9 7.6 8.3 12.5

Indianapolis, IN 28 18 32 31 46 3.6 2.3 4.0 3.8 5.7

Jacksonville, FL 10 12 40 30 30 1.7 2.0 6.7 4.9 4.9

Kansas City, MO-KS 14 23 30 84 95 1.5 2.5 3.2 8.8 9.9

Las Vegas-Paradise, NV 7 7 30 82 100 0.9 0.9 3.6 9.4 11.5

Los Angeles-Long Beach-Santa Ana, CA 414 533 511 743 873 6.6 8.4 8.0 11.6 13.6

Louisville, KY-IN 41 14 32 43 38 7.1 2.4 5.5 7.3 6.4

Memphis, TN-MS-AR 49 60 66 88 93 8.3 10.0 10.9 14.4 15.3

Miami-Fort Lauderdale-Miami Beach, FL 343 376 393 352 329 13.5 14.7 15.1 13.4 12.5

Milwaukee-Waukesha-West Allis, WI 18 10 18 21 36 2.5 1.4 2.4 2.9 4.9

Minneapolis-St. Paul-Bloomington, MN-WI 52 40 23 65 40 3.4 2.6 1.5 4.2 2.6

Nashville-Davidson-Murfreesboro, TN 20 20 15 32 38 3.0 3.0 2.2 4.6 5.4

New Orleans-Metairie-Kenner, LA 9 18 74 65 65 1.4 2.8 11.7 10.3 10.3

New York-Newark-Edison, NY-NJ-PA 537 644 758 736 780 6.0 7.2 8.4 8.1 8.6

Oklahoma City, OK 50 37 13 14 18 9.1 6.6 2.3 2.5 3.2

Orlando, FL 45 53 59 92 80 5.2 6.0 6.4 9.6 8.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 81 112 79 114 167 2.9 4.0 2.8 4.1 5.9

Phoenix-Mesa-Scottsdale, AZ NA 89 81 89 136 NA 4.9 4.3 4.6 7.0

Pittsburgh, PA 16 21 15 44 63 1.4 1.8 1.3 3.8 5.5

Portland-Vancouver-Beaverton, OR-WA 20 45 26 39 25 2.0 4.4 2.5 3.7 2.4

Providence-New Bedford-Fall River, RI-MA 15 33 20 21 18 1.9 4.2 2.5 2.7 2.3

Richmond, VA 7 10 10 12 27 1.3 1.8 1.8 2.1 4.7

Riverside-San Bernardino-Ontario, CA 62 86 102 108 98 3.5 4.7 5.4 5.5 5.0

Rochester, NY 5 6 12 5 14 1.0 1.2 2.4 1.0 2.8

Sacramento-Arden-Arcade-Roseville, CA 14 18 19 16 29 1.5 1.9 1.9 1.6 2.9

Salt Lake City, UT 7 5 4 8 14 1.4 1.0 0.8 1.5 2.7

San Antonio, TX 36 46 96 95 104 4.1 5.2 10.6 10.3 11.2

San Diego-Carlsbad-San Marcos, CA 31 107 128 169 223 2.1 7.3 8.7 11.4 15.1

San Francisco-Oakland-Fremont, CA 393 401 419 323 355 19.0 19.5 20.4 15.7 17.3

San Jose-Sunnyvale-Santa Clara, CA 29 52 52 42 45 3.3 5.9 5.9 4.7 5.0

Seattle-Tacoma-Bellevue, WA 59 68 132 121 158 3.8 4.3 8.3 7.6 9.9

St. Louis, MO-IL 20 39 62 45 62 1.5 3.0 4.6 3.3 4.6

Tampa-St. Petersburg-Clearwater, FL 47 90 86 77 95 3.9 7.3 6.9 6.0 7.4

Virginia Beach-Norfolk-Newport News, VA-NC 19 20 46 45 66 2.4 2.5 5.7 5.5 8.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 124 155 183 220 239 5.1 6.2 7.3 8.6 9.4

U.S. MSA TOTAL 4,285 5,048 5,561 6,221 6,847 5.8 6.6 7.2 7.9 8.7

Table 31. Primary and secondary syphilis — Men – Reported cases and rates in selected metropolitan

statistical areas* (MSAs) listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not allow

MSA-specific case counts and rates to be determined for some jurisdictions for some years.
130 Syphilis Tables STD Surveillance 2006

Age

Group

Cases Rates

Year Total Male Female Total Male Female

2002

10-14 15 4 11 0.1 0.0 0.1

15-19 351 135 216 1.7 1.3 2.2

20-24 842 533 309 4.2 5.2 3.1

25-29 895 668 227 4.7 6.9 2.4

30-34 1,097 877 220 5.2 8.3 2.1

35-39 1,367 1,121 246 6.2 10.2 2.2

40-44 1,023 845 178 4.4 7.4 1.5

45-54 982 825 157 2.5 4.2 0.8

55-64 217 196 21 0.8 1.5 0.2

65+ 67 59 8 0.2 0.4 0.0

TOTAL 6,862 5,268 1,594 2.4 3.7 1.1

2003

10-14 11 1 10 0.1 0.0 0.1

15-19 322 150 172 1.6 1.4 1.7

20-24 860 620 240 4.2 5.8 2.4

25-29 941 760 181 4.9 7.8 1.9

30-34 1,187 1,023 164 5.7 9.8 1.6

35-39 1,460 1,290 170 6.8 12.0 1.6

40-44 1,157 1,021 136 5.0 8.9 1.2

45-54 991 871 119 2.4 4.3 0.6

55-64 205 187 18 0.7 1.4 0.1

65+ 42 36 6 0.1 0.2 0.0

TOTAL 7,177 5,959 1,218 2.5 4.2 0.8

2004

10-14 9 2 7 0.0 0.0 0.1

15-19 339 191 148 1.7 1.8 1.5

20-24 1,029 735 294 5.0 6.9 2.9

25-29 1,125 943 182 5.8 9.5 1.9

30-34 1,282 1,116 166 6.3 10.9 1.7

35-39 1,467 1,313 154 7.0 12.5 1.5

40-44 1,344 1,198 146 5.9 10.6 1.3

45-54 1,035 915 120 2.5 4.5 0.6

55-64 281 249 32 1.0 1.8 0.2

65+ 55 54 1 0.2 0.4 0.0

TOTAL 7,975 6,721 1,254 2.7 4.7 0.8

2005

10-14 10 2 8 0.0 0.0 0.1

15-19 443 251 192 2.1 2.3 1.9

20-24 1,181 875 306 5.6 8.1 3.0

25-29 1,214 1,008 206 6.0 9.8 2.1

30-34 1,329 1,178 150 6.6 11.6 1.5

35-39 1,574 1,394 179 7.5 13.2 1.7

40-44 1,418 1,253 164 6.2 11.0 1.4

45-54 1,192 1,080 111 2.8 5.2 0.5

55-64 304 284 20 1.0 1.9 0.1

65+ 59 57 2 0.2 0.4 0.0

TOTAL 8,724 7,385 1,339 2.9 5.1 0.9

2006

10-14 13 2 11 0.1 0.0 0.1

15-19 565 332 233 2.7 3.1 2.3

20-24 1,382 1,083 299 6.6 10.0 2.9

25-29 1,574 1,333 241 7.8 13.0 2.5

30-34 1,221 1,058 163 6.1 10.4 1.6

35-39 1,581 1,427 154 7.5 13.5 1.5

40-44 1,516 1,363 153 6.6 12.0 1.3

45-54 1,443 1,278 165 3.4 6.1 0.8

55-64 375 340 35 1.2 2.3 0.2

65+ 81 79 2 0.2 0.5 0.0

TOTAL 9,756 8,297 1,459 3.3 5.7 1.0

Table 32. Primary and secondary syphilis — Reported cases and rates per 100,000 population by age group

and sex: United States, 2002–2006

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
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132 Syphilis Tables STD Surveillance 2006

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2002

10-14 2 1 1 10 28211101000

15-19 33 9 24 253 89 164 62 37 25 202101

20-24 129 89 40 546 313 233 146 117 29 13 94853

25-29 224 189 36 485 323 163 165 138 26 17 16 1431

30-34 404 373 31 476 310 166 192 172 20 22 21 1312

35-39 576 541 35 568 385 183 200 178 22 15 14 1835

40-44 452 429 23 448 305 142 102 93 8 15 14 1743

45-54 393 370 23 482 370 112 83 69 15 8 8 0 16 8 7

55-64 95 91 4 110 94 16 10 10 0000211

65+ 15 15 0 42 35 7 9 8 1 0 0 0 1 1 0

TOTAL 2,325 2,108 217 3,421 2,226 1,195 971 823 147 94 83 11 51 27 24

2003

10-14 000514505000101

15-19 48 24 24 205 93 112 63 28 35 651000

20-24 195 154 41 471 309 161 178 142 36 13 11 2330

25-29 301 265 36 408 293 115 195 173 23 28 25 3844

30-34 524 485 39 416 316 100 213 190 23 20 20 0 14 12 2

35-39 743 703 40 451 335 116 222 211 11 28 28 0 16 14 2

40-44 588 563 26 382 288 94 158 146 12 20 19 1953

45-54 489 472 17 373 287 86 107 97 9 10 8 1 13 6 6

55-64 104 100 4 81 68 13 13 12 1220440

65+ 17 16 1 18 16 2 5 2 3 0 0 0 1 1 0

TOTAL 3,010 2,783 227 2,811 2,005 805 1,160 1,001 159 127 119 8 69 50 19

2004

10-14 000826101000000

15-19 56 33 23 211 113 98 55 33 22 11 92633

20-24 242 185 57 573 375 198 188 156 32 19 16 3844

25-29 317 281 36 534 421 113 237 213 24 28 25 3 11 5 5

30-34 512 470 41 496 402 95 238 215 23 29 28 1 10 3 6

35-39 675 640 35 489 392 98 249 235 14 36 35 1 18 12 6

40-44 684 655 29 455 353 102 179 169 9 18 18 0 10 4 5

45-54 525 503 23 379 295 84 110 98 12 11 11 0 10 9 1

55-64 155 145 10 101 83 18 20 20 0211413

65+ 36 35 1 16 16 0 3 3 0 0 0 0 0 0 0

TOTAL 3,203 2,947 256 3,266 2,452 814 1,280 1,142 138 153 142 11 77 42 35

2005

10-14 000918110000000

15-19 67 36 30 304 173 131 62 36 26 541514

20-24 281 230 51 660 459 201 216 167 49 15 11 4871

25-29 331 299 32 612 480 132 236 198 38 27 25 2862

30-34 491 456 35 554 455 99 230 216 14 43 42 1 12 10 2

35-39 761 712 49 518 415 103 268 244 24 19 19 0844

40-44 741 700 40 446 350 97 193 172 21 26 24 2 12 7 4

45-54 660 631 29 385 320 65 126 111 14 15 14 1642

55-64 167 162 5 102 90 13 30 28 2440000

65+ 26 26 0 23 21 2 8 8 0 2 2 0 0 0 0

TOTAL 3,524 3,254 270 3,615 2,764 850 1,370 1,182 188 156 145 11 60 40 20

2006

10-14 1 0 1 11 29000000101

15-19 71 39 33 419 246 173 74 46 28 110000

20-24 291 247 44 853 630 223 218 187 31 12 11 1871

25-29 431 381 50 795 641 154 304 271 34 37 35 2761

30-34 433 395 38 497 398 99 243 223 20 34 31 3 14 11 3

35-39 720 676 44 532 447 85 282 263 18 33 32 1 14 9 5

40-44 802 756 46 443 356 87 227 213 14 30 29 1 15 10 5

45-54 766 729 38 500 394 107 143 129 14 24 22 2954

55-64 194 186 8 139 115 24 35 33 2220541

65+ 34 34 0 25 23 2 17 17 0 0 0 0 5 5 0

TOTAL 3,744 3,443 301 4,215 3,253 962 1,543 1,381 162 173 163 10 80 57 24

Table 33A. Primary and secondary syphilis — Reported cases by race/ethnicity, age group and sex: United States,

2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 32 for age-specific cases and rates and Tables 25-27 for total

and sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these

variables were specified. Differences between total cases from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2006 Syphilis Tables 133

Age

Group

White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.1 0.1 0.1 0.1 0.0 0.2 0.0 0.0 0.0

2002

15-19 0.3 0.1 0.4 8.3 5.8 11.0 1.9 2.2 1.6 0.2 0.0 0.5 0.4 0.0 0.9

20-24 1.0 1.4 0.6 19.0 22.1 16.0 4.0 5.9 1.8 1.4 2.0 0.9 4.2 5.2 3.2

25-29 2.0 3.3 0.6 19.4 27.1 12.5 4.4 6.7 1.6 1.5 2.9 0.2 2.5 3.8 1.2

30-34 3.0 5.6 0.5 17.9 24.6 11.8 5.4 9.0 1.2 1.8 3.5 0.2 1.9 1.3 2.4

35-39 3.9 7.3 0.5 20.5 29.5 12.5 6.3 10.7 1.5 1.4 2.7 0.2 4.6 3.7 5.5

40-44 2.8 5.3 0.3 16.0 23.2 9.6 3.8 6.8 0.7 1.5 2.8 0.2 3.9 4.6 3.2

45-54 1.3 2.5 0.2 10.7 17.8 4.6 2.3 3.8 0.8 0.5 1.1 0.0 5.1 5.7 4.5

55-64 0.5 0.9 0.0 4.3 8.2 1.1 0.5 1.1 0.0 0.0 0.0 0.0 1.1 1.2 1.1

65+ 0.0 0.1 0.0 1.4 3.1 0.4 0.5 1.0 0.1 0.0 0.0 0.0 0.7 1.5 0.0

TOTAL 1.2 2.2 0.2 9.5 13.0 6.3 2.5 4.1 0.8 0.8 1.4 0.2 2.1 2.3 1.9

10-14 0.0 0.0 0.0 0.1 0.1 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0 0.9

2003

15-19 0.4 0.4 0.4 6.7 5.9 7.4 1.9 1.7 2.2 0.7 1.2 0.2 0.0 0.0 0.0

20-24 1.5 2.4 0.6 16.0 21.1 10.9 4.8 6.8 2.2 1.4 2.3 0.4 1.5 3.0 0.0

25-29 2.6 4.6 0.6 16.1 24.1 8.7 5.1 8.3 1.3 2.5 4.4 0.5 4.9 5.0 4.9

30-34 4.0 7.4 0.6 15.7 25.2 7.2 5.9 9.9 1.4 1.6 3.3 0.0 8.1 13.8 2.4

35-39 5.2 9.8 0.6 16.6 26.2 8.1 7.0 12.5 0.8 2.6 5.3 0.0 9.0 15.9 2.3

40-44 3.6 7.0 0.3 13.6 21.9 6.3 5.8 10.3 0.9 1.9 3.7 0.2 4.5 6.0 3.2

45-54 1.6 3.1 0.1 8.0 13.4 3.4 2.8 5.1 0.5 0.5 1.0 0.1 4.0 4.2 3.8

55-64 0.5 0.9 0.0 3.0 5.7 0.9 0.6 1.2 0.1 0.2 0.5 0.0 2.3 4.8 0.0

65+ 0.1 0.1 0.0 0.6 1.4 0.1 0.3 0.3 0.3 0.0 0.0 0.0 0.7 1.5 0.0

TOTAL 1.5 2.8 0.2 7.7 11.5 4.2 2.9 4.9 0.8 1.0 1.9 0.1 2.8 4.2 1.5

10-14 0.0 0.0 0.0 0.2 0.1 0.4 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2004

15-19 0.4 0.5 0.4 6.7 7.1 6.3 1.6 1.9 1.3 1.2 1.9 0.5 2.7 2.7 2.8

20-24 1.9 2.8 0.9 19.1 25.0 13.2 5.0 7.5 1.9 1.9 3.1 0.6 3.9 3.9 3.9

25-29 2.7 4.7 0.6 20.5 33.5 8.4 6.1 9.8 1.4 2.4 4.4 0.5 6.1 6.1 6.0

30-34 4.0 7.4 0.7 18.9 32.2 6.8 6.4 10.8 1.4 2.3 4.4 0.2 5.7 3.9 7.5

35-39 4.9 9.2 0.5 18.4 31.2 6.9 7.6 13.5 0.9 3.1 6.2 0.2 10.6 14.1 7.1

40-44 4.3 8.2 0.4 16.1 26.7 6.8 6.2 11.3 0.7 1.7 3.6 0.0 5.1 4.7 5.4

45-54 1.7 3.3 0.1 8.0 13.4 3.3 2.7 4.8 0.6 0.6 1.3 0.0 3.0 5.6 0.6

55-64 0.7 1.3 0.1 3.6 6.6 1.2 0.9 1.9 0.0 0.2 0.2 0.2 2.0 1.1 2.9

65+ 0.1 0.3 0.0 0.5 1.4 0.0 0.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL 1.6 3.0 0.3 8.8 13.9 4.2 3.1 5.4 0.7 1.2 2.2 0.2 3.1 3.5 2.8

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2005

15-19 0.5 0.5 0.5 9.4 10.6 8.2 1.8 2.0 1.6 0.6 0.9 0.2 2.3 0.9 3.7

20-24 2.1 3.4 0.8 21.9 30.2 13.5 5.8 8.2 2.9 1.6 2.3 0.8 3.8 6.6 0.9

25-29 2.8 4.9 0.5 22.6 36.5 9.5 5.8 8.8 2.1 2.4 4.5 0.4 4.6 6.6 2.6

30-34 4.0 7.4 0.6 21.4 37.1 7.3 6.0 10.5 0.8 3.2 6.5 0.2 7.1 11.6 2.5

35-39 5.6 10.4 0.7 19.6 33.3 7.4 7.9 13.5 1.5 1.5 3.2 0.0 5.1 5.3 4.9

40-44 4.7 8.9 0.5 15.8 26.5 6.4 6.4 11.0 1.5 2.3 4.4 0.4 6.2 8.3 4.3

45-54 2.1 4.1 0.2 7.9 14.1 2.5 2.9 5.2 0.7 0.8 1.6 0.1 1.9 2.7 1.2

55-64 0.7 1.4 0.0 3.5 6.8 0.8 1.3 2.5 0.2 0.3 0.7 0.0 0.0 0.0 0.0

65+ 0.1 0.2 0.0 0.7 1.8 0.1 0.4 0.9 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 1.8 3.3 0.3 9.7 15.5 4.4 3.2 5.4 0.9 1.1 2.2 0.2 2.4 3.3 1.6

10-14 0.0 0.0 0.0 0.3 0.1 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 0.9

2006

15-19 0.5 0.6 0.5 12.9 15.0 10.8 2.1 2.6 1.6 0.1 0.2 0.0 0.0 0.0 0.0

20-24 2.2 3.7 0.7 28.3 41.5 14.9 5.8 9.2 1.8 1.3 2.3 0.2 3.8 6.4 1.1

25-29 3.6 6.3 0.8 29.3 48.8 11.0 7.6 12.1 1.9 3.2 6.2 0.4 4.1 6.9 1.2

30-34 3.5 6.4 0.6 19.2 32.5 7.3 6.4 10.9 1.2 2.6 4.8 0.5 8.2 12.8 3.7

35-39 5.3 9.9 0.7 20.2 35.9 6.1 8.3 14.6 1.2 2.8 5.5 0.2 8.3 10.5 6.1

40-44 5.1 9.6 0.6 15.7 27.0 5.8 7.6 13.6 1.0 2.7 5.4 0.2 7.9 10.7 5.4

45-54 2.5 4.7 0.2 10.2 17.4 4.0 3.3 6.0 0.7 1.3 2.5 0.2 2.8 3.3 2.4

55-64 0.8 1.6 0.1 4.7 8.7 1.4 1.5 2.9 0.2 0.2 0.4 0.0 2.5 4.2 0.9

65+ 0.1 0.3 0.0 0.8 1.9 0.1 0.7 1.7 0.0 0.0 0.0 0.0 2.9 6.6 0.0

TOTAL 1.9 3.5 0.3 11.3 18.3 4.9 3.6 6.3 0.8 1.3 2.5 0.1 3.3 4.7 1.9

Table 33B. Primary and secondary syphilis — Rates per 100,000 population by race/ethnicity, age group and sex:

United States, 2002–2006

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 32 for age-specific cases and rates and Tables 25-27 for total and

sex-specific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were

specified. Differences between total rates from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year

age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
134 Syphilis Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 211 140 231 184 341 4.7 3.1 5.1 4.0 7.5

Alaska 1 0 1 8 6 0.2 0.0 0.2 1.2 0.9

Arizona 200 232 219 134 186 3.7 4.2 3.8 2.3 3.1

Arkansas 51 71 56 48 67 1.9 2.6 2.0 1.7 2.4

California 716 820 873 1,153 1,369 2.0 2.3 2.4 3.2 3.8

Colorado 22 20 24 27 38 0.5 0.4 0.5 0.6 0.8

Connecticut 13 13 16 19 27 0.4 0.4 0.5 0.5 0.8

Delaware 9 11 25 9 16 1.1 1.3 3.0 1.1 1.9

District of Columbia 192 152 113 103 77 33.6 26.9 20.4 18.7 14.0

Florida 949 988 856 726 760 5.7 5.8 4.9 4.1 4.3

Georgia 701 720 333 380 366 8.2 8.3 3.8 4.2 4.0

Hawaii 21 6 3 4 2 1.7 0.5 0.2 0.3 0.2

Idaho 4 8 26 13 3 0.3 0.6 1.9 0.9 0.2

Illinois 528 350 322 397 267 4.2 2.8 2.5 3.1 2.1

Indiana 53 58 45 42 46 0.9 0.9 0.7 0.7 0.7

Iowa 8 5 12 6 6 0.3 0.2 0.4 0.2 0.2

Kansas 13 19 12 18 18 0.5 0.7 0.4 0.7 0.7

Kentucky 49 43 24 23 36 1.2 1.0 0.6 0.6 0.9

Louisiana 183 197 316 252 481 4.1 4.4 7.0 5.6 10.6

Maine 1 7 0 2 7 0.1 0.5 0.0 0.2 0.5

Maryland 181 211 213 289 193 3.3 3.8 3.8 5.2 3.4

Massachusetts 95 136 96 105 82 1.5 2.1 1.5 1.6 1.3

Michigan 255 122 121 69 43 2.5 1.2 1.2 0.7 0.4

Minnesota 23 45 21 46 58 0.5 0.9 0.4 0.9 1.1

Mississippi 149 173 130 162 197 5.2 6.0 4.5 5.5 6.7

Missouri 51 46 58 108 93 0.9 0.8 1.0 1.9 1.6

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 1 0 2 1 0.0 0.1 0.0 0.1 0.1

Nevada 12 35 24 64 119 0.6 1.6 1.0 2.7 4.9

New Hampshire 1 4 0 0 2 0.1 0.3 0.0 0.0 0.2

New Jersey 220 326 344 289 314 2.6 3.8 4.0 3.3 3.6

New Mexico 23 53 69 53 85 1.2 2.8 3.6 2.7 4.4

New York 756 1,019 744 1,084 993 3.9 5.3 3.9 5.6 5.2

North Carolina 333 261 261 215 294 4.0 3.1 3.1 2.5 3.4

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 84 92 184 136 115 0.7 0.8 1.6 1.2 1.0

Oklahoma 124 77 62 64 121 3.5 2.2 1.8 1.8 3.4

Oregon 18 27 29 16 19 0.5 0.8 0.8 0.4 0.5

Pennsylvania 237 216 183 204 286 1.9 1.7 1.5 1.6 2.3

Rhode Island 9 7 15 5 6 0.8 0.7 1.4 0.5 0.6

South Carolina 202 180 204 222 174 4.9 4.3 4.9 5.2 4.1

South Dakota 0 3 0 0 6 0.0 0.4 0.0 0.0 0.8

Tennessee 390 228 206 203 233 6.7 3.9 3.5 3.4 3.9

Texas 1,149 1,065 1,069 1,013 1,312 5.3 4.8 4.8 4.4 5.7

Utah 8 7 5 7 7 0.3 0.3 0.2 0.3 0.3

Vermont 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Virginia 94 74 108 148 165 1.3 1.0 1.4 2.0 2.2

Washington 23 36 51 63 81 0.4 0.6 0.8 1.0 1.3

West Virginia 1 2 9 3 6 0.1 0.1 0.5 0.2 0.3

Wisconsin 66 54 55 58 60 1.2 1.0 1.0 1.0 1.1

Wyoming 0 1 0 0 0 0.0 0.2 0.0 0.0 0.0

U.S. TOTAL 8,429 8,361 7,768 8,176 9,186 2.9 2.9 2.6 2.8 3.1

Northeast 1,332 1,728 1,398 1,708 1,719 2.5 3.2 2.6 3.1 3.1

Midwest 1,081 795 830 882 713 1.7 1.2 1.3 1.3 1.1

South 4,968 4,593 4,216 4,044 4,839 4.8 4.4 4.0 3.8 4.5

West 1,048 1,245 1,324 1,542 1,915 1.6 1.9 2.0 2.3 2.8

Guam 3 1 0 0 3 1.9 0.6 0.0 0.0 1.8

Puerto Rico 702 748 353 432 368 18.2 19.3 9.1 11.0 9.4

Virgin Islands 1 6 8 7 0 0.9 5.5 7.4 6.4 0.0

OUTLYING AREAS 706 755 361 439 371 17.1 18.2 8.7 10.5 8.9

TOTAL 9,135 9,116 8,129 8,615 9,557 3.1 3.1 2.7 2.9 3.2

Table 34. Early latent syphilis — Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2002–2006
STD Surveillance 2006 Syphilis Tables 135

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 585 614 281 314 293 12.9 13.3 6.0 6.4 6.0

Austin-Round Rock, TX 25 42 59 59 51 1.9 3.0 4.2 4.1 3.5

Baltimore-Towson, MD 151 189 167 211 136 5.8 7.2 6.3 7.9 5.1

Birmingham-Hoover, AL 33 24 42 82 220 3.1 2.2 3.9 7.5 20.2

Boston-Cambridge-Quincy, MA-NH 81 117 70 84 65 1.8 2.6 1.6 1.9 1.5

Buffalo-Cheektowaga-Tonawanda, NY 2 2 4 3 14 0.2 0.2 0.3 0.3 1.2

Charlotte-Gastonia-Concord, NC-SC 49 51 58 71 98 3.5 3.5 3.9 4.7 6.4

Chicago-Naperville-Joliet, IL-IN-WI 510 344 322 395 269 5.5 3.7 3.4 4.2 2.8

Cincinnati-Middletown, OH-KY-IN 1 0 8 13 7 0.0 0.0 0.4 0.6 0.3

Cleveland-Elyria-Mentor, OH 13 7 33 21 11 0.6 0.3 1.5 1.0 0.5

Columbus, OH 55 44 72 41 55 3.3 2.6 4.3 2.4 3.2

Dallas-Fort Worth-Arlington, TX 508 488 380 381 532 9.3 8.7 6.7 6.5 9.1

Denver-Aurora, CO 19 17 22 22 32 0.8 0.7 0.9 0.9 1.4

Detroit-Warren-Livonia, MI 228 112 103 59 34 5.1 2.5 2.3 1.3 0.8

Hartford-West Hartford-East Hartford, CT 7 2 5 7 10 0.6 0.2 0.4 0.6 0.8

Houston-Baytown-Sugar Land, TX 198 237 246 207 291 4.0 4.7 4.7 3.9 5.5

Indianapolis, IN 31 23 24 19 18 2.0 1.4 1.5 1.2 1.1

Jacksonville, FL 27 40 75 56 56 2.3 3.3 6.1 4.5 4.5

Kansas City, MO-KS 12 31 23 51 41 0.6 1.6 1.2 2.6 2.1

Las Vegas-Paradise, NV 7 28 19 57 112 0.5 1.8 1.2 3.3 6.5

Los Angeles-Long Beach-Santa Ana, CA 390 434 445 666 851 3.1 3.4 3.4 5.2 6.6

Louisville, KY-IN 36 34 16 16 18 3.0 2.9 1.3 1.3 1.5

Memphis, TN-MS-AR 239 177 170 171 174 19.4 14.3 13.6 13.6 13.8

Miami-Fort Lauderdale-Miami Beach, FL 516 578 477 302 304 9.9 10.9 8.9 5.6 5.6

Milwaukee-Waukesha-West Allis, WI 53 41 37 36 46 3.5 2.7 2.4 2.4 3.0

Minneapolis-St. Paul-Bloomington, MN-WI 23 41 19 43 52 0.8 1.3 0.6 1.4 1.7

Nashville-Davidson-Murfreesboro, TN 127 31 30 29 42 9.4 2.3 2.1 2.0 3.0

New Orleans-Metairie-Kenner, LA 45 48 85 68 127 3.4 3.6 6.4 5.2 9.6

New York-Newark-Edison, NY-NJ-PA 903 1,259 1,012 1,281 1,178 4.9 6.8 5.4 6.8 6.3

Oklahoma City, OK 81 62 47 36 74 7.2 5.5 4.1 3.1 6.4

Orlando, FL 172 117 90 124 91 9.8 6.5 4.8 6.4 4.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 263 256 220 171 280 4.6 4.4 3.8 2.9 4.8

Phoenix-Mesa-Scottsdale, AZ NA 165 165 97 166 NA 4.6 4.4 2.5 4.3

Pittsburgh, PA 15 11 8 28 43 0.6 0.5 0.3 1.2 1.8

Portland-Vancouver-Beaverton, OR-WA 19 22 23 12 9 0.9 1.1 1.1 0.6 0.4

Providence-New Bedford-Fall River, RI-MA 12 11 25 10 9 0.7 0.7 1.5 0.6 0.6

Richmond, VA 17 24 18 24 29 1.5 2.1 1.6 2.0 2.5

Riverside-San Bernardino-Ontario, CA 43 34 40 64 64 1.2 0.9 1.1 1.6 1.6

Rochester, NY 2 8 4 13 8 0.2 0.8 0.4 1.3 0.8

Sacramento-Arden-Arcade-Roseville, CA 8 5 11 11 23 0.4 0.3 0.5 0.5 1.1

Salt Lake City, UT 7 4 5 3 5 0.7 0.4 0.5 0.3 0.5

San Antonio, TX 108 66 79 144 172 6.0 3.6 4.3 7.6 9.1

San Diego-Carlsbad-San Marcos, CA 34 41 84 117 123 1.2 1.4 2.9 4.0 4.2

San Francisco-Oakland-Fremont, CA 203 230 235 220 220 4.9 5.5 5.7 5.3 5.3

San Jose-Sunnyvale-Santa Clara, CA 11 20 13 18 18 0.6 1.2 0.7 1.0 1.0

Seattle-Tacoma-Bellevue, WA 18 30 42 60 74 0.6 1.0 1.3 1.9 2.3

St. Louis, MO-IL 40 28 31 34 30 1.5 1.0 1.1 1.2 1.1

Tampa-St. Petersburg-Clearwater, FL 80 142 103 101 177 3.2 5.6 4.0 3.8 6.7

Virginia Beach-Norfolk-Newport News, VA-NC 35 21 45 78 74 2.2 1.3 2.7 4.7 4.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 243 195 182 208 171 4.8 3.8 3.5 4.0 3.3

U.S. MSA TOTAL 6,285 6,547 5,774 6,338 6,997 4.2 4.2 3.7 4.0 4.4

Table 35. Early latent syphilis — Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
136 Syphilis Tables STD Surveillance 2006

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 334 309 232 193 262 7.4 6.9 5.1 4.2 5.7

Alaska 8 7 6 5 8 1.2 1.1 0.9 0.8 1.2

Arizona 666 659 572 455 521 12.2 11.8 10.0 7.7 8.8

Arkansas 124 172 142 124 92 4.6 6.3 5.2 4.5 3.3

California 2,107 2,024 2,293 2,527 2,773 6.0 5.7 6.4 7.0 7.7

Colorado 86 82 90 70 73 1.9 1.8 2.0 1.5 1.6

Connecticut 147 163 108 88 106 4.2 4.7 3.1 2.5 3.0

Delaware 42 29 26 15 38 5.2 3.5 3.1 1.8 4.5

District of Columbia 180 129 174 148 120 31.5 22.9 31.4 26.9 21.8

Florida 1,686 1,610 1,364 1,422 1,445 10.1 9.5 7.8 8.0 8.1

Georgia 743 836 701 898 977 8.7 9.6 7.9 9.9 10.8

Hawaii 27 39 25 42 46 2.2 3.1 2.0 3.3 3.6

Idaho 11 18 25 21 6 0.8 1.3 1.8 1.5 0.4

Illinois 546 633 614 663 760 4.3 5.0 4.8 5.2 6.0

Indiana 196 252 164 182 111 3.2 4.1 2.6 2.9 1.8

Iowa 38 29 19 13 43 1.3 1.0 0.6 0.4 1.4

Kansas 44 32 49 51 41 1.6 1.2 1.8 1.9 1.5

Kentucky 72 83 79 54 78 1.8 2.0 1.9 1.3 1.9

Louisiana 439 1,195 979 696 551 9.8 26.6 21.7 15.4 12.2

Maine 6 6 5 3 6 0.5 0.5 0.4 0.2 0.5

Maryland 415 443 399 387 526 7.6 8.0 7.2 6.9 9.4

Massachusetts 346 375 307 168 172 5.4 5.8 4.8 2.6 2.7

Michigan 408 451 470 297 210 4.1 4.5 4.6 2.9 2.1

Minnesota 65 103 96 89 83 1.3 2.0 1.9 1.7 1.6

Mississippi 247 220 212 160 237 8.6 7.6 7.3 5.5 8.1

Missouri 118 96 114 114 166 2.1 1.7 2.0 2.0 2.9

Montana 4 0 0 0 1 0.4 0.0 0.0 0.0 0.1

Nebraska 19 15 8 12 26 1.1 0.9 0.5 0.7 1.5

Nevada 86 102 189 169 117 4.0 4.6 8.1 7.0 4.8

New Hampshire 15 14 21 17 20 1.2 1.1 1.6 1.3 1.5

New Jersey 637 572 319 375 297 7.4 6.6 3.7 4.3 3.4

New Mexico 48 75 97 68 66 2.6 4.0 5.1 3.5 3.4

New York 2,620 2,715 2,979 2,054 2,833 13.7 14.1 15.5 10.7 14.7

North Carolina 424 417 285 213 352 5.1 5.0 3.3 2.5 4.1

North Dakota 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Ohio 105 189 148 153 192 0.9 1.7 1.3 1.3 1.7

Oklahoma 89 211 79 50 58 2.5 6.0 2.2 1.4 1.6

Oregon 29 43 50 52 51 0.8 1.2 1.4 1.4 1.4

Pennsylvania 342 329 273 308 335 2.8 2.7 2.2 2.5 2.7

Rhode Island 45 50 62 35 51 4.2 4.6 5.7 3.3 4.7

South Carolina 269 263 194 239 155 6.5 6.3 4.6 5.6 3.6

South Dakota 0 0 0 2 10 0.0 0.0 0.0 0.3 1.3

Tennessee 514 511 459 493 527 8.9 8.7 7.8 8.3 8.8

Texas 2,299 2,200 2,244 2,336 2,501 10.6 9.9 10.0 10.2 10.9

Utah 56 51 59 33 38 2.4 2.2 2.5 1.3 1.5

Vermont 0 0 2 0 2 0.0 0.0 0.3 0.0 0.3

Virginia 362 395 380 361 343 5.0 5.3 5.1 4.8 4.5

Washington 63 121 135 144 160 1.0 2.0 2.2 2.3 2.5

West Virginia 2 7 6 12 13 0.1 0.4 0.3 0.7 0.7

Wisconsin 38 41 43 37 42 0.7 0.7 0.8 0.7 0.8

Wyoming 1 3 3 1 1 0.2 0.6 0.6 0.2 0.2

U.S. TOTAL 17,168 18,319 17,300 16,049 17,644 6.0 6.3 5.9 5.4 6.0

Northeast 4,158 4,224 4,076 3,048 3,822 7.7 7.8 7.5 5.6 7.0

Midwest 1,577 1,841 1,725 1,613 1,686 2.4 2.8 2.6 2.4 2.6

South 8,241 9,030 7,955 7,801 8,275 8.0 8.6 7.5 7.3 7.7

West 3,192 3,224 3,544 3,587 3,861 4.9 4.9 5.3 5.3 5.7

Guam 9 13 13 16 7 5.6 7.9 7.8 9.5 4.2

Puerto Rico 398 390 608 554 535 10.3 10.1 15.6 14.2 13.7

Virgin Islands 2 5 4 5 4 1.8 4.6 3.7 4.6 3.7

OUTLYING AREAS 409 408 625 575 546 9.9 9.8 15.0 13.7 13.0

TOTAL 17,577 18,727 17,925 16,624 18,190 6.0 6.3 6.0 5.5 6.1

Table 36. Late and late latent syphilis — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2002–2006
STD Surveillance 2006 Syphilis Tables 137

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Atlanta-Sandy Springs-Marietta, GA 460 566 522 714 814 10.2 12.3 11.1 14.5 16.6

Austin-Round Rock, TX 59 78 85 89 74 4.4 5.7 6.0 6.1 5.1

Baltimore-Towson, MD 222 229 195 209 283 8.5 8.8 7.4 7.9 10.7

Birmingham-Hoover, AL 99 74 40 57 94 9.3 6.9 3.7 5.2 8.6

Boston-Cambridge-Quincy, MA-NH 312 330 256 149 147 7.0 7.4 5.8 3.4 3.3

Buffalo-Cheektowaga-Tonawanda, NY 7 7 11 4 7 0.6 0.6 1.0 0.3 0.6

Charlotte-Gastonia-Concord, NC-SC 66 87 45 61 83 4.7 6.1 3.1 4.0 5.5

Chicago-Naperville-Joliet, IL-IN-WI 512 630 576 611 687 5.5 6.7 6.1 6.5 7.3

Cincinnati-Middletown, OH-KY-IN 24 16 24 18 37 1.2 0.8 1.2 0.9 1.8

Cleveland-Elyria-Mentor, OH 10 23 11 9 24 0.5 1.1 0.5 0.4 1.1

Columbus, OH 52 102 72 76 67 3.1 6.1 4.3 4.4 3.9

Dallas-Fort Worth-Arlington, TX 683 735 701 792 809 12.5 13.1 12.3 13.6 13.9

Denver-Aurora, CO 66 64 56 51 51 2.9 2.8 2.4 2.2 2.2

Detroit-Warren-Livonia, MI 356 383 400 238 155 7.9 8.5 8.9 5.3 3.5

Hartford-West Hartford-East Hartford, CT 50 52 28 35 32 4.3 4.4 2.4 2.9 2.7

Houston-Baytown-Sugar Land, TX 796 768 783 685 856 16.0 15.1 15.1 13.0 16.2

Indianapolis, IN 74 93 68 80 56 4.7 5.8 4.2 4.9 3.4

Jacksonville, FL 36 73 70 41 63 3.1 6.1 5.7 3.3 5.0

Kansas City, MO-KS 45 41 40 53 75 2.4 2.2 2.1 2.7 3.9

Las Vegas-Paradise, NV 67 87 167 139 95 4.4 5.5 10.1 8.1 5.6

Los Angeles-Long Beach-Santa Ana, CA 1,245 1,137 1,451 1,649 1,759 9.8 8.9 11.2 12.8 13.6

Louisville, KY-IN 42 63 60 40 42 3.6 5.3 5.0 3.3 3.5

Memphis, TN-MS-AR 276 278 242 272 287 22.4 22.4 19.4 21.6 22.8

Miami-Fort Lauderdale-Miami Beach, FL 1,012 909 769 742 773 19.3 17.2 14.3 13.7 14.3

Milwaukee-Waukesha-West Allis, WI 24 22 28 18 16 1.6 1.5 1.8 1.2 1.1

Minneapolis-St. Paul-Bloomington, MN-WI 52 89 79 74 65 1.7 2.9 2.5 2.4 2.1

Nashville-Davidson-Murfreesboro, TN 172 158 145 126 112 12.7 11.5 10.4 8.9 7.9

New Orleans-Metairie-Kenner, LA 71 187 259 190 133 5.4 14.2 19.6 14.4 10.1

New York-Newark-Edison, NY-NJ-PA 3,111 3,077 3,058 2,241 2,905 16.7 16.5 16.3 12.0 15.5

Oklahoma City, OK 63 135 42 28 18 5.6 11.9 3.7 2.4 1.6

Orlando, FL 159 129 106 183 217 9.1 7.2 5.7 9.5 11.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 345 392 361 284 315 6.0 6.8 6.2 4.9 5.4

Phoenix-Mesa-Scottsdale, AZ NA 589 468 363 424 NA 16.4 12.6 9.4 11.0

Pittsburgh, PA 13 8 2 15 18 0.5 0.3 0.1 0.6 0.8

Portland-Vancouver-Beaverton, OR-WA 19 34 35 43 40 0.9 1.7 1.7 2.1 1.9

Providence-New Bedford-Fall River, RI-MA 58 74 81 37 65 3.6 4.6 5.0 2.3 4.0

Richmond, VA 59 77 56 50 49 5.2 6.8 4.9 4.3 4.2

Riverside-San Bernardino-Ontario, CA 166 184 174 208 203 4.7 5.1 4.6 5.3 5.2

Rochester, NY 10 18 25 17 68 1.0 1.7 2.4 1.6 6.5

Sacramento-Arden-Arcade-Roseville, CA 26 11 33 8 78 1.3 0.6 1.6 0.4 3.8

Salt Lake City, UT 36 33 42 23 21 3.6 3.3 4.1 2.2 2.0

San Antonio, TX 165 109 164 178 156 9.2 6.0 8.8 9.4 8.3

San Diego-Carlsbad-San Marcos, CA 87 139 124 133 202 3.0 4.7 4.2 4.5 6.9

San Francisco-Oakland-Fremont, CA 266 260 258 165 156 6.4 6.3 6.2 4.0 3.8

San Jose-Sunnyvale-Santa Clara, CA 48 57 39 56 22 2.8 3.3 2.2 3.2 1.3

Seattle-Tacoma-Bellevue, WA 50 74 93 100 122 1.6 2.4 2.9 3.1 3.8

St. Louis, MO-IL 84 69 85 86 89 3.1 2.5 3.1 3.1 3.2

Tampa-St. Petersburg-Clearwater, FL 177 166 110 139 140 7.1 6.6 4.3 5.2 5.3

Virginia Beach-Norfolk-Newport News, VA-NC 118 104 100 105 85 7.3 6.4 6.1 6.4 5.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 483 470 511 453 496 9.6 9.2 9.9 8.7 9.5

U.S. MSA TOTAL 12,433 13,490 13,150 12,137 13,585 8.2 8.6 8.3 7.6 8.5

Table 37. Late and late latent syphilis — Reported cases and rates in selected metropolitan statistical areas*

(MSAs) listed in alphabetical order: United States, 2002–2006

*Data are presented for 50 MSAs with the largest population based on 2000 U.S. census. NA = Not available. STD morbidity reporting methods do not

allow MSA-specific case counts and rates to be determined for some jurisdictions for some years.
138 Syphilis Tables STD Surveillance 2006

Rank* State† Cases Rate per 100,000 Live Births

1 Nevada 15 42.6

2 Maryland 19 25.5

3 New Mexico 7 24.7

4 Texas 79 20.7

5 Louisiana 13 19.9

6 Arkansas 7 18.1

7 Arizona 16 17.1

8 Alabama 9 15.1

9 New Jersey 15 13.0

10 California 66 12.1

11 Michigan 13 10.0

12 Florida 21 9.6

U.S. TOTAL§ 349 8.5

13 Illinois 15 8.3

14 Tennessee 6 7.5

15 Georgia 9 6.5

16 New York 15 6.0

17 North Carolina 6 5.0

18 Utah 2 3.9

19 Oklahoma 2 3.9

20 Missouri 3 3.9

21 South Carolina 2 3.5

22 Colorado 2 2.9

23 Virginia 3 2.9

24 Kansas 1 2.5

25 Kentucky 1 1.8

26 Minnesota 1 1.4

YEAR 2010 TARGET 1.0

Alaska 0 0.0

Connecticut 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Maine 0 0.0

Massachusetts 0 0.0

Mississippi 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Ohio 0 0.0

Oregon 0 0.0

Pennsylvania 0 0.0

Rhode Island 0 0.0

South Dakota 0 0.0

Vermont 0 0.0

Washington 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

Table 38. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state, ranked

by rates: United States, 2006

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Mother’s state of residence used to assign case.

§

Total includes cases reported by the District of Columbia with 1 case and a rate of 12.6, but excludes outlying areas (Guam with 0 cases and rate of

0.0, Puerto Rico with 13 cases and rate of 25.4, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2006 Syphilis Tables 139

Cases Rates per 100,000 Live Births

State/Area* 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 6 4 11 5 9 10.2 6.7 18.5 8.4 15.1

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 20 29 26 28 16 22.8 31.9 27.8 29.9 17.1

Arkansas 10 2477 26.7 5.3 10.4 18.1 18.1

California 61 64 67 75 66 11.5 11.8 12.3 13.8 12.1

Colorado 2 3 2 1 2 2.9 4.3 2.9 1.5 2.9

Connecticut 0 1 0 1 0 0.0 2.3 0.0 2.4 0.0

Delaware 0 0 1 0 0 0.0 0.0 8.8 0.0 0.0

District of Columbia 11101 13.3 13.1 12.6 0.0 12.6

Florida 28 27 16 16 21 13.6 12.7 7.3 7.3 9.6

Georgia 13 11 6 1 9 9.8 8.1 4.3 0.7 6.5

Hawaii 0 2 0 0 0 0.0 11.0 0.0 0.0 0.0

Idaho 0 4 3 0 0 0.0 18.3 13.3 0.0 0.0

Illinois 40 20 26 23 15 22.1 11.0 14.4 12.7 8.3

Indiana 97420 10.6 8.1 4.6 2.3 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 1 2 0 1 0.0 2.5 5.0 0.0 2.5

Kentucky 3 1 1 0 1 5.5 1.8 1.8 0.0 1.8

Louisiana 2 6 19 13 13 3.1 9.2 29.1 19.9 19.9

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 19 9 10 16 19 25.9 12.0 13.4 21.4 25.5

Massachusetts 1 0 0 0 0 1.2 0.0 0.0 0.0 0.0

Michigan 35 38 23 17 13 26.9 29.0 17.7 13.1 10.0

Minnesota 1 0 1 3 1 1.5 0.0 1.4 4.2 1.4

Mississippi 62300 14.5 4.7 7.0 0.0 0.0

Missouri 1 4 3 3 3 1.3 5.2 3.9 3.9 3.9

Montana 1 0 0 0 0 9.1 0.0 0.0 0.0 0.0

Nebraska 0 1 0 0 0 0.0 3.9 0.0 0.0 0.0

Nevada 0 0 1 1 15 0.0 0.0 2.8 2.8 42.6

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 36 21 13 16 15 31.4 18.0 11.3 13.9 13.0

New Mexico 76367 25.2 21.6 10.6 21.1 24.7

New York 31 42 22 10 15 12.3 16.6 8.8 4.0 6.0

North Carolina 16 20 9 11 6 13.6 16.9 7.5 9.2 5.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 3 3 2 2 0 2.0 2.0 1.3 1.3 0.0

Oklahoma 2 1 2 1 2 4.0 2.0 3.9 1.9 3.9

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 5 2 0 1 0 3.5 1.4 0.0 0.7 0.0

Rhode Island 0 0 1 0 0 0.0 0.0 7.8 0.0 0.0

South Carolina 15 15 10 4 2 27.5 27.0 17.7 7.1 3.5

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 10 7946 12.9 8.9 11.3 5.0 7.5

Texas 72 77 65 67 79 19.3 20.4 17.0 17.6 20.7

Utah 0 0 1 0 2 0.0 0.0 2.0 0.0 3.9

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 1 1 6 3 3 1.0 1.0 5.8 2.9 2.9

Washington 2 0 0 0 0 2.5 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 1 0 1 2 0 1.5 0.0 1.4 2.9 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 460 432 374 339 349 11.4 10.6 9.1 8.2 8.5

Northeast 73 66 36 28 30 10.8 9.6 5.3 4.1 4.4

Midwest 90 74 62 52 33 10.3 8.3 7.0 5.8 3.7

South 204 184 173 148 178 13.8 12.2 11.3 9.7 11.7

West 93 108 103 111 108 9.4 10.7 10.1 10.9 10.6

Guam 11010 31.1 30.5 0.0 29.3 0.0

Puerto Rico 24 17 11 13 13 45.5 33.5 21.5 25.4 25.4

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 25 18 11 14 13 43.4 32.4 19.6 24.9 23.2

TOTAL 485 450 385 353 362 11.9 10.9 9.2 8.5 8.7

Table 39. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state/area and region

listed in alphabetical order: United States and outlying areas, 2002–2006

*Mother’s state of residence used to assign case.
140 Syphilis Tables STD Surveillance 2006

Year of Birth Race/Ethnicity Cases Rate per 100,000 Live Births

2002

White/Non-Hispanic 36 1.6

Black/Non-Hispanic 257 44.2

Hispanic 146 16.7

Asian/Pacific Islander 10 4.8

Native American/Alaskan Native 3 7.6

Other 1 NA

Unknown 7 NA

Total 460 11.4

2003

White/Non-Hispanic 35 1.5

Black/Non-Hispanic 201 34.7

Hispanic 166 18.2

Asian/Pacific Islander 14 6.5

Native American/Alaskan Native 2 5.1

Other 3 NA

Unknown 11 NA

Total 432 10.6

2004

White/Non-Hispanic 41 1.8

Black/Non-Hispanic 168 28.8

Hispanic 144 15.2

Asian/Pacific Islander 6 2.7

Native American/Alaskan Native 2 5.0

Other 1 NA

Unknown 12 NA

Total 374 9.1

2005

White/Non-Hispanic 31 1.3

Black/Non-Hispanic 156 26.8

Hispanic 124 13.1

Asian/Pacific Islander 15 6.8

Native American/Alaskan Native 5 12.4

Other 2 NA

Unknown 6 NA

Total 339 8.2

2006

White/Non-Hispanic 38 1.6

Black/Non-Hispanic 141 24.2

Hispanic 146 15.4

Asian/Pacific Islander 8 3.6

Native American/Alaskan Native 5 12.4

Other 4 NA

Unknown 7 NA

Total 349 8.5

Table 40. Congenital syphilis — Reported cases and rates in infants < 1 year of age by race/ethnicity of

mother: United States, 2002–2006

NA = Not applicable
STD Surveillance 2006 Chancroid Tables 141

Cases Rates per 100,000 Population

State/Area 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006

Alabama 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 2 2 1 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 2 0 1 1 0 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 7 2 1 1 1 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 0 2 0 0 0.0 0.0 0.1 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 2 0 2 4 1 0.0 0.0 0.0 0.1 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 3 3 3 1 0 0.0 0.0 0.0 0.0 0.0

Michigan 0 0 2 0 1 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New York 2 10 4 1 5 0.0 0.1 0.0 0.0 0.0

North Carolina 0 2 1 5 5 0.0 0.0 0.0 0.1 0.1

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 0 2 1 0 0 0.0 0.1 0.0 0.0 0.0

Pennsylvania 0 1 1 0 0 0.0 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 24 24 4 0 14 0.6 0.6 0.1 0.0 0.3

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Texas 5 3 3 1 5 0.0 0.0 0.0 0.0 0.0

Utah 0 2 1 0 0 0.0 0.1 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 1 0 0 0 1 0.0 0.0 0.0 0.0 0.0

Washington 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wyoming 0 1 0 1 0 0.0 0.2 0.0 0.2 0.0

U.S. TOTAL 48 54 30 17 33 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 2 4 1 3 0 0.1 0.1 0.0 0.1 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 2 4 1 3 0 0.0 0.1 0.0 0.1 0.0

TOTAL 50 58 31 20 33 0.0 0.0 0.0 0.0 0.0

Table 41. Chancroid — Reported cases and rates by state/area listed in alphabetical order: United States and

outlying areas, 2002–2006
142 Selected STDs Table STD Surveillance 2006

Table 42. Selected STDs and complications — Initial visits to physicians' offices, National Disease and

Therapeutic Index: United States, 1966–2006

*Women only.

†

Women 15-44 only. NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard error for estimates 100,000-300,000 are between 20%

and 30%; 300,000–600,000 are between 16% and 20%; 600,000–1,000,000 are 13% and 15%; and 1,000,000–5,000,000 are between 9% and 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Appendix (Other Data Sources) for more information.

Year

Genital

Herpes

Genital

Warts

Vaginal

Trichomoniasis*

Other

Vaginitis*

Pelvic Inflammatory

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000
APPENDIX
APPENDIX
Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance,

2006 presents surveillance information

derived from the official statistics for the

reported occurrence of nationally notifiable

sexually transmitted diseases in the United

States, test positivity and prevalence data

from numerous prevalence monitoring

initiatives, sentinel surveillance of

gonococcal antimicrobial resistance, and

national health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data

are collected and compiled from reports

sent by the STD control programs and

health departments in the 50 states, the

District of Columbia, selected cities, U.S.

dependencies and possessions, and

independent nations in free association with

the United States to the Division of STD

Prevention (DSTDP), National Center for

HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention (NCHHSTP), Centers for

Disease Control and Prevention (CDC).

Included among the dependencies,

possessions, and independent nations are

Guam, Puerto Rico, and the Virgin Islands.

These entities are identified as “outlying

areas” of the United States in selected

figures and tables.

Reporting Formats

STD morbidity data presented in this report

are compiled from a combination of data

reported on standardized hardcopy report

forms and electronic data received via the

National Electronic Telecommunications

System for Surveillance (NETSS).

Summary Report Forms (hardcopy

format)

The following hardcopy forms were used to

report national STD morbidity data:

1. FORM CDC 73.998: Monthly

Surveillance Report of Early Syphilis. This

monthly hardcopy reporting form was used

from 1984 to 2002 to report summary data

for P&S syphilis and early latent syphilis by

county and state.

2. FORM CDC 73.688: Sexually

Transmitted Disease Morbidity Report. This

quarterly hardcopy reporting form was

used from 1963 to 2002 to report summary

data for all stages of syphilis, congenital

syphilis, gonorrhea, chancroid, chlamydia,

and other STDs by sex and source of report

(private vs. public) for the 50 states,

Washington, D.C., and 64 selected cities

(including San Juan, Puerto Rico) and

outlying areas of the United States. Note:

genital chlamydial infection became a

nationally notifiable condition in 1996, and

the form was modified to support reporting

of chlamydia that year. Congenital syphilis

was dropped from this aggregate form in

1995 and replaced by the case-specific

CDC 73.126 form listed below.

3. FORM CDC 73.2638: Report of Civilian

Cases of Primary & Secondary Syphilis,

Gonorrhea, and Chlamydia by Reporting

Source, Sex, Race/Ethnicity, and Age

Group. This annual hardcopy form was

used from 1981 to 2002 to report summary

data for P&S syphilis, gonorrhea, and

chlamydia by age, race, sex and source

(public vs. private) for all states and seven

large cities (Baltimore, Chicago, New York

City, Los Angeles, Philadelphia, San

STD Surveillance 2006 Appendix Interpreting STD Surveillance Data 143
Francisco, and Washington, D.C.), and

outlying areas of the United States. Note:

genital chlamydial infection became a

nationally notifiable condition in 1996 and

the form was modified to support reporting

of chlamydia that year.

4. FORM CDC 73.126: Congenital Syphilis

(CS) Case Investigation and Report. This

case-specific hardcopy form was first used

in 1983 and continues to be used to report

detailed case-specific data for congenital

syphilis in some reporting areas.

National Electronic

Telecommunications System for

Surveillance (NETSS, electronic

format)

Notifiable STD data reported electronically

through NETSS comprise the nationally

notifiable disease information that is

published in the Morbidity and Mortality

Weekly Report (MMWR).

As of December 31, 2003, all 50 states and

Washington, D.C. had converted from

summary hardcopy reporting to electronic

submission of line-listed (i.e., case-specific)

STD data via NETSS (41 reporting areas

are submitting congenital syphilis

surveillance data via NETSS). Puerto Rico

converted to electronic reporting in 2006.

Guam and the Virgin Islands continue to

report using summary hardcopy forms.

Jurisdictions differ in their ability to resolve

differences in total cases derived from

summary hardcopy monthly, quarterly, and

annual reports (as well as electronically

submitted line-listed data). Thus,

depending on the database used, there

may be discrepancies in the total number of

cases among the figures and tables for

earlier years. In most instances, these

discrepancies are less than 5% of total

reported cases and have minimal impact on

national case totals and rates. However, for

a specific jurisdiction, the discrepancies

may be larger.

Surveillance data and updates sent to

CDC on hardcopy forms and for

NETSS electronic data through June

22, 2007 have been included in this

report. Data received after this date

will appear in subsequent annual

Surveillance Reports. The data

presented in the figures and tables in

this document supersede those in all

earlier publications.

Population Denominators and Rate

Calculations

2000–2006 Rates and Population

Crude incidence rates (new

cases/population) were calculated on an

annual basis per 100,000 population. In

this report, the 2006 rates for the United

States, all states, counties, metropolitan

statistical areas (MSAs), and outlying areas

were calculated by dividing the number of

cases reported from each area in 2006 by

the estimated area-specific 2005 population

(the most current detailed population file

available at time of publication).

The National Center for Health Statistics

released bridged race population counts for

2000–2005 resident population based on

the Census 2000 counts. These estimates

resulted from bridging the 31 race

categories used in Census 2000, as

specified in the 1997 Office of Management

and Budget (OMB) standards, to the five

race/ethnicity groups specified under the

1977 OMB standards.

From 2001 to 2002, population estimates for

Guam were obtained from the Guam

Bureau of Statistics and Plans; estimates for

Puerto Rico were obtained from the Bureau

of Census; and estimates for the Virgin

Islands were obtained from the University of

the Virgin Islands. After 2002, population

estimates for all outlying areas were obtained

from the Bureau of Census web site

http://www.census.gov/ipc/www/idb/

tables.html. The 2005–2006 rates for

144 Interpreting STD Surveillance Data Appendix STD Surveillance 2006
outlying areas were calculated using the

2005 population estimates.

Due to use of the updated population data,

rates for the period 2000–2005 may be

different from prior Surveillance Reports.

1990–1999 Rates and Population

The population counts for 1990–1999

incorporated the bridged single-race

estimates of the April 1, 2000 resident

population. These files were prepared by

the U.S. Census Bureau with support from

the National Cancer Institute.

1981–1989 Rates and Population

For the United States, rates were calculated

using Bureau of the Census population

estimates for 1981 through 1989 (Bureau

of the Census; United States Population

Estimates by Age, Sex and

Race:1980–1989 [Series P-25, No. 1045];

Washington: U.S. Government Printing

Office, 1990; and United States Population

Estimates by Age, Sex and Race: 1989

[Series P-25, No. 1057]; Washington: U.S.

Government Printing Office, 1990.

1941–1980 Rates and Population

Rates for 1941–1980 are based on

population estimates from the Bureau of

Census and currently maintained by the

Division of STD Prevention.

1941–2006 Congenital Syphilis Rates and

Live Births

Congenital syphilis (CS) data in Table 1 of

Sexually Transmitted Disease Surveillance

2006 present the number of congenital

syphilis cases per 100,000 live births for all

years during the period 1941 through

2006. Previous publications presented

congenital syphilis rates per 100,000

population for 1941-1994 and for cases

diagnosed at < 1 year of age per 100,000

live births. To allow for trends in CS rates to

be compared over time, beginning in 2006

live births will be used as the denominator

for CS and case counts will no longer be

limited to those diagnosed within the first

year of life. CS morbidity (cases) are

assigned to their year of birth. Rates of

congenital syphilis for 1963–1988 were

calculated using published live birth data

(NCHS; Vital Statistics Report, United

States, 1988 [Vol.1-Natality]). Congenital

syphilis rates for 1989–2003 were

calculated using live births from the

National Center for Health Statistics

(NCHS) (Vital Statistics: Natality Tapes

1989–2002 or Vital Statistics Reports,

United States 1999, Vol. 48

No.10-Natality). Race-specific rates for

2004–2006 were calculated using live birth

data for 2004.

Reporting Practices

Although most areas generally adhere to

the national notifiable STD case definitions

collaboratively developed by the Council of

State and Territorial Epidemiologists

(CSTE) and CDC, there may be differences

in the policies and systems for collecting

surveillance data. Thus, comparisons of

case numbers and rates between

jurisdictions should be interpreted with

caution. However, since case definitions

and surveillance activities within a given

area remain relatively stable over time,

trends should be minimally affected by

these differences. In many areas, the

reporting from publicly supported

institutions (e.g., STD clinics) has been

more complete than from other sources

(e.g., private practitioners). Thus, trends

may not be representative of all segments

of the population.

Reporting of Metropolitan Statistical

Area-specific Surveillance Data

Sexually Transmitted Disease Surveillance,

2006 continues the presentation of STD

incidence data and rates for the fifty

Metropolitan Statistical Areas (MSAs) with

the largest populations based on 2000 U.S.

STD Surveillance 2006 Appendix Interpreting STD Surveillance Data 145
Census data. Sexually Transmitted Disease

Surveillance reports prior to 2005

presented data by selected cities which

estimated city-specific morbidity and were

derived from county data. Since county

data were used to estimate city-specific

morbidity and current STD project areas’

reporting practices do not support direct

identification of city-specific morbidity

reports, MSAs (described below) were

chosen as a geographic unit smaller than a

state or territory for presentation of STD

morbidity data.

Metropolitan Statistical Areas are defined

by the Office of Management and Budget

to provide nationally consistent definitions

for collecting, tabulating, and publishing

federal statistics for a set of geographic

areas.1 An MSA is associated with at least

one urbanized area that has a population of

at least 50,000. The MSA comprises the

central county or counties containing the

core, plus adjacent outlying counties having

a high degree of social and economic

integration with the central county as

measured through commuting. The title of

an MSA includes the name of its principal

city with the largest Census 2000

population. If there are multiple principal

cities, the names of the second largest and

third largest principal cities appear in the

title in order of descending population size.

The MSA concept has been used as a

statistical representation of the social and

economic linkages between urban cores

and outlying, integrated areas. However,

MSAs do not equate to an urban-rural

classification; all counties included in MSAs

and many other counties contain both

urban and rural territory and populations.

Programs that treat all parts of an MSA as if

they were as urban as the densely settled

core ignore the rural conditions that may

exist in some parts of the area. In short,

MSAs are not designed as a general

purpose geographic framework for

nonstatistical activities or for use in

program funding formulas.

For more information on MSA definitions

used in this report, please visit this web site:

http://www.census.gov/population/

estimates/metro-city/03mfips.txt

Management of Unknown, Missing or

Invalid Age Group, Race/Ethnicity,

and Sex Data

The percentage of unknown, missing or

invalid data for age group, race/ethnicity,

and sex varies from year to year, state to

state, and by disease for reported STDs

(Table A1).

When the percentage of unknown, missing,

or invalid data for the variables - age

group, race/ethnicity, and sex - exceeds

50% for any state, the state’s incidence

data and population data are excluded

from the tables presenting data stratified by

one or more of these variables. For those

states reporting > 50% valid data for these

variables, unknown, missing or invalid data

are redistributed based on the state’s

distribution of known age group,

race/ethnicity, and sex data, respectively. As

a result of this procedure, incidence and

rate data stratified by one or more of the

variables - age group, race/ethnicity, and

sex – may not accurately reflect total

national incidence or rates.

Classification of STD Morbidity

Reporting Sources

Prior to 1996, states classified the source of

case reports as either private source

(including private physicians, and private

hospitals and institutions) or public (clinic)

source (primarily STD clinics). As states

began reporting morbidity data

electronically in 1996, the classification

categories for source of case reports

expanded to include the following data

sources: STD clinics, HIV counseling and

testing sites, drug treatment clinics, family

planning clinics, prenatal/obstetrics clinics,

tuberculosis clinics, private

physicians/HMOs, hospitals (inpatient),

146 Interpreting STD Surveillance Data Appendix STD Surveillance 2006
emergency rooms, correctional facilities,

laboratories, blood banks, National Job

Training Program, school-based clinics,

mental health providers, military, Indian

Health Service, and other unspecified

sources. Analysis of the data reported

electronically after 1996 confirmed that the

new STD clinic source of report data

corresponded to the earlier reporting source

category, public (clinic) source. Therefore,

source of case report data for the period

1984–2006 are presented as STD clinic or

non-STD clinic only (Table A2).

Definition of DHHS Regions

The ten U.S. Department of Health and

Human Services (DHHS) regions referred

to in the text and figures include the

following jurisdictions: Region I =

Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, and Vermont;

Region II = New Jersey, New York, Puerto

Rico, and U.S. Virgin Islands; Region III =

Delaware, District of Columbia, Maryland,

Pennsylvania, Virginia, and West Virginia;

Region IV = Alabama, Florida, Georgia,

Kentucky, Mississippi, North Carolina,

South Carolina, and Tennessee; Region V=

Illinois, Indiana, Michigan, Minnesota,

Ohio, and Wisconsin; Region VI =

Arkansas, Louisiana, New Mexico,

Oklahoma, and Texas; Region VII = Iowa,

Kansas, Missouri, and Nebraska; Region

VIII = Colorado, Montana, North Dakota,

South Dakota, Utah, and Wyoming; Region

IX = Arizona, California, Guam, Hawaii,

and Nevada; and Region X = Alaska,

Idaho, Oregon, and Washington.

Chlamydia Morbidity Reporting

Trends in chlamydia morbidity reporting

from many areas are more reflective of

changes in diagnosis, screening, and

reporting practices than of actual trends in

disease incidence. As areas develop

chlamydia prevention and control

programs, including improved surveillance

systems to monitor trends, the data should

improve and become more representative

of true trends in disease.

Syphilis Morbidity Reporting

“Total syphilis” or “all stages of syphilis”

includes primary, secondary, latent

(including early latent, late latent, and latent

syphilis of unknown duration),

neurosyphilis, late (including late syphilis

with clinical manifestations other than

neurosyphilis), and congenital syphilis.

In 1996, the syphilis stage, “late syphilis

with clinical manifestations other than

neurosyphilis (late benign and

cardiovascular syphilis)”, was added to the

syphilis case definition (see STD Case

Definitions in this Appendix).

While neurosyphilis can occur at almost

any stage of syphilis, between 1996 and

2005, it was classified and reported as one

of several mutually exclusive stages of

syphilis. Beginning in 2005, neurosyphilis

was no longer classified or reported as a

distinct stage of syphilis. The Division of

STD Prevention is reviewing these data

collection and reporting changes to

determine their impact on syphilis

surveillance case definitions.

Congenital Syphilis Morbidity

Reporting

In 1988, the surveillance case definition for

congenital syphilis was changed. This case

definition has greater sensitivity than the

former definition.2 In addition, many areas

have greatly enhanced active case finding

for congenital syphilis since 1988. For these

reasons, the number of reported cases

increased dramatically during 1989–1991.

All reporting areas had implemented the

new case definition for reporting congenital

syphilis by January 1, 1992.

In addition to changing the case definition

for congenital syphilis, CDC introduced a

new data collection form (CDC 73.126) in

1990 (revised October 2003). Since 1995,

STD Surveillance 2006 Appendix Interpreting STD Surveillance Data 147
the data collected on this form have been

used for reporting congenital syphilis cases

and associated rates. This form is used to

collect individual case information which

allows more thorough analysis of case

characteristics. For the purpose of analyses

by race/ethnicity, if either the race or

ethnicity question was answered, the case

was included. For example, if “white” race

was marked, but ethnicity was left blank,

the individual was counted as

“non-Hispanic white”. Congenital syphilis

cases were reported by state and city of

residence of the mother for the period 1995

through 2006.

Chlamydia, Gonorrhea, and Syphilis

Prevalence Monitoring

Chlamydia and gonorrhea test positivity

and syphilis seroreactivity were calculated

for the following: women attending family

planning clinics and prenatal clinics, men

and women entering the National Job

Training Program, men attending STD

clinics and primary care clinics participating

in the MSM Prevalence Monitoring Project,

and men and women entering corrections

facilities. Positivity was calculated by

dividing the number of positive tests for

chlamydia, gonorrhea, or syphilis

(numerator) by the total number of positive

and negative tests for each disease

(denominator) and was expressed as a

percentage. Except for the National Job

Training Program screening data, these

data sources may include more than one

test from the same individual if that person

was tested more than once during a year.

To increase the stability of the annual

National Job Training Program prevalence

estimates, chlamydia or gonorrhea

prevalence data are presented when valid

test results for 100 or more students per

year are available for the population

subgroup and state. The majority of the

National Job Training Program’s chlamydia

screening tests are tested by a single

national contract laboratory which provides

those data to CDC. Gonorrhea screening

tests for male and female students in many

training centers are tested by local

laboratories; these data are not available to

CDC. To insure that state-specific

gonorrhea screening data presented here

are representative of all students entering

training centers, gonorrhea test results for

students at centers submitting specimens to

the national contract laboratory are

included only if the number of gonorrhea

tests submitted is greater than 90% of the

number of chlamydia tests submitted from

the same center for the same time period.

Various laboratory test methods were used

for all of these data sources except the

National Job Training Program. For most of

the figures presenting test positivity or

prevalence data, no adjustments of test

positivity based on laboratory test type and

sensitivity were made. However, for Figure

10 and Figure J, the chlamydia test results

for each test type were weighted to reflect

the sensitivity of the test used.3 The weights

used in this adjustment are the reciprocals

of the sensitivities of the laboratory test

methods used. These test type-specific

sensitivities were estimates derived from

published evaluations of chlamydia

screening tests.4,5 Limitations of this

adjustment include: unknown dates when

laboratories changed tests, missing

information on the test method, variation of

test sensitivity within a technology type,

and no adjustment for supplemental testing

such as negative grey zone testing. For

more details on chlamydia prevalence, refer

to the following annual publication: Centers

for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance

2006 Supplement: Chlamydia Prevalence

Monitoring Project Annual Report 2006.

Atlanta, GA: U.S. Department of Health

and Human Services (available first quarter

2008).

In the MSM Prevalence Monitoring Project

the syphilis seroreactivity data in most

instances do not reflect confirmatory testing

148 Interpreting STD Surveillance Data Appendix STD Surveillance 2006
and thus biologic false positive test results

were not systematically excluded. The

extent to which these data reflect

prevalence of active syphilis infection varies

by site. Similarly, in the Corrections

Prevalence Monitoring Project, syphilis

seroreactivity test results were not

confirmed. Only a few juvenile corrections

sites submitted data to CDC, making

overall interpretation difficult due to the

small sample size. Because only selected

corrections facilities participated in the

Corrections Prevalence Monitoring Project,

state-specific positivity for syphilis,

chlamydia, and gonorrhea may not be

representative of all corrections facilities in

the state.

Prevalence data for region- and

state-specific figures were published with

permission from the Regional Infertility

Prevention Program, selected state STD

prevention programs, and the National Job

Training Program.

Gonococcal Isolate Surveillance

Project (GISP)

Data on antimicrobial susceptibility in

Neisseria gonorrhoeae were collected

through the Gonococcal Isolate

Surveillance Project (GISP), a sentinel

system of 28 STD clinics and five regional

laboratories located throughout the United

States. For more details on findings from

GISP gonorrhea surveillance activities, refer

to the following annual publication: Centers

for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance

2006 Supplement: Gonococcal Isolate

Surveillance Project (GISP) Annual Report

2006. Atlanta, GA: U.S. Department of

Health and Human Services (available first

quarter 2008).

Other Surveillance Data Sources

National Disease and Therapeutic Index

(NDTI)

The information on the number of initial

visits to private physicians’ offices for

sexually transmitted diseases was based on

analysis of data from the National Disease

and Therapeutic Index (NDTI)

(machine-readable files or summary

statistics for the period 1966 through

2006).The NDTI is a probability sample

survey of private physicians’ clinical

management practices. For more

information on this database, contact IMS

Health, 660 W. Germantown Pike,

Plymouth Meeting, PA 19462; Telephone:

(800) 523-5333.

National Hospital Discharge Survey

(NHDS)

The information on patients hospitalized for

pelvic inflammatory disease or ectopic

pregnancy was based on analysis of data

from the National Hospital Discharge

Survey (machine-readable files for years

1980–2005), an ongoing nation wide

sample survey of medical records of

patients discharged from acute care

hospitals in the United States, conducted by

the National Center for Health Statistics.

For more information, see Graves EJ; 1988

Summary: National Hospital Discharge

Survey; Advance data No. 185; Hyattsville

(MD): National Center for Health

Statistics,1990.

National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

The National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

(machine-readable files for 1995–2005)

was used to obtain estimates of the number

of emergency room visits for pelvic

inflammatory disease among women ages

15 to 44 years. The estimates generated

using these data sources (NHDS and

STD Surveillance 2006 Appendix Interpreting STD Surveillance Data 149
NHAMCS-ER) are based on statistical

surveys and therefore have sampling

variability associated with the estimates.

Healthy People 2010 Objectives

Healthy People 20106 is a set of health

objectives for the U.S. to achieve over the

first decade of the new century. It is used by

people, States, communities, professional

organizations, and others to help develop

programs to improve health. HP2010

builds on initiatives pursued over the past

two decades. The 1979 Surgeon General’s

Report, Healthy People, and Healthy

People 2000: National Health Promotion

and Disease Prevention Objectives

established national health objectives and

served as the basis for the development of

State and community plans. Like its

predecessors, Healthy People 2010 was

developed through a broad consultation

process, built on the best scientific

knowledge and designed to measure

programs over time. Healthy People 2010

is organized into 28 focus areas, each with

objectives and measures designed to drive

action that will support two overarching

goals: 1) increasing the quality and years of

healthy life and 2) eliminating health

disparities.

Focus area 25 of Healthy People 2010

–Sexually Transmitted Diseases, – contains

objectives and measures related to STDs.

The baselines, HP2010 targets and annual

progress toward the targets are reported in

Table A3. The year 2010 targets for the

diseases addressed in this report are:

primary and secondary syphilis–0.2 case

per 100,000 population; congenital

syphilis–1.0 case per 100,000 live births;

and gonorrhea–19.0 cases per 100,000

population. An additional target established

in the HP2010 objectives is to reduce the

Chlamydia trachomatis test positivity to 3%

among females aged 15 to 24 years who

attend family planning and STD clinics and

among males aged 15 to 24 who attend

STD clinics.

Government Performance and

Results Act of 1993 (GPRA) Goals

The Government Performance and Results

Act of 1993 (GPRA) was enacted by

Congress to increase the confidence of

citizens in the capability of the federal

government, to increase the effectiveness

and accountability of federal programs, to

improve service delivery, to provide

agencies a uniform tool for internal

management and to assist Congressional

decision making. GPRA requires each

agency to have a performance plan with

long-term outcomes and annual, measurable

performance goals and to report on these

plans annually, comparing results with

annual goals. There are two STD GPRA

goals: 1) reduction in pelvic inflammatory

disease (PID) and 2) elimination of syphilis.

Each of these goals has measures. The

long-term goals and measures of progress

are reported in Table A4.

150 Interpreting STD Surveillance Data Appendix STD Surveillance 2006

1 Office of Management and Budget. Standards

for Defining Metropolitan and Micropolitan

Statistical Areas: Notice Federal Register

December 27, 2000; 65(249): 82228-38

2 Kaufman RE, Jones OG, Blount JH, Wiesner

PJ. Questionnaire survey of reported early

congenital syphilis: problems in diagnosis,

prevention, and treatment. Sexually Transmitted

Diseases 1977;4:135-9.

3 Webster Dicker L, Mosure DJ, Levine WC,Black

CM, Berman SM. The impact of switching

laboratory tests on reported trends in Chlamydia

trachomatis infections. Am J Epidemiol

2000;151:430-435.

4 Newhall WJ, DeLisle S, Fine D, et al.

Head-to-head evaluation of five different

non-culture chlamydia tests relative to a

quality-assured culture standard. Sexually

Transmitted Diseases 1994;21:S165-6.
STD Surveillance 2006 Appendix Interpreting STD Surveillance Data 151

5 Black CM, Marrazzo J, Johnson RE, et al.

Head-to-head multi center comparision of DNA

probe and nucleic acid amplification tests for

Chlamydia trachomatis infection in women

performed with an improved reference

standard. J Clin Micro 2002;40:3757-3763.

6 U.S. Department of Health and Human

Services. Healthy People 2010 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2

vols.Washington, DC: U.S. Government

Printing Office, November 2000.
152 Percentage Unknown Appendix STD Surveillance 2006

Primary and Secondary Syphilis Gonorrhea Chlamydia

State

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Sex of

Partners

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Alabama 3.1 0.0 0.0 23.8 28.9 1.0 0.0 31.3 0.6 0.1

Alaska 0.0 0.0 0.0 100.0 0.2 0.0 0.0 0.0 0.0 0.0

Arizona 14.8 0.0 2.0 35.5 24.5 0.0 0.1 30.3 0.0 0.1

Arkansas 0.0 0.0 0.0 36.4 3.4 0.3 0.0 4.2 0.5 0.0

California 3.4 0.3 0.1 11.4 33.4 0.7 0.6 34.1 0.5 0.5

Colorado 5.8 0.0 0.0 8.7 27.1 0.0 0.0 42.0 0.4 0.0

Connecticut 1.6 0.0 0.0 0.0 25.9 0.3 0.0 34.1 1.1 0.0

Delaware 0.0 0.0 0.0 100.0 1.0 0.0 0.0 1.9 0.0 0.0

District of Columbia 0.9 0.0 0.0 18.1 22.3 0.8 0.4 46.5 0.6 1.2

Florida 4.2 0.0 0.0 39.6 9.8 0.2 0.0 14.2 0.3 0.0

Georgia 2.9 0.2 0.0 21.3 38.6 1.3 0.8 50.2 1.4 0.9

Hawaii 0.0 0.0 0.0 22.2 41.2 0.3 0.0 49.6 0.3 0.1

Idaho* 33.3 0.0 0.0 33.3 24.8 0.0 0.5 21.5 0.1 0.4

Illinois 3.7 0.0 0.0 9.7 12.8 0.0 0.0 15.8 0.0 0.0

Indiana 2.2 0.0 0.0 7.5 13.4 0.4 0.4 16.9 0.7 0.5

Iowa 0.0 0.0 0.0 42.1 9.3 0.1 0.0 11.9 0.2 0.0

Kansas 0.0 0.0 0.0 18.5 22.7 0.2 0.0 28.9 0.2 0.0

Kentucky 4.1 1.4 0.0 21.9 22.0 0.5 0.2 26.5 0.3 0.3

Louisiana 0.9 0.0 0.0 100.0 16.0 0.4 0.8 25.0 0.6 1.2

Maine* 0.0 0.0 0.0 0.0 10.9 0.0 0.0 20.0 0.4 0.0

Maryland 0.7 0.0 0.0 9.7 25.9 0.4 0.2 36.5 0.5 0.4

Massachusetts 4.8 0.0 0.0 8.9 31.4 0.3 0.1 39.5 0.5 0.2

Michigan 0.8 0.0 0.0 100.0 46.8 0.2 0.2 47.3 0.2 0.3

Minnesota 6.4 0.0 0.0 0.0 14.4 0.0 0.0 15.4 0.0 0.0

Mississippi 3.5 0.0 0.0 5.8 15.2 0.1 0.0 17.8 0.1 0.0

Missouri 0.0 0.0 0.0 4.8 17.1 0.1 0.0 22.9 0.1 0.0

Montana* 0.0 0.0 0.0 0.0 24.7 0.0 0.0 17.2 0.6 0.3

Nebraska* 0.0 0.0 0.0 28.6 25.9 0.2 1.1 24.2 0.4 1.3

Nevada 17.5 0.0 0.0 2.9 31.1 0.5 0.0 38.8 0.3 0.0

New Hampshire 0.0 0.0 0.0 0.0 12.2 0.0 0.0 8.9 0.0 0.0

New Jersey 2.9 0.0 0.0 12.1 37.9 0.7 0.1 46.2 1.0 0.1

New Mexico 3.8 0.0 0.0 10.1 8.5 0.2 0.0 7.6 0.3 0.1

New York 19.8 0.0 0.0 38.5 38.2 0.4 0.0 42.7 0.5 0.0

North Carolina 0.3 0.0 0.0 100.0 1.2 0.0 0.0 1.5 0.0 0.0

North Dakota* 0.0 0.0 0.0 100.0 3.9 0.0 0.0 9.3 0.0 0.1

Ohio 2.2 0.0 0.0 7.6 29.0 2.0 1.0 34.7 2.7 1.5

Oklahoma 1.4 0.0 0.0 5.7 2.4 0.0 0.0 2.6 0.0 0.0

Oregon 3.4 0.0 0.0 100.0 6.3 0.0 0.0 11.0 0.0 0.0

Pennsylvania 1.9 0.0 0.0 2.3 22.6 0.4 0.0 24.5 0.1 0.0

Rhode Island 0.0 0.0 0.0 7.1 10.4 0.0 0.0 24.9 0.1 0.2

South Carolina 0.0 0.0 0.0 16.7 29.1 0.9 0.1 37.6 0.6 0.1

South Dakota 0.0 0.0 0.0 7.7 0.0 0.8 0.0 0.3 1.6 0.0

Tennessee 0.0 0.0 0.0 2.4 13.5 0.1 0.0 17.7 0.1 0.0

Texas 0.2 0.0 0.0 2.4 9.2 0.3 0.1 8.6 0.2 0.1

Utah 0.0 0.0 0.0 14.3 3.9 0.0 0.0 4.9 0.1 0.0

Vermont* 33.3 0.0 0.0 33.3 0.0 0.0 0.0 0.3 0.0 0.0

Virginia 0.0 0.0 0.0 3.2 3.0 0.1 0.0 10.3 0.1 0.1

Washington 4.9 0.0 0.0 14.8 20.4 0.9 0.0 20.1 1.0 0.0

West Virginia 18.2 0.0 0.0 9.1 11.0 0.1 0.0 11.5 0.3 0.1

Wisconsin 0.0 0.0 0.0 4.4 23.5 0.0 0.1 27.1 0.0 0.2

Wyoming* 0.0 0.0 0.0 0.0 13.3 4.2 0.0 25.2 1.3 0.0

U.S. TOTAL 4.1 0.1 0.1 22.7 21.6 0.5 0.2 26.3 0.5 0.2

*Percentages for P&S syphilis are based on less than 10 cases.

NOTE: "Unknown" includes unknown, missing, or invalid data values.

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values for selected variables by state

and by nationally notifiable STD, 2006
STD Surveillance 2006 Appendix STD Reporting Source 153

Non-STD Clinic STD Clinic Total*

Disease Male Female Total Male Female Total Male Female Total

Chlamydia 156,390 629,883 787,878 82,638 93,169 175,977 252,630 775,788 1,030,911

Gonorrhea 93,744 139,217 233,429 64,582 31,238 95,923 170,508 187,033 358,366

Primary Syphilis 1,418 141 1,559 917 132 1,049 2,400 278 2,678

Secondary Syphilis 4,029 749 4,781 1,713 399 2,114 5,893 1,180 7,078

Early Latent Syphilis 4,280 1,623 5,906 2,129 915 3,047 6,581 2,599 9,186

Late and Late Latent Syphilis† 8,030 4,929 12,972 2,682 1,637 4,319 10,915 6,716 17,644

Chancroid 7 7 14 5 12 17 12 21 33

Table A2. Reported cases of sexually transmitted disease reporting source and by sex: United States, 2006

*Totals include unknown sex and reporting source.

†

Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical

manifestations other than neurosyphilis.

See Appendix (Classification of STD Morbidity Reporting Source).
154 Healthy People 2010 Appendix STD Surveillance 2006

HP 2010 Objectives

Baseline

Year Baseline 2002 2003 2004 2005 2006

HP 2010

Target

25-1 Reduce the proportion of adolescents and

young adults with Chlamydia trachomatis

infections

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

1997 5.0% 6.0%* 6.4%* 6.9%* 6.9%* 7.1%* 3.0%

b. Females aged 15 to 24 years attending STD clinics

1997 12.2% 13.5%* 14.1%* 15.3%* 15.4%* 14.8%* 3.0%

c. Males aged 15 to 24 years attending STD clinics

1997 15.7% 17.5%* 19.3%* 20.8%* 20.5%* 20.8%* 3.0%

25-2 Reduce gonorrhea (cases per 100,000

population)

1997 123.0 122.0 115.2 112.4 114.6 120.9 19.0

25-3 Eliminate sustained domestic transmission

of primary and secondary syphilis (cases

per 100,000 population)

1997 3.2 2.4 2.5 2.7 2.9 3.3 0.2

25-4 Reduce the proportion of adults aged 20 to

29 years with genital herpes infection

1988-94 17.0% 11.0% NA NA NA NA 14.0%

25-6 Reduce the proportion of females aged 15

to 44 years who have ever required

treatment for pelvic inflammatory disease

(PID)

1995 8.0% 5.0% NA NA NA NA 5.0%

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)

1995 27.0% 22.0% NA NA NA NA 15.0%

25-9 Reduce congenital syphilis (cases per

100,000 live births)

1997 27.0 11.4 10.6 9.1 8.2 8.5 1.0

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status

HP 2010 Objective Data Source

25-1

25-2

25-3

25-4

25-6

25-7

25-9

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

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

National Survey of Family Growth (NSFG), CDC, NCHS.

National Survey of Family Growth (NSFG), CDC, NCHS.

STD Surveillance System (STDSS), CDC, NCHHSTP.

*Overall positivity not adjusted for changes in laboratory test method and associated increases in test sensitivity.

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.

NA=Not available.
STD Surveillance 2006 Appendix GPRA Goals 155

GPRA Goals Baseline Actual Performance

Long-Term

Goal

2002 2005 2006 2010

Goal 1: Reduction in PID (as measured by initial visits to physicians in

women 15-44 years of age) 197,000 176,000 106,000 168,000

a. Prevalence of Chlamydia in high-risk women  25 years 10.1%* 9.2%* 13.1%* 8.6%*

b. Prevalence of Chlamydia in women  25 years in family planning clinics 5.6%* 6.3%* 6.7%* 4.9%*

c. Incidence of Gonorrhea/100,000 population in women 15-44 years of age 279 275 290 237

Goal 2: Elimination of Syphilis (as measured by incidence of P&S

Syphilis/100,000 population) 2.4 2.9 3.3 2.2

a. Incidence of P&S Syphilis/100,000 population - men 3.8 5.1 5.7 4.2

b. Incidence of P&S Syphilis/100,000 population - women 1.1 0.9 1.0 0.38

c. Incidence of Congenital Syphilis/100,000 live births 10.2 8.2 8.5 3.9

d. Black:white rate ratio of P&S Syphilis 8:1 5.4:1 5.9:1 3:1

GPRA Goals Data Source

1

1-a

1-b

1-c

2

2-a

2-b

2-c

2-d

National Disease and Therapeutic Index (IMS Health).

National Job Training Program.

Regional Infertility Prevention Projects (IPP)

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

STD Surveillance System (STDSS), CDC, NCHHSTP.

*Median state-specific chlamydia prevalence among women was not adjusted for changes in laboratory test method and associated increases in test sensitivity.

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted Diseases Goals and Measures

STD Surveillance Case Definitions

PART 1. CASE DEFINITIONS1FOR NATIONALLY NOTIFIABLE INFECTIOUS DISEASES

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi.

Laboratory criteria for diagnosis

• Isolation of H. ducreyi from a clinical specimen

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by

darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed 7

days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease

caused by herpes simplex virus (HSV) or a culture negative for HSV.

Confirmed: a clinically compatible case that is laboratory confirmed

Chlamydia trachomatis, Genital Infections (Revised 9/96)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute

salpingitis, or other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. trachomatis include lymphogranuloma venereum (see

Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

• Isolation of C. trachomatis by culture or

• Demonstration of C. trachomatis in a clinical specimen by detection of antigen or

nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis.

Infection may be asymptomatic.

Laboratory criteria for diagnosis

• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive

Neisseria gonorrhoeae) from a clinical specimen, or

STD Surveillance 2006 Appendix STD Surveillance Case Definitions 157
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or

nucleic acid, or

• Observation of gram-negative intracellular diplococci in a urethral smear obtained

from a male

Case classification

Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician

Confirmed: a case that is laboratory confirmed

Syphilis (All Definitions Revised 9/96)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.

Syphilis, primary

Clinical description

A stage of infection with Treponema pallidum characterized by one or more chancres (ulcers);

chancres might differ considerably in clinical appearance.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, direct

fluorescent antibody (DFA-TP), or equivalent methods

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary

syphilis and a reactive serologic test (nontreponemal: Venereal Disease Research Laboratory

[VDRL] or rapid plasma reagin [RPR]; treponemal: fluorescent treponemal antibody absorbed

[FTA-ABS] or microhemagglutination assay for antibody to T. pallidum [MHA-TP])

Confirmed: a clinically compatible case that is laboratory confirmed

Syphilis, secondary

Clinical description

A stage of infection caused by T. pallidum and characterized by localized or diffuse

mucocutaneous lesions, often with generalized lymphadenopathy. The primary chancre may still

be present.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, DFATP,

or equivalent methods

Case classification

Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer 4

Confirmed: a clinically compatible case that is laboratory confirmed

158 STD Surveillance Case Definitions Appendix STD Surveillance 2006
Syphilis, latent

Clinical description

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected

person without causing symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories based on the duration of infection.

Case classification

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following:

• No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and

a reactive treponemal test (i.e., FTA-ABS or MHA-TP)

• A past history of syphilis therapy and a current nontreponemal test titer demonstrating

fourfold or greater increase from the last nontreponemal test titer

Syphilis, early latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12

months, latent syphilis is classified as early latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the

infection within the previous 12 months based on one or more of the following criteria:

• Documented seroconversion or fourfold or greater increase in titer of a

nontreponemal test during the previous 12 months

• A history of symptoms consistent with primary or secondary syphilis during the

previous 12 months

• A history of sexual exposure to a partner who had confirmed or probable primary or

secondary syphilis or probable early latent syphilis (documented independently as

duration  1 year)

• Reactive nontreponemal and treponemal tests from a person whose only possible

exposure occurred within the preceding 12 months

Syphilis, late latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred  1 year previously, latent

syphilis is classified as late latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired

the disease within the preceding 12 months (see Syphilis, early latent) and whose age and titer do

not meet the criteria specified for latent syphilis of unknown duration.

Syphilis, latent, of unknown duration

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as having

occurred within the previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified as latent syphilis of unknown duration.

STD Surveillance 2006 Appendix STD Surveillance Case Definitions 159
Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the patient is aged 13–35 years and has a nontreponemal titer  32

Neurosyphilis

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

• A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both the following:

• Elevated CSF protein or leukocyte count in the absence of other known causes of

these abnormalities

• Clinical symptoms or signs consistent with neurosyphilis without other known causes

for these clinical abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions

of the cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal

muscle) may be involved. Late syphilis usually becomes clinically manifest only after a period of

15–30 years of untreated infection.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely visualized in late lesions)

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or

other structures with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical symptoms or signs consistent with

neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with

clinical manifestations.

160 STD Surveillance Case Definitions Appendix STD Surveillance 2006
Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs  500 g and the

mother had untreated or inadequately treated* syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity

exists, and only severe cases are clinically apparent at birth. An infant or child (aged  2 years) may

have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child

may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).

Laboratory criteria for diagnosis

Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific

stains in specimens from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated*

syphilis at delivery, regardless of signs in the infant, or an infant or child who has a reactive

treponemal test for syphilis and any one of the following:

• Any evidence of congenital syphilis on physical examination

• Any evidence of congenital syphilis on radiographs of long bones

• A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

• An elevated CSF cell count or protein (without other cause)

• A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM

enzyme-linked immunosorbent assay

Confirmed: a case that is laboratory confirmed

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after

infancy. Signs of congenital syphilis may not be obvious, and stigmata may not yet have developed.

Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in

either congenital or acquired syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. In

a young child, the possibility of sexual abuse should be considered as a cause of acquired rather

than congenital syphilis, depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and children as well as syphilitic

stillbirths.

*Inadequate treatment consists of any nonpenicillin therapy or penicillin administered  30 days before delivery.

STD Surveillance 2006 Appendix STD Surveillance Case Definitions 161
PART 2. CASE DEFINITIONS1

FOR NON-NOTIFIABLE INFECTIOUS DISEASES

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions

Laboratory criteria for diagnosis

• Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

• Demonstration of virus by antigen detection technique in clinical specimens from

cervix, urethra, or anogenital lesion, or

• Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an

anogenital lesion

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by appropriate serologic tests and darkfield microscopy, when available) with either a diagnosis of genital herpes based on clinical presentation (without laboratory confirmation) or a history

of one or more previous episodes of similar genital lesions

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no

previous diagnosis should be reported.

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or

external genitalia, perineum, or perianal region

Laboratory criteria for diagnosis

• Histopathologic changes characteristic of human papillomavirus infection in

specimens obtained by biopsy or exfoliative cytology or

• Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or

serologic evidence that the growth is the result of secondary syphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no

previous diagnosis should be reported.

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area

caused by infection with Calymmatobacterium granulomatis. A clinically compatible case would

have one or more painless or minimally painful granulomatous lesions in the anogenital area.

162 STD Surveillance Case Definitions Appendix STD Surveillance 2006
Laboratory criteria for diagnosis

• Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained

smears or biopsies of granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital lesions, suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted.

Laboratory criteria for diagnosis

• Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

• Demonstration by immunofluorescence of inclusion bodies in leukocytes of an

inguinal lymph node (bubo) aspirate, or

• Positive microimmunofluorescent serologic test for a lymphogranuloma venereum

strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or

characteristic proctogenital lesions with supportive laboratory findings of a single C. trachomatis

complement fixation titer of  64

Confirmed: a clinically compatible case that is laboratory confirmed

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or

Trichomonas vaginalis. Cervical inflammation is defined by the presence of one of the following

criteria:

• Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on

a white, cotton-tipped swab (positive swab test)

• Induced endocervical bleeding (bleeding when the first swab is placed in the

endocervix)

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid

detection, and no evidence of T. vaginalis on wet mount

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or

trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from

infection with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea,

trichomoniasis, and chlamydia are excluded, a clinically compatible illness should be classified as

STD Surveillance 2006 Appendix STD Surveillance Case Definitions 163
MPC. An illness in a female that meets the case definition of MPC and C. trachomatis infection

should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may be diagnosed by the presence of one of the following criteria:

• A visible abnormal urethral discharge, or

• A positive leukocyte esterase test from a male aged  60 years who does not have a

history of kidney disease or bladder infection, prostate enlargement, urogenital

anatomic anomaly, or recent urinary tract instrumentation, or

• Microscopic evidence of urethritis ( 5 white blood cells per high-power field) on a

Gram stain of a urethral smear

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic

acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture,

Gram stain, or antigen or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result

from infection with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case definition of NGU and C. trachomatis infection should be

classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and

endocervix to the endometrium, fallopian tubes, and/or contiguous structures. In a female who has

lower abdominal pain and who has not been diagnosed as having an established cause other than

pelvic inflammatory disease (PID) (e.g., ectopic pregnancy, acute appendicitis, and functional

pain), all the following clinical criteria must be present:

• Lower abdominal tenderness, and

• Tenderness with motion of the cervix, and

• Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

• Meets the surveillance case definition of C. trachomatis infection or gonorrhea

• Temperature  100.4 F ( 38.0 C)

• Leukocytosis  10,000 white blood cells/mm3

• Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

164 STD Surveillance Case Definitions Appendix STD Surveillance 2006
• Pelvic abscess or inflammatory complex detected by bimanual examination or by

sonography

• Patient is a sexual contact of a person known to have gonorrhea, chlamydia, or

nongonococcal urethritis

Case classification

Confirmed: a case that meets the clinical case definition

Comment

For reporting purposes, a clinician’s report of PID should be counted as a case.

STD Surveillance 2006 Appendix STD Surveillance Case Definitions 165

1 Centers for Disease Control and Prevention.

Case definitions for infectious conditions under

public health surveillance, 1997. MMWR

1997;46(No. RR-10;1).
STD Project Directors, STD Program Managers, and State and Territorial Epidemiologists

We gratefully acknowledge the contributions of state STD project directors, STD program managers, and state and territorial

epidemiologists to this report. The persons listed were in the positions shown as of September 14, 2007.

STD Project Directors STD Program Managers State Epidemiologists

Alabama Charles H. Woernle Sandra Langston John Lofgren

Alaska Wendy Crator Donna Cecere Joe McLaughlin

Arizona Judy Norton Alfonso Urquidi Kenneth Komatsu

Arkansas Gary Horton Mark Barnes Jim Phillips

California Gail Bolan Romni Neiman Gilberto Chavez

Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez

San Francisco Jeffrey Klausner Wendy Wolf Gilberto Chavez

Colorado Maureen Bush Bob Bongiovanni Ken Gershman

Connecticut James L. Hadler Heidi Jenkins James L. Hadler

Delaware James C. Welch Catherine Mosley Paula Eggers

District of Columbia Karyn Berry John Heath John Davies-Cole

Florida Russell Eggert Karla Schmitt John Middaugh

Georgia Linda Smart-Smith Russ Cantrell Susan Lance

Hawaii Peter Whiticar Roy Ohye Paul Effler

Idaho Richard Armstrong Vacant Christine G. Hahn

Illinois Charlie Rabins Ed Renier Craig Conover (Acting)

Chicago Will Wong John Paffel Craig Conover (Acting)

Indiana Jerry Burkman Jim Beall Robert Teclaw

Iowa Julie McMahon Karen Thompson Patricia Quinlisk

Kansas Brenda Walker R. Allen Mayer Gail Hansen

Kentucky Robert Brawley David Raines Kraig Humbaugh

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard

Maine Bob Woods Jennah Godo Kathleen F. Gensheimer

Maryland Barbara Conrad Glen Oltoff David Blythe

Baltimore Laura Herrera Victoria Stovall David Blythe

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria

Michigan Mark Miller Mark A. Miller Corrine Miller

Minnesota Julia Ashley Julia Ashley Ruth Lynfield

Mississippi Craig Thompson Craig Thompson Lovetta Brown

Missouri Herbert Michael Vacant Bao-Ping Zhu

Montana Laurie Kops Vacant Todd A. Damrow

Nebraska Phil Medina Phil Medina Thomas J. Safranek

Nevada Richard Whitley Bill Hill Ishan Azzam

New Hampshire Denise Rondeau Drew Thomits Jose Montero

New Jersey Janet DeGraaf Jerry Carolina Eddy A. Bresnitz

New Mexico Daryl Smith Jaime Vega-Hernandez C. Mack Sewell

New York F. Bruce Coles Dennis Murphy Perry F. Smith

New York City Susan Blank Steve Rubin Marcelle Layton

North Carolina Evelyn M. Foust Evelyn M. Foust Jeffrey Engel

North Dakota Kimberly Weis Kimberly Weis Kirby Kruger

Ohio Barbara Bradley Amy LaGesse Forrest W. Smith

Oklahoma Michael Harmon Chang Lee Kristy Bradley

Oregon Vada Latin Doug Harger Melvin Kohn

Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta

Philadelphia Caroline Johnson Vacant Veronica Urdaneta

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy

South Carolina Dorothy Waln (Acting) Robert Ray James J. Gibson

South Dakota Laurie Gill David Morgan Lon Kightlinger

Tennessee Jeanece Seals Robert Burke Allen Craig

Texas Felipe Rocha Jim Lee Vincent Fonseca

Utah Jennifer Brown Tim Lane Robert T. Rolfs

Vermont Daniel Daltry Daniel Daltry Cortland Lohff

Virginia Kathryn Hafford Kathryn Hafford (Acting) Carl Armstrong

Washington Larry Klopfenstein Larry Klopfenstein Marcia Goldoft

West Virginia Loretta E. Haddy Susan Hall Loretta E. Haddy

Wisconsin Sandra Breitborde Anthony Wade Jeffrey Davis

Wyoming Brownen Anderson Vacant Tracy Murphy

American Samoa Utoofili Asofaafeta Maga Sarona Maae Joseph Roth

Federated States of

Micronesia Nena S. Nena Johnny Hebel Nena S. Nena

Government of the

Marshall Islands Justina Langidrik Zachraias Zachraias James Hosfschneider

Guam Josie O'Mallan Bernadette Schumann Robert L. Haddock

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia Enid Garcia

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez3

Virgin Islands Darlene Carty Taetia Phillips-Dorsett Darlene Carty

166 Contributors Appendix STD Surveillance 2006