STD burdens minorities, young women most of all
Janelle Yates
OBG Management Senior Editor
Young people, minorities, and women bear the brunt of sexually transmitted disease (STD) in the United States, reports the Centers for Disease Control and Prevention (CDC) in a new publication that highlights these and other disparities.
For example, almost 50% of the approximately 19 million STDs reported each year affect people 15 to 24 years of age. And yet these figures, which reflect reports of three notifiable STDs—Chlamydia trachomatis infection, gonorrhea, and syphilis—“represent only a small proportion of the true national burden of STDs,” the CDC notes in Sexually Transmitted Disease Surveillance 2007 . “Many cases of notifiable STDs go undiagnosed, and some common viral infections, such as human papillomavirus (HPV) and genital herpes, are not reported at all.”
CDC screening recommendations Focus on at-risk populations
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Chlamydia trachomatis
This infection is most common among young women and is usually asymptomatic. CDC recommends annual screening of all:
- sexually active women younger than 26 years
- older women who have risk factors such
as new or multiple sex partners.
To reduce the impact of disease, it also is necessary to treat the disease among men, because many young women who have been diagnosed with chlamydial infection may become reinfected by an untreated male partner. The CDC recommends that women be retested for Chlamydia approximately 3 months after treatment and that they be given antibiotic therapy to be delivered to their male partners if other strategies for reaching and treating partners are unlikely to succeed.
Gonorrhea
Although easily cured, gonorrhea causes serious health problems, including pelvic inflammatory disease and its sequelae, if left untreated. CDC supports a US Preventive Services Task Force
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recommendation to screen all high-risk, sexually active women for gonorrhea. This population includes:
- women younger than 25 years, including sexually active adolescents
- women who have a history of gonorrhea infection or other STD
- women who have new or multiple sexual partners or who use a condom inconsistently
- sex workers
- intravenous drug users.
When treating gonorrhea, drug resistance is a special concern. Data from 2007 indicate widespread resistance to fluoroquinolones, and the CDC no longer recommends their use to treat gonorrhea. That limits treatment to a single class of antibiotics—cephalosporins.
Syphilis
The CDC recommends that all pregnant women be screened for syphilis at the first prenatal visit to protect their infants from the serious complications associated with congenital syphilis.
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Infection with Chlamydia affects three times as many women as men
Among the disparities highlighted by the CDC are:
- The reported chlamydial infection case rate for women in 2007 was almost triple the rate for men: 543.6 versus 190.0 for every 100,000 people. In addition, women are more likely to suffer serious consequences of chlamydial infection, such as pelvic inflammatory disease (PID), which can lead to infertility, ectopic pregnancy, and chronic pelvic pain. Women 15 to 19 years of age had the highest rate (3,004.7 for every 100,000 people), followed by women 20 to 24 years old (2,948.8).
- Chlamydia infection affects African- American, American Indian/Alaska Native, and Hispanic women disproportionately. In 2007, black women 15 to 19 years old had the highest rate of any group (9,646.7). The rate among black women overall (1,906) was almost eight times the rate among white women (249.3) and almost three times that of Hispanic women (753.3).
- In 2007, the overall gonorrhea rate was 118.9 cases for every 100,000 people, with slightly more cases among women than among men. Like chlamydial infection, gonorrhea is substantially underdiagnosed and underreported, with approximately twice as many new infections estimated to occur each year as are reported.
- Between 2006 and 2007, the rate of primary and secondary syphilis increased 15.2%, from 3.3 to 3.8 cases for every 100,000 people, and the number of cases increased from 9,756 to 11,466. The rate of congenital syphilis (transmission from mother to infant) increased for the second year in a row, from 9.3 for every 100,000 live births in 2006 to 10.5 in 2007.
Although they represent only 12% of the total US population, African Americans made up about 70% of gonorrhea cases and almost half of all Chlamydia and syphilis cases in 2007. Hispanics comprise 15% of the US population, but accounted for 19% of all Chlamydia cases.
To read more of the full report, visit www.cdc.gov/std/stats07.
Related articles:Screen all young women every year for Chlamydia, CDC urges www.obgmanagement.com/article_pages.asp?AID=5929&UID
Genital herpes: common questions about diagnosis and transmission By Gary A. Richwald, MD, MPH, and Priya Karkhanis www.obgmanagement.com/supplement.asp?ref=SupplOBG0808_CME_2
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