Gonorrhea Rates Up, Syphilis Rates Down, CDC Reports

Between 1997 and 1999, gonorrhea rates have increased in the United States for the first time in 25 years, while syphilis cases continue to decline, as they have for the past 10 years, the CDC reported yesterday. The CDC report "paints the most complete picture ever" of STDs in the United States, the Washington Post reports. The gonorrhea rate, which fell nearly 75% between 1975 and 1996, briefly remained level before rising 9% between 1997 and 1999. Some of the increase can be attributed to "more sensitive tests and more widespread testing," according to CDC epidemiologist Ronald Valdiserri, but researchers also point to the rising incidence among young gay men, who may be less likely to practice safe sex with the advent of better treatment for AIDS. Valdiserri explained, "There's the perception that high-risk sexual behavior no longer carries the extreme consequences it once did because of the advances in HIV treatment." The current rate of gonorrhea in the United States is 133 cases per 100,000 people, with 849 cases per 100,000 among blacks; 75 per 100,000 among Hispanics; and 28 per 100,000 among whites. CDC epidemiologist Judith Wasserheit said that this data suggests that "while there are certainly differences in sexual risk behavior and other factors by race and ethnicity, those are tremendously overshadowed by differences in access to care" (Brown, Washington Post, 12/6).

Syphilis Rates Decline
The "only good news" contained in the CDC report was the decline in syphilis cases between 1997 and 1999 (Maugh, Los Angeles Times, 12/6). At 2.5 cases per 100,000 people, the syphilis rate is "just a fraction of the gonorrhea rate, and is even more geographically cloistered," the Post reports. While 79% of the nation's counties reported no syphilis cases last year, Indianapolis led U.S. cities with 50 cases per 100,000, bumping Baltimore from its former top spot with 38 cases per 100,000. The Post notes that Baltimore witnessed a "dramatic" decline in syphilis cases, with 102 cases per 100,000 just three years ago -- "a rate that was among the highest in the industrialized world." In addition, syphilis rates among blacks nationwide fell between 1997 and 1999 (Washington Post, 12/6). Still, 75% of new syphilis cases reported in 1999 occurred among blacks. Valdiserri called the sequestering of syphilis cases among specific ethnicities and locations "a direct result of poverty and inadequate access to health care." But researchers hope that because the disease is concentrated in a relatively small area, they will be able to "stamp [it] out" (Los Angeles Times, 12/6). The decline in syphilis cases may be due to the CDC's October 1999 launch of a national effort to "eliminate" syphilis as a public health problem.

Chlamydia More Common than Gonorrhea and Syphilis Combined
Meanwhile, chlamydia rates were measured last year at 254 cases per 100,000, a rate that Wasserheit believes "grossly underestimates the true burden of (the disease) in this country." According to experts, there are approximately three million cases of chlamydia annually, mostly detected among adolescents and young adults. Although chlamydia can be cured with antibiotics, 40% of women infected with the microbe eventually develop pelvic inflammatory disease, which "greatly" increases the likelihood of infertility. Also, because it causes no symptoms in about 50% of infected men, it is difficult to detect without widespread screening. Wasserheit said, "If we care about the health of our adolescents, we clearly have to do a better job about chlamydia prevention" (Washington Post, 12/6).

HPV 'Most Prevalent'
The CDC study also found that human papillomavirus, the sexually transmitted virus responsible for causing 95% of all cervical cancer cases, is the "most prevalent" STD. Researchers from the CDC examined blood samples collected from 1991 to 1994 through the National Health and Nutrition Examination Survey for antibodies to HPV-16, one of about 30 types of HPV and the one responsible for causing about 50% of cervical cancers. The Post reports that antibodies were found in 8% of American men and 18% of American women, meaning that they were exposed to the virus at some point during their lives (Washington Post, 12/6). The prevalence of HPV-16 was highest among black women ages 20 to 29, at 36% (Naujeck, AP/St. Paul Pioneer Press, 12/6). Overall, 19% of African Americans carry the strain, compared with 13% of whites and 9% among Mexican Americans. The risk of transmitting HPV can be reduced by condom use; however, it cannot be "entirely prevented" because the virus can "colonize" on genital skin not protected by a condom (Washington Post, 12/6). The CDC estimates that 20 million Americans carry HPV infections of some kind, with 5.5 million new infections occurring each year (AP/St. Paul Pioneer Press, 12/6).