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

¹ Concluding 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, 2002 presents statistics and trends for sexually transmitted diseases (STDs) in the United States through 2002. 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 the STD project areas; (2) prevalence data from the Regional Infertility Prevention Projects, the National Job Training Program (formerly the Job Corps), the Jail STD Prevalence Monitoring Projects, the Adolescent Women Reproductive Health Monitoring Project, the Men Who Have Sex With Men (MSM) Prevalence Monitoring Project, and the Indian Health Service; (3) sentinel surveillance of gonococcal antimicrobial resistance from the Gonococcal Isolate Surveillance Project (GISP); and (4) national sample 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, are the sources of many of the figures and all 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 among the United States population.

Sexually Transmitted Disease Surveillance, 2002 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 state, county, city, and national levels. The Appendix includes the sources and limitations of the data used to produce this report.

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 A1 displays progress made towards the HP2010 objectives for STDs. These objectives are used as reference points throughout this edition of Sexually Transmitted Disease Surveillance, 2002.

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, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02, Atlanta, Georgia, 30333.

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, the Regional Infertility Prevention Projects, the U.S. Department of Labor and the Indian Health Service, 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 forHIV, STD, and TB Prevention, Centers for Disease Control and Prevention: Stuart Berman, Susan Bradley, Jim Braxton, Sharon Clanton, Susan Conner, Deblina Datta, Darlene Davis, Linda Webster Dicker, Melinda Flock, LaZetta Grier, Alesia Harvey, James Heffelfinger, Rose Horsley, Kathleen Hutchins, Richard Kahn, Elvin Magee, Catherine McLean, Debra Mosure, Rob Nelson, Lori Newman, Michael Phillips, LuEtta Schneider, Maya Sternberg, Katherine Stone, Emmett Swint, Susan Wang, Hillard Weinstock, and Akbar Zaidi.