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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 low-risk types was 26.8% (95% confidence interval [CI], 23.3%-30.9%) among U.S. females aged 14 to 59 years (n = 1,921). 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 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).

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.


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