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The National Profile section contains figures that show trends and the distribution of nationally reportable STDs (chlamydia, gonorrhea, syphilis, and chancroid) by age, sex, race/ethnicity, and location for the United States.
National Overview of STDs, 2016
All Americans should have the opportunity to make choices that lead to health and wellness. Working together, interested, committed public and private organizations, communities, and individuals can take action to prevent sexually transmitted diseases (STDs) and their related health consequences. In addition to federal, state, and local public support for STD prevention activities, local community leaders can promote STD prevention education. Health care providers can assess their patients’ risks and talk to them about testing. Parents can better educate their children about STDs and sexual health. Individuals can use condoms consistently and correctly, and openly discuss ways to protect their health with partners and providers. As noted in the Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, surveillance is a key component of all our efforts to prevent and control these diseases.1
This overview summarizes national surveillance data for 2016 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis.
In 2016, a total of 1,598,354 cases of Chlamydia trachomatis infection were reported to the CDC, making it the most common notifiable condition in the United States. This case count corresponds to a rate of 497.3 cases per 100,000 population, an increase of 4.7% compared with the rate in 2015. During 2015–2016, rates of reported chlamydia increased in all regions of the United States.
Rates of chlamydia are highest among adolescent and young adult females, the population targeted for routine chlamydia screening. Among young women attending family planning clinics participating in a sentinel surveillance program who were tested for chlamydia, 9.2% of 15–19 year olds and 8.0% of 20–24 year olds were positive. Although rates of reported cases among men are generally lower than rates among women, reflecting the larger number of women screened for this infection, increased availability of urine testing and extragenital testing has resulted in an increased number of men, including gay, bisexual, and other men who have sex with men (collectively referred to as MSM) being tested and diagnosed with a chlamydial infection.
Rates of reported chlamydia varied among different racial and ethnic minority populations. In 2016, rates were highest among Blacks and American Indians/Alaska Natives. However, during 2012–2016, rates decreased 3.5% among Blacks and 6.4% among American Indians/Alaska Natives and increased among Whites, Asians, and Native Hawaiian/Other Pacific Islanders.
In 2009, the national rate of reported gonorrhea cases reached an historic low of 98.1 cases per 100,000 population. During 2009–2012, the rate increased slightly each year to 106.7 cases per 100,000 population in 2012 and has increased steadily during 2014–2016. In 2016, 468,514 gonorrhea cases were reported for a rate of 145.8 cases per 100,000 population, an increase of 18.5% from 2015.
During 2015–2016, the rate of reported gonorrhea increased 22.2% among men and 13.8% among women. The magnitude of the increase among men suggests either increased transmission or increased case ascertainment (e.g., through increased extra-genital screening) among MSM or both. The concurrent increases among cases reported among women, suggests parallel increases in heterosexual transmission, increased screening among women, or both.
In 2016, the rate of reported cases of gonorrhea remained highest among Blacks (481.2 cases per 100,000 population) and among American Indians/Alaska Natives (242.9 cases per 100,000 population). During 2012–2016, rates increased among all racial and ethnic groups.
Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. Dual therapy with ceftriaxone and azithromycin is now the only CDC recommended treatment for gonorrhea.2 In 2016, the percentage of isolates with elevated minimum inhibitory concentrations (MICs) of cefixime and ceftriaxone remained low (0.3% and 0.3%, respectively). During 2013–2016, the percentage of isolates with reduced azithromycin susceptibility increased from 0.6% to 3.6%. Continued monitoring of susceptibility patterns to these antibiotics is critical.
In 2000 and 2001, the national rate of reported primary and secondary (P&S) syphilis cases was 2.1 cases per 100,000 population, the lowest rate since reporting began in 1941. However, the P&S syphilis rate has increased almost every year since 2001. In 2016, 27,814 P&S syphilis cases were reported, representing a national rate of 8.7 cases per 100,000 population and a 17.6% increase from 2015. During 2015–2016, the P&S syphilis rate increased among both men and women in every region of the country; overall, the rate increased 14.7% among men and 35.7% among women.
During 2012–2016, P&S syphilis rates were consistently highest among persons aged 20–29 years, but rates increased in every 5-year age group among those aged 15–64 years. In 2016, rates were highest among Blacks (23.3 per 100,000 population) and Native Hawaiian/Other Pacific Islanders (13.9 per 100,000 population); however, rates increased among all racial and ethnic groups during in 2012–2016.
During 2000–2016, the rise in the P&S syphilis rate was primarily attributable to increased cases among men and, specifically, among MSM. In 2016, men accounted for almost 90% of all cases of P&S syphilis. Of those male cases for whom sex of sex partner was known, 80.6% were MSM. Reported cases of P&S syphilis continued to be characterized by a high rate of HIV co-infection, particularly among MSM. Among 2016 P&S syphilis cases with known HIV-status, 47.0% of MSM were HIV-positive, 10.7% of cases among MSW and 4.1% of cases among women were HIV-positive.
The 2013 rate of congenital syphilis (9.2 cases per 100,000 live births) marked the first increase in congenital syphilis since 2008. During 2013–2014, the rate increased 27.2%, during 2014–2015 the rate increased 6.0%, and then increased 27.6% during 2015–2016. There were 628 cases of congenital syphilis reported in 2016 compared with 492 cases in 2015. In 2016, rates of congenital syphilis were highest among Blacks (43.1 cases per 100,000 live births), followed by American Indians/Alaska Natives (31.6 cases per 100,000 live births), and Hispanics (20.5 cases per 100,000 live births).
2. Centers for Disease Control and Prevention, Sexually transmitted diseases treatment guidelines, 2015. MMWR Morb Mortal Wkly Rep 2015; 64(No.