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/Hispanic ethnicity, and location for the United States.
National Overview of STDs, 2017
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 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 2017 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis.
In 2017, a total of 1,708,569 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 528.8 cases per 100,000 population, an increase of 6.9% compared with the rate in 2016. During 2016–2017, rates of reported chlamydia increased among both males and females, in all regions of the United States, and among all racial and Hispanic ethnicity groups.
Rates of reported chlamydia are highest among adolescent and young adults and have increased in recent years. In 2017, almost two-thirds of all reported chlamydia cases were among persons aged 15–24 years. Among women aged 15–24 years, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,635.3 cases per 100,000 females, an increase of 4.9% from 2016 and of 8.8% from 2013.
Although rates of reported cases among men are generally lower than rates among women, reflecting the larger number of women screened for this infection, rates among men increased almost 40% during 2013–2017. Increases in rates among men may reflect 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 due to increased availability of urine testing and extragenital screening.
In 2017, a total of 555,608 cases of gonorrhea were reported to CDC, making it the second most common notifiable condition in the United States. Rates of reported gonorrhea increased 75.2% since the historic low in 2009 and increased 18.6% since 2016. During 2016–2017, rates of reported gonorrhea increased among both males and females, in all regions of the United States, and among all racial and Hispanic ethnicity groups.
During 2016–2017, the rate of reported gonorrhea increased 19.3% among men and 17.8% among women. The magnitude of the increase among men suggests either increased transmission, increased case ascertainment (e.g., through increased extra-genital screening among MSM), or both. The concurrent increase in cases reported among women, suggests parallel increases in heterosexual transmission, increased screening among women, or both.
Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. Therapy with ceftriaxone and azithromycin is now the only CDC recommended treatment for gonorrhea.2 Since 2008, the percentage of isolates with elevated ceftriaxone minimum inhibitory concentrations (MICs) has remained low and was only 0.2% in 2017. During 2014–2017, the percentage of isolates with elevated azithromycin MICs increased from 2.5% to 4.4%. Continued monitoring of susceptibility patterns to these antibiotics is critical.
In 2017, a total of 30,644 cases of primary and secondary (P&S) syphilis, the most infectious stages of the disease, were reported in the United States, yielding a rate of 9.5 cases per 100,000 population. Since reaching a historic low in 2000 and 2001, the rate of P&S syphilis has increased almost every year, increasing 10.5% during 2016–2017. Rates increased among both males and females, among all racial and Hispanic ethnicity groups, and in 72.0% of states and the District of Columbia.
During 2000–2017, the rise in the P&S syphilis rate was primarily attributable to increased cases among men and, specifically, among MSM. In 2017, men accounted for almost 90% of all cases of P&S syphilis and MSM accounted for 68.2% of reported P&S syphilis cases among women or men with information about sex of sex partners. In states with consistent information on sex of sex partner, the number of P&S syphilis cases increased 8.6% among MSM, 17.8% among MSW, and 24.9% among women during 2016–2017. Among P&S syphilis cases with known HIV-status, 45.5% of MSM, 8.8% of MSW, and 4.5% of women were HIV-positive in 2017.
The 2013 rate of congenital syphilis (9.2 cases per 100,000 live births) marked the first increase in congenital syphilis since 2008. Since 2013, the rate of congenital syphilis has increased each year. In 2017, there were a total of 918 reported cases of congenital syphilis, including 64 syphilitic stillbirths and 13 infant deaths. The national rate of 23.3 cases per 100,000 live births represents a 43.8% increase relative to 2016 and a 153.3% increase relative to 2013. This increase in the congenital syphilis rate has paralleled increases in P&S syphilis among all women and reproductive-aged women during 2013–2017 (155.6% and 142.8% increase, respectively).