The National Profile section contains figures that show trends and the distribution of nationally notifiable STDs (chlamydia, gonorrhea, syphilis, and chancroid) by age, sex, race/Hispanic ethnicity, and location for the United States.
National Overview of STDs, 2018
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 take sexual histories as a part of routine preventive exams to assess patients’ risks and identify STD testing and treatment opportunities. Parents can talk to their children about STDs and sexual health. Individuals can discuss ways to protect their health with sexual partners, including using condoms consistently and correctly. 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 report provides trends in STDs to inform prevention and control strategies. This overview summarizes national surveillance data for 2018 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis.
In 2018, a total of 1,758,668 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 539.9 cases per 100,000 population, an increase of 2.9% compared with the rate in 2017. During 2017–2018, rates of reported chlamydia increased among both males and females, in all regions of the United States, and among all racial/Hispanic ethnicity groups.
Rates of reported chlamydia are highest among adolescent and young adults. In 2018, almost two-thirds of all reported chlamydia cases were among persons aged 15–24 years. Among females aged 15–24 years, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,693.6 cases per 100,000 females, an increase of 1.0% from 2017 and of 11.8% from 2014.
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 37.8% during 2014–2018. Increases in rates among men may reflect an increased number of men, including gay, bisexual, and other men who have sex with men (MSM) being tested and diagnosed with a chlamydial infection due to increased availability of urine testing and extragenital screening, increased transmission among men, or both.
In 2018, a total of 583,405 cases of gonorrhea were reported to the CDC, making it the second most common notifiable condition in the United States. Rates of reported gonorrhea have increased 82.6% since the historic low in 2009. During 2017–2018, the overall rate of reported gonorrhea increased 5.0%, and rates increased among both males and females, in all regions of the United States, and among all racial/Hispanic ethnicity groups.
Since 2013, the rate of reported gonorrhea has been higher among men compared to women. Among men, the rate of reported gonorrhea increased 6.0% during 2017–2018 and 78.7% during 2014–2018, while rates among women increased 3.6% during 2017–2018 and 45.2% during 2014–2018. The higher case rate among men and the magnitude of recent increases 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.
Gonorrhea can quickly develop resistance to antibiotics used to treat infection, and in 2018, more than half of all infections were estimated to be resistant to at least one antibiotic.
Since 2009, almost all circulating strains in the United States, based on gonococcal isolates collected through sentinel surveillance, remain susceptible to ceftriaxone, the primary treatment for gonorrhea;2 only 0.2% of isolates displayed elevated ceftriaxone minimum inhibitory concentrations in 2018. Continued monitoring of susceptibility patterns to antibiotics is critical to inform treatment gonorrhea guidelines.
In 2018, 115,045 cases of all stages of syphilis, were reported, including 35,063 cases of primary and secondary (P&S) syphilis, the most infectious stages of the disease. Since reaching a historic low in 2000 and 2001, the rate of P&S syphilis has increased almost every year, increasing 14.9% during 2017–2018. Rates increased among both males and females, in all regions of the United States, and among all racial/Hispanic ethnicity groups.
Since 2000, rates of P&S syphilis have increased among men, primarily attributable to increases in cases among MSM. Similar to past years, in 2018, MSM accounted for the majority (53.5%) of all reported cases of P&S syphilis and, of these, 41.6% were known to be living with diagnosed HIV. Although rates of P&S syphilis are lower among women, rates have increased substantially in recent years, increasing 30.4% during 2017–2018 and 172.7% during 2014–2018, suggesting a rapidly growing heterosexual epidemic.
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 2018, 1,306 cases of congenital syphilis were reported. Although the majority of cases were reported from a few states, 41 states reported at least one case of congenital syphilis in 2018. The national rate of 33.1 cases per 100,000 live births in 2018 represents a 39.7% increase relative to 2017 and a 185.3% increase relative to 2014. During 2017–2018 the number of syphilitic stillbirths increased (from 64 to 78 stillbirths), as did the number of congenital syphilis related infant deaths (from 13 to 16 deaths).