2012 STD Surveillance Adolescents and Young Adults

2012 STD Surveillance Adolescents and Young Adults

This overview summarizes national surveillance data for 2012 on the three notifiable diseases for which there are federally funded control programs: chlamydia, gonorrhea, and syphilis. Although topical prophylaxis of infants at delivery is effective for prevention of gonococcal ophthalmia neonatorum, prevention of neonatal pneumonia requires prenatal detection and treatment. dependencies and possessions, and independent nations in free association with the United States to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC). Trends in rates of reported cases of chlamydia are influenced by changes in incidence of infection, as well as changes in diagnostic, screening, and reporting practices. Although trends by sex varied by region, nationwide, the gonorrhea rate decreased among women, but increased among men. This is the first time since nationwide reporting for chlamydia began that the overall rate of reported cases of chlamydia has decreased. Primary and secondary syphilis are the earliest stages of infection, reflect symptomatic disease, and are indicators of incident infection.10 For these reasons, trend analyses of syphilis focus upon cases and rates of reported cases of P&S syphilis.

Rates varied among different racial and ethnic minority populations. Additionally, increasing use of electronic laboratory reporting has likely increased the proportion of diagnosed cases that are reported. Most recently, declining susceptibility to cefixime (an oral cephalosporin antibiotic) resulted in a change to the CDC treatment guidelines, so that dual therapy with ceftriaxone (an injectable cephalosporin) and azithromycin is now the only CDC-recommended treatment regimen for gonorrhea.3 The emerging threat of cephalosporin resistance highlights the need for continued surveillance of N. 20- to 24-Year-Old Men—In 2012, as in previous years, men aged 20–24 years had the highest rate of chlamydia among men (1,350.4 cases per 100,000 males). In 2012, 56.8% of chlamydia cases were reported by these MSAs. As of December 31, 2003, all 50 states and the District of Columbia had converted from summary hard copy reporting to electronic submission of line-listed (i.e., case-specific) STD data through NETSS (43 reporting areas submit congenital syphilis surveillance data through NETSS). The South accounted for 43.5% of P&S syphilis cases in 2012 and 44.1% in 2011.

20- to 24-Year-Old Women—In 2012, women aged 20–24 years had the highest rate of gonorrhea (578.5 cases per 100,000 females) compared with any other age or sex group (Figure 16, Table 21). During 2011– 2012, the gonorrhea rate for women in this age group increased 1.6%. Participating clinics submit to MDH demographic and clinical data on every test performed. Although blacks comprise approximately 5% of Minnesota’s population, they account for 29% of reported chlamydia cases. 20- to 24-Year-Old Men—In 2012, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (462.8 cases per 100,000 males) compared with other males (Figure 16, Table 21). Additional factors affecting validity of the STD surveillance data include STD screening coverage, individual test-seeking behavior, and accuracy of diagnostic tests. Syphilis rates among women aged 15–19 years increased annually during 2004–2009, from 1.5 cases per 100,000 females to 3.3 cases in 2009, but decreased from 2.9 cases in 2010 to 2.3 cases in 2012.

2012 STD Surveillance Adolescents and Young Adults
Linden St., is offering free STD testing this month from 9 a.m. Rates in women have been highest each year among those aged 20–24 years with 3.9 cases per 100,000 females in 2012 (Figures 35 and 36, Table 35). OSU has 13 locations on campus that offer free condoms—no questions asked—to students. This report highlights an increasing sexual health crisis in the United States, but it only shows a fraction of the true burden of STDs in this country, as it only covers three STDs (chlamydia, gonorrhea, and syphilis). Rates ranged from 19.1 to 100 per 100,000 population in 1,300 counties (41.4%) and more than 100 cases per 100,000 population in 650 counties (20.7%). The greater the number of sex partners, the greater the risk of infection. These changes reflect a shift in the age distribution of P&S syphilis; rates were highest among men aged 35–39 years during 2002–2006.

During the mid-1990s to 2011, chlamydia and gonorrhea positivity among young women screened in clinics and juvenile correctional facilities participating in infertility prevention activities were reported to CDC to monitor chlamydia prevalence. As the national infertility prevention program expanded, these data became difficult to interpret as trends were influenced by changes in screening coverage, screening criteria, and test technologies, as well as demographic changes in patients attending clinics reporting data to CDC. The Administration on Children, Youth and Families and FYSB jointly oversee the program. Positivity data continue to be useful locally to inform clinic-based screening recommendations and to identify at-risk populations in need of prevention interventions, but are no longer collected to monitor national trends in chlamydia and gonorrhea. In alignment with the Precaution Adoption Process Model advocated by the National Institutes of Health we suggest that comprehensive sex and HIV/STD education should be taught as part of the biology curriculum in middle and high school science classes, along with a social studies curriculum that addresses risk-aversion behaviors and planning for the future. The NJTP screens participants for chlamydia and gonorrhea within two days of entry to the program. All of NJTP’s chlamydia screening tests and the majority of gonorrhea screening tests are conducted by a single national contract laboratory*, which provides these data to CDC.

To increase the stability of the estimates, chlamydia or gonorrhea prevalence data are presented when valid test results for 100 or more students per year are available for the population subgroup and state. Of these, 85.0% (3,545 cases) were diagnosed with AIDS, while 15.0% (628 cases) were diagnosed with HIV. Among men entering the program in 47 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.0% (range: 0.6% to 13.5%) (Figure I). Among women entering the program in 45 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence in 2012 was 1.3% (range: 0.0% to 4.8%) (Figure J). Among men entering the program in 41 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence was 0.7% (range: 0.0% to 2.8%) (Figure K). 1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008.

Sex Transm Dis. 2013 Mar;40(3):187-93. 2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, Berman SM, Markowitz LE. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009 Dec;124(6):1505-12 doi: 10.1542/peds.2009-0674. Epub 2009 Nov 23.

4 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, Plowman S, et al. Data by age, race/ethnicity and gender are not currently available for Guam and the Virgin Islands. Health Promot Pract (online). May 23, 2011.

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