Sex Diseases Still Rising; Chlamydia Is Leader

The incidence of gonorrhea, which had declined sharply, has risen in the last two years in this
country while the number of chlamydia and syphilis cases continue to rise, federal health officials
said yesterday.
Chlamydia and gonorrhea are the two most common diseases among those doctors must report in
the United States. And the 1,030,911 cases of Chlamydia in 2006 are the highest ever recorded for
any nationally reported disease in any year, the officials said in releasing their annual report on
sexually transmitted diseases. They said that because of underreporting, a more accurate estimate
is 2.8 million new Chlamydia cases annually.

About 19 million new cases of all kinds of sexually transmitted diseases occur in this country each
year, but only the three are nationally reported. Genital herpes, papillomavirus and trichomonas
infections account for the vast majority of cases, but doctors are not required to report them
nationally.

Different reasons account for the rise of each of the three reportable and curable diseases, and for
each a different approach is needed to reduce its incidence, Dr. John M. Douglas Jr., head of the
division of sexually transmitted diseases at the Centers for Disease Control and Prevention, told
reporters by telephone.

The three reported sexually transmitted diseases affect African-Americans disproportionately.

The black to white ratios are gonorrhea 18 to 1, syphilis 6 to 1 and Chlamydia 8 to 1, Dr. Douglas
said in an interview. The reasons for the disparities are not clear. Lack of access to health care
may be one problem.

“Chlamydia is now the most common S.T.D. ever reported,” Dr. Douglas said, but not by much.
The next most common is gonorrhea, with just over one million cases reported each year from
1976 to 1980. The peak for gonorrhea was 1,013,00. Gonorrhea cases then declined steadily.

The chlamydia microbe can cause pelvic inflammatory disease and resulting abdominal pain,
ectopic pregnancy and infertility in women.

Chlamydia’s rise in incidence is due mainly to urging by the centers for annual testing of sexually
active women under age 26. Current tests are more sensitive in detecting chlamydia than those
used a few years ago. Most cases were among women who had no symptoms but could transmit
the microbe.

Chlamydia screening has led to detection of the microbe among more men as their female
partners advise them to get tested and treated to avoid re-infections. Infected individuals are
advised to get re-tested about three months after treatment to make sure they are cured.

The centers are also encouraging doctors to give antibiotics and educational material to patients
to give to their sexual partners who are reluctant to seek care. One aim of the practice, called
expedited partners therapy, is to reduce re-infections. The practice is legal in 11 states and
ambiguous or illegal in the 39 others.

From 1975 through 1997 the reported rate of gonorrhea dropped 74 percent, and then plateaued,
only to rise the last two years to 358,366 cases in 2006. The centers estimate that at least twice
that number actually occurred.

Much of the rise seems the result of an increasing tendency to couple gonorrhea and chlamydia
testing of urine samples.
African-Americans account for 69 percent of all gonorrhea in this country. “The biggest increase
in gonorrhea regionally has been in the South, and we do not have a ready explanation for that,”
Dr. Douglas said.

Even in the days before penicillin became available in World War II to cure syphilis, the number
of reported syphilis cases peaked at 575,000, and that total included individuals who never could
be treated and developed the late stages of the disease that cause brain and heart damage.

Syphilis cases dropped to their lowest ever total in 2000 soon after health officials had announced
a national syphilis elimination program.

But cases have risen each year since then to 9,756 cases in 2006. Most cases have involved gay
men, who account for about 65 percent of cases, and to lesser extent women. Also, a small
number of cases have occurred among newborns.

Recently, health departments have had to take on more projects with little, if any, increase in
budgets, Dr. Douglas said. Outbreaks have occurred in some areas where they were well
controlled. Also, health workers have had to decrease partner notification programs and
screening in detention centers and jails.

HIV and other sexually transmitted diseases among sex workers and technical students in northeast
Thailand.

Ungchusak K, Rehle T, Aiemsukwat C, Kunasol P, Tharmaphornpilas P, Brinkman U,

Siraprapasiri T; International Conference on AIDS.

Int Conf AIDS. 1992 Jul 19-24; 8: Th77 (abstract no. ThC 1559).

Division of Epidemiology, MOPH Thailand.

OBJECTIVES: To study the epidemiology and social behavior of female commercial

sex workers (CSWs) and male technical school students in a major Northeastern city,
in order to better plan HIV intervention programs. METHODS: As a result of
cooperation and trust between brothel owners and public health officials, about 220
CSWs in all 24 brothels in the city were persuaded to make weekly visits to the
public STD clinic between November 1990 and September 1991. Male students of
average age 18 years in a technical school (n = 1138) completed self-administered
anonymous questionnaires, and underwent anonymous testing for HIV and syphilis.
RESULTS: Although the population of CSWs remained steady between 200 and 230,
turnover was 25%-35% every 3 months. HIV testing in 3/91, 6/91, and 9/91 found
rates increasing form 7%, to 13%, to 15%, with corresponding quartery
seroincidence of 1.5%(2/131), 2.4%(3/125), and 2.9%(4/138), respectively. Median
gonorrhea incidence was 9 per person-weeks of followup (range 6-12). Among the
men, 42%(482/1138) reported ever having sex with CSWs, half of whom began only
after entering the school. Sex with women not CSWs was reported, too. HIV infection
was found in 0.8%(9/1138) of the men, and VDRL reactivity with TPHA confirmation
was 0.2% (2/1138). Eighty percentages of students who went to the brothel drank
alcohol and only 60% used condom all the time. CONCLUSIONS: The high HIV
incidence and prevalence measured in CSWs stimulated local and national authorities
to speed up targeted control programs for this particularly high-risk group, such as
"100% Condom Only" programs to enforce condom usage by customers. The 40% of
male technical school students who do not use condoms when patronizing CSWs
should be a prime target for research and prevention programs to modify this high-
risk behavior.