CDC Releases STI Statistics for 2011, Rates Go Up Especially Among Young People and MSM

Last week the Centers for Disease Control and Prevention (CDC) released tracking data on three Sexually Transmitted Infections (STIs): Chlamydia, Gonorrhea, and Syphilis. The news is not great; rates of these infections are going up especially among some groups.  

The report found that in 2011:

• 1.4 million chlamydia infections were reported to the CDC. The rate of cases per 100,000 people increased 8 percent, to 457.6 in 2011 from 423.6 in 2010.
• 321,849 gonorrhea infections were reported to the CDC. The rate increased 4 percent to 104.2 cases per 100,000 in 2011 from 100.2 in 2010.  
• 13,970 cases of primary and secondary syphilis were reported to the CDC. The rate of 4.5 cases per 100,000 was unchanged from 2010.  

According to the report, the majority of cases of both gonorrhea and chlamydia were found in young people ages 15 to 24. Specifically, 27 percent of gonorrhea cases were among adolescents ages 15 to 19 and 35 percent of gonorrhea cases were among young adults ages 20 to 24. The break downs for chlamydia cases were similar with adolescents 15 to 19 accounting for 32 percent of the cases and young adults ages 20 to 24 accounting for 38 percent of cases. This is particularly disturbing because if untreated both chlamydia and gonorrhea can lead to Pelvic Inflammatory Disease which is a major cause of infertility among young women. 

The 2011 trends for syphilis found that 72 percent of cases of primary and secondary syphilis occurred among men who have sex with men. The CDC explains that primary and secondary syphilis “are the most infectious stages of the disease, and if not adequately treated, can lead to visual impairment, stroke, and in rare cases, even death.” Syphilis also increases an individual’s risk for HIV infection—in part because it increases an HIV-positive individual’s viral load which makes him/her more contagious. The CDC concludes:

“Given the high prevalence of HIV in the MSM community, increasing syphilis infections among men who have sex with men are particularly troubling.”

This report is a good opportunity to look at trends in reported cases of STIs but it likely does not capture the extent of this epidemic of this country. In truth, these STIs often have no symptoms and many individuals who are infected go undiagnosed. Moreover, the CDC does not collect data on other common STIs including HPV, Herpes, and trichomoniasis, all of which are quite widespread. In total, the CDC estimates that over 19 million new cases of STIs occur in this country each year and that STIs cost the health care system approximately 17 billion dollars each year.

To combat this epidemic the CDC recommends that all sexually active young women under 25 and all older women considered at-risk (such as those in new relationships or communities with high STI rates) get screened for Chlamydia each year; at-risk sexually active women should be screened for gonorrhea annually; and all sexually active men who have sex with men should be screened each year for chlamydia, gonorrhea, syphilis, and HIV.

It is also important to remember that condoms are highly effective in preventing STDs.  

STIs in New York City Concentrated in a Few Zip Codes

Also released last week was a report by New York City’s Department of Health and Mental Hygiene that used 2010 STI data and census data to determine where the city’s STI cases were most concentrated. The department analyzed disease data on HIV/AIDS, hepatitis B, hepatits C, chlamydia, gonorrhea, syphilis, and tuberculosis (which is a communicable disease though not sexually transmitted). High-morbidity zip codes were defined as those with disease rates in the top 20 percent of all NYC zip codes. Zip codes were then given a score (0-7) indicating the number of diseases for which they had rates in the top 20 percent.  

The study found that: 68 percent of zip codes in the Bronx were in the top 20 percent for multiple STDs, compared to 45 percent of zip codes in Manhattan, 25 percent in Queens, and 22 percent in Brooklyn. No zip codes in Staten Island were in the top fifth for multiple STDs.

Not surprisingly, poverty and STI Rates are inextricable linked. The study found that 19 zip codes with high rates of poverty in the South Bronx, north-central Brooklyn, and northern Manhattan had HIV/AIDS, chlamydia, and gonorrhea rates in the top 20 percent. Perhaps most telling are the results for the Tremont section of the Bronx. This neighborhood ranked in the top quintile for all of the seven diseases surveyed and 43 percent of its residents live below the federal poverty line.

HPV Makes a Comeback in Menopausal Women

A new study in the Journal of Infectious Diseases suggests that HPV may make a comeback in women as they near menopause. The study looked at over 850 women ages 35 through 60 who had cervical cancer screening between 2008 and 2011. Though the study did find that women who had had a new sexual partner within the six months prior to screening were more likely to have HPV, these women accounted for only 3 percent of those in the sample. Other women tested positive for HPV without having had new partners. Researchers believe the cause of this to be a reawakening of a dormant infection.

The researchers suggest that a woman’s immune system may be capable of controlling or suppressing HPV when she is young but as the immune system weakens with age, the virus can come back. They liken this to what has been show to happen with the varicella zoster virus which causes chicken pox: “The virus can lie dormant in the bodies of people who were infected as children, then come raging back as shingles later in life.” Though linked primarily to cervical cancer, HPV is also linked to cancers of the head and neck, vulva, vagina, penis, and anus all of which could pose great risk for the older population.

This new research also found that the 77 percent of the women who tested positive for HPV reported having had five or more lifetime partners. The researchers suggest that the women entering menopause now—who came of age during or after the sexual revolution of the 60’s and 70’s—will be at far greater risk of reactivated HPV infections than the generations before them who were much less likely to be exposed to the virus in the first place.

The authors conclude that these finding may mean we have to change our screening measures to include more regular pap smears for women over 40 years of age.