Sexually Transmitted Disease Surveillance 2008 Division of STD Prevention November 2009 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention Atlanta, Georgia 30333 Acknowledgments Publication of this report would not have been possible without the contributions of the State and Territorial Health Departments, the Sexually Transmitted Disease Control Programs, the Regional Infertility Prevention Projects, and Public Health Laboratories. We also acknowledge the contributions of staff within the Division of STD Prevention, the Statistics and Data Management Branch and the Epidemiology and Surveillance Branch. ii STD Surveillance 2008 Copyright Information All material contained in this report is in the public domain and may be used and reprinted without special permission; citation to source, however, is appreciated. Suggested Citation Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services; November 2009. Printed copies and the on-line version of this report can be obtained at the following web site: http://www. cdc.gov/std/pubs/ Selected STD Surveillance and Prevention References and Websites STD Surveillance Reports 1993–2008 http://www.cdc.gov/std/stats/ STD Data on Wonder http://wonder.cdc.gov/std.html STD Data Management & Information Technology http://www.cdc.gov/std/Program/data-mgmt.htm STD Fact Sheets http://www.cdc.gov/std/healthcomm/fact_sheets.htm STD Treatment Guidelines http://www.cdc.gov/STD/treatment/ STD Program Evaluation Guidelines http://www.cdc.gov/std/program/pupestd.htm STD Program Operation Guidelines http://www.cdc.gov/std/program/default.htm Recommendations for Public Health Surveillance of Syphilis in the United States http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a7.htm Behavioral Surveillance Youth Risk Behavior Surveillance System: http://www.cdc.gov/HealthyYouth/yrbs/index.htm National Survey of Family Growth: Advance Data 362. Sexual Behavior and Selected Health Measures: Men and Women 15–44 Years of Age, United States, 2002. 56 pp. (PHS) 2003–1250: http://www.cdc.gov/nchs/ products/pubs/pubd/ad/361–370/ad362.htm STD Surveillance 2008 iii Foreword “STDs are hidden epidemics of enormous health and To successfully prevent STDs, many stakeholders economic consequence in the United States. They need to redefine their mission, refocus their efforts, are hidden because many Americans are reluctant modify how they deliver services, and accept new to address sexual health issues in an open way and responsibilities. In this process, strong leadership, because of the biologic and social characteristics of innovative thinking, partnerships, and adequate these diseases. All Americans have an interest in STD resources will be required. The additional investment prevention because all communities are impacted required to effectively prevent STDs may be by STDs and all individuals directly or indirectly considerable, but it is negligible when compared with pay for the costs of these diseases. STDs are public the likely return on the investment. The process of health problems that lack easy solutions because preventing STDs must be a collaborative one. No one they are rooted in human behavior and fundamental agency, organization, or sector can effectively do it societal problems. Indeed, there are many obstacles to alone; all members of the community must do their effective prevention efforts. The first hurdle will be to part. A successful national initiative to confront and confront the reluctance of American society to openly prevent STDs requires widespread public awareness confront issues surrounding sexuality and STDs. and participation and bold national leadership from Despite the barriers, there are existing individual- and the highest levels.”1 community-based interventions that are effective and can be implemented immediately. That is why a multifaceted approach is necessary to both the individual and community levels. 1 Concluding statement from the Institute of Medicine’s Summary Report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, National Academy Press, Washington, DC, 1997, p.43. STD Surveillance 2008 v Preface Sexually Transmitted Disease Surveillance, 2008 Sexually Transmitted Disease Surveillance, 2008 presents statistics and trends for sexually transmitted consists of four parts: (1) The National Profile diseases (STDs) in the United States through 2008. contains figures that provide an overview of STD This annual publication is intended as a reference morbidity in the United States. The accompanying document for policy makers, program managers, text identifies major findings and trends for selected health planners, researchers, and others who are STDs. (2) The Special Focus Profiles contain figures concerned with the public health implications of and text describing STDs in selected subgroups and these diseases. The figures and tables in this edition populations that are a focus of national and state supersede those in earlier publications of these prevention efforts. (3) TheDetailed Tables provide data. statistical information about STDs at the county, metropolitan statistical area (MSA), regional, state, The surveillance information in this report is based and national levels. (4) The Appendix (Interpreting on the following sources of data: (1) notifiable disease STD Surveillance Data) includes information reporting from state and local STD programs; (2) on interpreting the STD surveillance data used to projects that monitor STD prevalence in various produce this report; Healthy People 2010 (HP2010) settings including; the Regional Infertility Prevention STD objectives and progress toward meeting them; Projects (IPP); the National Job Training Program; Government Performance and Results Act (GPRA) the Indian Health Service; the Men Who Have Sex goals and progress toward meeting them; and STD With Men (MSM) Prevalence Monitoring Project; surveillance case definitions. the Gonococcal Isolate Surveillance Project (GISP); and (3) national surveys implemented by federal and Any comments and suggestions that would improve private organizations. the usefulness of future publications are appreciated and should be sent to: The STD surveillance systems operated by state and local STD control programs, which provide the case Director, Division of STD Prevention report data for chlamydia, gonorrhea, syphilis, and National Center for HIV/AIDS, Viral Hepatitis, chancroid are the data sources of many of the figures STD, and TB Prevention and most of the statistical tables in this publication. Centers for Disease Control and Prevention These systems are an integral part of program 1600 Clifton Road, Mailstop E-02 management at all levels of STD prevention and Atlanta, Georgia, 30333 control in the United States. Because of incomplete diagnosis and reporting, the number of STD cases reported to the Centers for Disease Control and Prevention (CDC) is less than the actual number of cases occurring in the United States population. National summary data of case reports for other STDs are not available because they are not nationally notifiable diseases. vi STD Surveillance 2008 Guide to Acronyms Add Health National Longitudinal Study of Adolescent Health CDC Centers for Disease Control and Prevention CSF Cerebrospinal Fluid DHHS Department of Health and Human Services DSTDP Division of STD Prevention GISP Gonococcal Isolate Surveillance Project GPRA Government Performance and Results Act HEDIS Healthcare Effectiveness Data and Information Set HIV Human Immunodeficiency Virus HP2010 Healthy People 2010 HPV Human Papillomavirus HSV Herpes Simplex Virus IPP Infertility Prevention Project MICs Minimum Inhibitory Concentrations MMWR Morbidity and Mortality Weekly Report MPC Mucopurulent Cervicitis MSA Metropolitan Statistical Area MSM Men Who Have Sex With Men NAATs Nucleic Acid Amplification Tests NDTI National Disease and Therapeutic Index NGU Nongonococcal Urethritis NHANES National Health and Nutrition Examination Survey NHDS National Hospital Discharge Survey OMB Office of Management and Budget P&S Primary and Secondary PID Pelvic Inflammatory Disease QRNG Quinolone-resistant Neisseria gonorrhoeae RPR Rapid Plasma Reagin STD Sexually Transmitted Disease VDRL Venereal Disease Research Laboratory STD Surveillance 2008 vii Contents Acknowledgments .......................................................................................................................................... ii Foreword .........................................................................................................................................................v Preface ............................................................................................................................................................vi Guide to Acronyms .......................................................................................................................................vii Figures in the National Profile .........................................................................................................................x Figures in the Special Focus Profiles ...............................................................................................................xii Tables in the National Profile .......................................................................................................................xiv