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Sexually Transmitted Disease Surveillance 2010

Sexually Transmitted Disease Surveillance 2010

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Sexually Transmitted Disease Surveillance 2010

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  1. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

  2. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Chlamydia

  3. Chlamydia—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 750 Men 625 Women Total 500 375 250 125 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.

  4. Chlamydia—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 500 400 300 200 West Midwest Northeast 100 South 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  5. Chlamydia—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 422.6 per 100,000 population.

  6. Chlamydia—Rates by County, United States, 2010 Rate per 100,000 population <300.0 (n = 1,962) 300.1–400.0 (n = 418) >400.0 (n = 762)

  7. Chlamydia—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700 Age 774.3 3,378.2 15–19 1,187.0 3,407.9 20–24 25–29 598.0 1,236.1 30–34 309.0 530.9 153.2 35–39 220.1 40–44 91.3 94.7 45–54 39.3 32.8 10.9 55–64 9.3 65+ 2.8 2.1 Total 233.7 610.6

  8. Chlamydia—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 1500 American Indians/Alaska Natives Asians/Pacific Islanders Blacks 1200 Hispanics Whites 900 600 300 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  9. Chlamydia—Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 800 700 600 500 Non-STD Clinic, Men Non-STD Clinic, W omen 400 STD Clinic, Men 300 STD Clinic, W omen 200 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  10. Chlamydia—Percentage of Reported Cases by Sex and Selected Reporting Sources, United States, 2010 Percentage 40 Private Physician/HMO* STD Clinic 35 Other HD* Clinic 30 Family Planning Clinic Emergency Room 25 20 15 10 5 0 Men Women *HMO = health maintenance organization; HD = health department. NOTE: These categories represent 72.5% of cases with a known reporting source. Of all cases, 11.6% had a missing or unknown reporting source.

  11. Chlamydia—Prevalence by Age Group and Race/Ethnicity, National Health and Nutrition Examination Survey, 1999–2002 Prevalence, % 16 Non-Hispanic Whites Non-Hispanic Blacks Mexican-Americans 12 8 4 0 14–19 20–29 30–39 Age NOTE: Error bars indicate 95% confidence intervals. SOURCE: Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. 2007;147(2):89-96.

  12. Chlamydia—Median State-specific Positivity Rates Among Women Aged 15–24 Years Tested in Family Planning Clinics, Infertility Prevention Project, United States, 1997–2010 Median State-Specific Positivity Rate, % 10 8 6 4 2 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year NOTE: As of 1997, all 10 U.S. Department of Health and Human Services (HHS) regions, which represent all 50 states, the District of Columbia, and outlying areas, reported chlamydia positivity data.

  13. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2010 NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15–24 years screened during 2010.

  14. Chlamydia—Trends in Positivity Rates Among Women Aged 15–24 Years Tested in Family Planning Clinics, by U.S. Department of Health and Human Services (HHS) Region, Infertility Prevention Project, 2006–2010 * 2009 percent positivity for Region VI previously published in the 2009 Surveillance report has been corrected.

  15. Chlamydia—Percentage of Nucleic Acid Amplification Tests Used Among Women Aged 15–24 Years Tested in Family Planning Clinics, by U.S. Department of Health and Human Services (HHS) Region, Infertility Prevention Project, 2006–2010 Percentage Percentage Percentage Percentage 100 100 100 100 80 80 80 80 60 60 60 60 40 40 40 40 20 20 20 20 0 0 0 0 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 Region I Region II Region III Region IV Percentage Percentage Percentage Percentage 100 100 100 100 80 80 80 80 60 60 60 60 40 40 40 40 20 20 20 20 0 0 0 0 06 07 08 09 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 10 Region V Region VI Region VII Region VIII Percentage Percentage 100 100 80 80 60 60 40 40 20 20 0 0 06 07 08 09 10 06 07 08 09 10 Region IX Region X

  16. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Gonorrhea

  17. Gonorrhea—Rates, United States, 1941–2010 Rate (per 100,000 population) 500 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 Year

  18. Gonorrhea—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 400 Men Women Total 300 200 100 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year

  19. Gonorrhea—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 300 West Midwest 250 Northeast South 200 150 100 50 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  20. Gonorrhea—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 99.6 per 100,000 population.

  21. Gonorrhea—Rates by County, United States, 2010 Rate per 100,000 population <19.0 (n = 1,408) 19.1–100.0 (n = 1,107) >100.0 (n = 627)

  22. Gonorrhea—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 750 600 450 300 150 0 0 150 300 450 600 750 Age 253.4 570.9 15–19 421.0 560.7 20–24 241.3 226.3 25–29 146.5 107.5 30–34 85.1 48.2 35–39 64.2 23.8 40–44 45–54 34.1 9.0 1.9 11.0 55–64 2.4 0.5 65+ 94.1 106.5 Total

  23. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) Age Group 1,000 30–34 15–19 35–39 20–24 40–44 800 25–29 600 400 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  24. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) Age Group 750 30–34 15–19 35–39 20–24 40–44 600 25–29 450 300 150 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  25. Gonorrhea—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 600 500 400 American Indians/Alaska Natives 300 Asians/Pacific Islanders Blacks Hispanics 200 Whites 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  26. Gonorrhea—Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 200 Non-STD Clinic, Men Non-STD Clinic, Women STD Clinic, Men 160 STD Clinic, Women 120 80 40 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  27. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting Sources, United States, 2010 Percentage 35 Private Physician/HMO* STD Clinic 30 Other HD* Clinic Family Planning Clinic 25 Emergency Room 20 15 10 5 0 Men Women * HMO = health maintenance organization; HD = health department. NOTE: These categories represent 69.5% of cases with known reporting source. Of all cases, 13.2% had a missing or unknown reporting source.

  28. STD Surveillance Network­­ (SSuN)—Proportion of MSM,* MSW,* and Women Among Interviewed† Gonorrhea Cases by Site, 2010 Percentage MSM 100 MSW Women 80 60 40 20 0 San Francisco California‡ Colorado Louisiana Virginia Philadelphia New York City Connecticut Washington Chicago Alabama Baltimore * MSM = men who have sex with men; MSW = men who have sex with women only. † SSuN interviews conducted from a randomly selected patient population with gonorrhea (n = 3,446). ‡ California data excludes San Francisco.

  29. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2010 * States/areas not meeting minimum inclusion criteria. NOTE: Includes states and outlying areas that reported positivity data on at least 500 women aged 15–24 years who were screened during 2010.

  30. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel Sites and Regional Laboratories, United States, 2010

  31. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP Isolates, 2006–2010 Percentage 100 2006 2007 2008 80 2009 2010 60 40 20 0 0.015 0.03 0.06 0.125 0.25 <0.008 MICs (µg/ml)

  32. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Cefixime Among GISP Isolates, 2006 and 2009–2010 Percentage 100 2006 2009 80 2010 60 40 20 0 <0.015 0.03 0.06 0.125 0.25 0.5 MICs (µg/ml) NOTE: Isolates were not tested for cefixime susceptibility in 2007 and 2008.

  33. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Azithromycin Among GISP Isolates, 2006–2010 Percentage 40 2006 2007 2008 30 2009 2010 20 10 0 0.06 0.125 0.25 0.5 1 2 4 8 16 <0.03 MICs (µg/ml)

  34. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeae Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990–2010 Percentage 20 Resistance Intermediate Resistance 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year NOTE: Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) >1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125–0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.

  35. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and Ciprofloxacin Resistance Among GISP Isolates, 2010 6.9% 2.0% 0.6% 1.8% 2.9% Susceptible 9.4% PenR TetR 3.5% QRNG 72.8% PenR/TetR PenR/QRNG TetR/QRNG PenR/TetR/QRNG NOTE: PenR = penicillinase producing Neisseriagonorrhoeaeand chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR = chromosomally and plasmid mediated tetracycline-resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

  36. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea Among GISP Participants, 1988–2010 Percentage 100 Other Tetracyclines Penicillins Ofloxacin 80 Ciprofloxacin 60 Cefixime Ceftriaxone 250 mg 40 20 Spectinomycin Ceftriaxone 125 mg Other Cephalosporins 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NOTE: For 2010, “Other” includes no therapy (1.2%), azithromycin 2 g (1.7%), and other less frequently used drugs.

  37. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Syphilis

  38. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2010 Cases (in thousands) 600 Primary and Secondary 500 Early Latent Total Syphilis 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 Y ear

  39. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, United States, 1990–2010 Rate (per 100,000 population) Rate Ratio (log scale) 16:1 25 Male Rate Female Rate 20 Total Rate 8:1 Male-to-Female Rate Ratio 15 4:1 10 2:1 5 1:1 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year

  40. Primary and Secondary Syphilis—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 10 West Midwest 8 Northeast South 6 4 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  41. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.5 per 100,000 population.

  42. Primary and Secondary Syphilis—Rates by County, United States, 2010 Rate per 100,000 population <0.2 (n = 2,167) 0.21–2.2 (n = 383) >2.2 (n = 592) NOTE: In 2010, 2,167 (69.0%) of 3,141 counties in the United States reported no cases of primary and secondary syphilis.

  43. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 25 20 15 10 5 0 0 5 10 15 20 25 Age 5.6 3.0 15–19 21.9 4.5 20–24 19.2 3.0 25–29 15.8 2.0 30–34 12.7 1.4 35–39 13.8 1.0 40–44 8.5 0.8 45–54 0.2 2.7 55–64 0.6 0.0 65+ 7.9 1.1 Total

  44. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) 6 Age Group 15–19 30–34 5 20–24 35–39 25–29 40–44 4 3 2 1 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  45. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) 25 Age Group 30–34 15–19 20 35–39 20–24 40–44 25–29 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  46. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 25 American Indians/Alaska Natives Asians/Pacific Islanders 20 Blacks Hispanics Whites 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  47. Primary and Secondary Syphilis—Reported Cases* by Stage, Sex, and Sexual Behavior, United States, 2010 Cases 6,000 Primary Secondary 5,000 4,000 3,000 2,000 1,000 0 Women MSM† MSW† * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information. † MSW = men who have sex with women only; MSM = men who have sex with men.

  48. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and Race/Ethnicity,† United States, 2010 Cases 3,000 Whites 2,500 Blacks Hispanics Other 2,000 1,500 1,000 500 0 Women MSM‡ MSW‡ * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information; 2.0% of reported male cases with sex of sex partner data were missing race/ethnicity data. † No imputation was done for race/ethnicity. ‡ MSW = men who have sex with women only; MSM = men who have sex with men.

  49. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 10 Non-STD Clinic, Men Non-STD Clinic, Women 8 STD Clinic, Men STD Clinic, Women 6 4 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  50. Primary and Secondary Syphilis—Percentage of Reported Cases* by Sex, Sexual Behavior, and Selected Reporting Sources, 2010 Percentage Correctional Facility 40 HIV Counseling and Testing Site Private Physician/HMO† 35 STD Clinic 30 25 20 15 10 5 0 MSW† Women MSM† * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information, and 2.7% of reported male cases with sex of sex partner data were missing source of information data. † HMO = health maintenance organization; MSW = men who have sex with women only; MSM = men who have sex with men.