Trends in the Well-Being of America's Children and Youth, 2000. HC 2.12 Sexually Transmitted Diseases Among Adolescents

01/01/2000

Sexually Transmitted Diseases (STDs) have potentially severe consequences. Gonorrhea infections are a major cause of pelvic inflammatory disease, which in turn may lead to adverse reproductive consequences such as infertility, ectopic pregnancy, or the birth of children with physical and mental developmental disabilities. Syphilis facilitates the transmission of HIV and may be particularly important to contributing to HIV transmission in areas with high rates of both infections.47 The increase in sexual activity among teenagers described in Section SD 4.1 has exposed a growing number of young people to the risk of STDs. Despite this increased risk, the reported rate of incidence has declined among adolescents for both gonorrhea and syphilis.

Decline in Gonorrhea Rates. Gonorrhea rates have declined for all youth since 1975 (see Table HC 2.12.A). Among youth ages 15 through 19, rates decreased by more than half, from 1,275.1 cases of gonorrhea per 100,000 youth in 1975 to 560.6 cases per 100,000 youth in 1998. Gonorrhea rates also decreased among youth ages 10 through 14, but the decline started in more recent years and has not been as dramatic as among older youth. The rate for this age group was 46.7 per 100,000 in 1975, peaked at 68.9 cases in 1990, and, by 1998, had declined to 32.6 cases per 100,000.

Differences in Gonorrhea Rates by Gender. For youth ages 15 through 19 and ages 10 through 14, females have had consistently higher reported rates of gonorrhea than males (see Figure HC 2.12.A). In 1998, rates for females ages 15 through 19 were 779.7 per 100,000, versus 354.9 per 100,000 males of the same age.

Differences in Gonorrhea Rates by Race and Hispanic Origin.48 Blacks have consistently had the highest reported rates of gonorrhea, frequently more than 10 times the rate of any other racial or ethnic group. Rates for blacks have been falling since 1990 for both age groups (for ages 15 through 19, the rate dropped from 6,316.2 in 1990 to 2,950.8 per 100,000 in 1998). By contrast, in 1998 gonorrhea rates per 100,000 for 15- through 19-yearolds of other groups were 404.4 for American Indians/Alaska Natives, 233.2 for Hispanics, 127.3 for whites, and 71.4 for Asians (see Table HC 2.12.A).

Decline in Syphilis Rates. Table HC 2.12.B shows that reported rates for primary and secondary syphilis have decreased for youth ages 10 through 14 and 15 through 19 since their peak in 1990. The rate for teens ages 15 through 19 is substantially higher than the rate for youth ages 10 through 14. The reported rate for syphilis in 1998 for ages 15 through 19 was 3.2 cases per 100,000, compared with less than one case per 100,000 for ages 10 through 14.

Higher Syphilis Rates Among Females. Females from both age groups have reported more cases of syphilis than their male counterparts (see Figure HC 2.12.B). In 1998, females ages 15 through 19 had a rate of 4.5 cases per 100,000, more than double the male rate of 1.9 cases per 100,000.

Differences in Syphilis Rates by Race and Hispanic Origin.49 Black youth ages 15 through 19 have rates of syphilis more than 10 times higher than all other racial and ethnic groups throughout the period 1990 through 1998. Rates have been falling for all groups except American Indians/Alaska Natives, whose reported syphilis rates have fluctuated since 1990 (see Table HC 2.12.B).

Figure HC 2.12.A Reported rates of gonorrheaa for youth ages 15 through 19 in the United States, by gender (per 100,000 population ages 15 through 19): Selected years, 1975-1998

Figure HC 2.12.A Reported rates of gonorrheaa for youth ages 15 through 19 in the United States, by gender (per 100,000 population ages 15 through 19): Selected years, 1975-1998

a Although most areas generally adhere to the case definitions for STDs found in Case Definitions for Public Health Surveillance (Morbidity and Mortality Weekly Report 1990; 39: 1-43), there are significant differences between individual areas in case definitions as well as in the policies and systems for collecting surveillance data. In many areas, reporting from publicly supported institutions (e.g., STD clinics) was more complete than from other sources (e.g., private practitioners).

Sources: Data for 1975 from Centers for Disease Control and Prevention, Division of STD Prevention, 1996, Table 7; data for 1980 and 1985 from Centers for Disease Control and Prevention, Division of STD Prevention, 1987, Table 3; data for 1990-1992 from Division of STD/HIV Prevention, December 1994, Table 9.B; data for 1993 from Division of STD Prevention, 1997, Table 12.B; data for 1994-1997 from Division of STD Prevention, 1999, Table 12B.


Table HC 2.12.A Reported rates of youth gonorrheaa in the United States, by age, gender, and race and Hispanic origin (per 100,000 population): Selected years, 1975–1998

  1975 1980 1985 1990 1995 1996 1997 1998
Ages 10-14
Total 46.7 48.7 47.7 68.9 41.3 33.2 30.7 32.6
Gender                
Male 20.9 23.6 23.8 32.1 12.4 9.1 8.5 8.5
Female 73.6 74.8 72.9 107.5 71.7 58.6 54.1 58.0
Race and Hispanic originb,c
White 14.3 8.9 7.5 7.2 6.8
Black 386.8 237.0 179.8 162.2 175.9
Hispanic 15.3 19.3 15.8 15.0 14.0
Asian/Pacific 4.5 5.6 3.3 3.5 3.5
Islander American Indian/Alaska Native 22.7 19.0 21.7 23.7 25.1
Ages 15-19
Total 1,275.1 1,187.3 1,189.9 1,114.4 671.0 543.6 521.6 560.6
Gender
Male 1,103.9 953.4 930.5 993.7 503.2 373.6 348.1 354.6
Female 1,446.4 1,424.6 1,455.1 1,241.6 847.8 724.5 706.2 779.7
Race and Hispanic originb,c
White 230.3 145.1 125.8 117.4 127.3
Black 6,316.2 3,815.3 2,904.8 2,780.0 2,950.8
Hispanic 268.7 270.3 222.7 223.5 233.2
Asian/Pacific Islander 70.0 81.0 64.1 68.6 71.4
American
Indian/Alaska Native 414.6 296.2 329.0 342.9 404.4

a Although most areas generally adhere to the case definitions for STDs found in "Case Definitions for Public Health Surveillance" (Morbidity and Mortality Weekly Report 1990; 39: 1-43), there are significant differences between individual areas in case definitions.

b For the following years, the states/areas listed did not report race/ethnicity for most cases: 1990 (Baltimore, New Jersey, New York City, New York State, and Kentucky); 1991 (Baltimore, New York City, New York State, and Kentucky); 1992 (New York City and New York State); 1993 (New York City, New York State, and Georgia); 1994 (New York City, New York State, and Georgia); 1995 (Georgia, New Jersey, New York City, and New York State); and 1996 (New Jersey, New York City, and New York State); 1997 (Idaho, New Jersey, New York City, and New York State), and 1998 (Idaho and New Jersey). Massachusetts did not report age for most cases in 1990. Cases and population denominators have been excluded for these states/areas for the appropriate years.

c Estimates for whites and blacks exclude Hispanics of those races. Persons of Hispanic origin may be of any race.

Sources: Data for 1975 from Centers for Disease Control and Prevention, 1996, Table 7; data for 1980 and 1985 from Centers for Disease Control and Prevention, 1987; Table 3; data for 1990-1992 from Division of STD/HIV Prevention, 1994; Table 9.B; data for 1993 from Division of STD Prevention, 1997; Table 12.B; data for 1994-1998 from Division of STD Prevention, 1999. Table 12B.


Table HC 2.12.B Reported rates of youth primary and secondary syphillisa in the United States, by age, gender, and race and Hispanic origin (per 100,000 population): Selected years, 1975-1998

  1975 1980 1985 1990 1991b 1992 1993b 1994 1995 1996b 1997b 1998
Ages 10-14
Total 1.1 0.9 0.9 1.8 1.4 1.3 0.9 0.6 0.6 0.3 0.2 0.2
Gender                        
Male 0.7 0.5 0.5 0.5 0.4 0.3 0.3 0.1 0.1 0.1 0.0 0.1
Female 1.5 1.3 1.4 3.2 2.5 2.3 1.6 1.2 1.0 0.5 0.4 0.4
Race and Hispanic originc
White 0.1 0.1 0.1 0.1 0.1 0.0 0.0 0.0 0.0
Black 10.6 8.6 8.1 5.9 3.8 3.5 1.6 1.3 1.2
Hispanic 1.1 0.4 0.4 0.1 0.1 0.1 0.1 0.1 0.0
Asian/Pacific Islander 0.2 0.3 0.0 0.2 0.0 0.0 0.0 0.0 0.0
American Indian/Alaska Native 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Ages 15-19
Total 17.8 17.2 17.0 29.8 27.8 22.5 17.0 12.7 10.1 6.1 4.1 3.2
Gender
Male 18.0 19.2 16.3 20.9 19.1 15.5 10.8 8.3 6.6 4.1 2.6 1.9
Female 17.5 15.1 17.7 39.2 37.0 29.9 23.5 17.3 13.8 8.2 5.8 4.5
Race and Hispanic originc
White 2.9 2.6 2.0 1.6 1.4 1.1 0.9 0.5 0.4
Black 174.6 164.8 136.7 103.5 76.5 60.9 35.1 23.0 17.8
Hispanic 15.2 12.5 8.5 5.6 2.8 2.4 1.7 2.1 1.5
Asian/Pacific Islander 1.7 1.9 1.4 1.0 0.8 0.5 0.8 0.4 0.4
American Indian/Alaska Native 2.8 7.0 2.7 0.6 2.4 4.2 1.1 0.5 3.8

a Although most areas generally adhere to the case definitions for STDs found in Case Definitions for Public Health Surveillance (Morbidity and Mortality Weekly Report 1990; 39: 1-43), there are significant differences between individual areas in case definitions as well as in the policies and systems for collecting surveillance data. In many areas, reporting from publicly supported institutions (e.g., STD clinics) was more complete than from other sources (e.g., private practitioners).

b For the indicated states/areas, cases and population denominators have been excluded for the years indicated: 1991 (Kentucky, as race/ethnicity was not reported for most cases); 1993 (Baltimore, because age was not reported for most cases); and 1996 (Rhode Island, because race/ethnicity was not reported for most cases).

c Estimates for whites and blacks exclude Hispanics of those races. Persons of Hispanic origin may be of any race.

Sources: Data for 1975 from Centers for Disease Control and Prevention,1986, Table 8; data for 1980 and 1985 from Centers for Disease Control and Prevention, Division of STD Prevention, 1987, Table 2; data for 1990-1992 from Division of STD/HIV Prevention. December, 1994; Table 21.B; data for 1993 from Division of STD Prevention, 1997, Table 24.B; data for 1994-1998 from Division of STD Prevention, 1999, Table 24B.

 


Figure HC 2.12.B Reported rates of primary and secondary syphilisa for youth ages 15 through 19 in the United States, by gender (per 100,000 population ages 15 through 19): Selected years, 1975-1998

Figure HC 2.12.B Reported rates of primary and secondary syphilisa for youth ages 15 through 19 in the United States, by gender (per 100,000 population ages 15 through 19): Selected years, 1975-1998

a Although most areas generally adhere to the case definitions for STDs found in Case Definitions for Public Health Surveillance (Morbidity and Mortality Weekly Report 1990; 39: 1-43), there are significant differences between individual areas in case definitions as well as in the policies and systems for collecting surveillance data. In many areas, reporting from publicly supported institutions (e.g., STD clinics) was more complete than from other sources (e.g., private practitioners).

Sources: Data for 1975 from Centers for Disease Control and Prevention, Division of STD Prevention, 1996, Table 7; data for 1980 and 1985 from Centers for Disease Control and Prevention, Division of STD Prevention, 1987, Table 3; data for 1990-1992 from Division of STD/HIV Prevention, 1994, Table 9.B; data for 1993 from Division of STD Prevention, 1997, Table 12.B; data for 1994-1998 from Division of STD Prevention, 1999, Table 12B.


47 Centers for Disease Control and Prevention, Division of STD Prevention. September 1999. Sexually Transmitted Disease Surveillance, 1998. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, p. 21.

48 Estimates for whites and blacks exclude Hispanics of those races.

49 Estimates for whites and blacks exclude Hispanics of those races

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