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Sexually Transmitted Diseases in the U.S.
Key Facts
- There were 15.3 million new cases of sexually transmitted diseases (STDs) in the U.S. in 1996-3 million higher than the mid-1980s calculation by the Centers for Disease Control and Prevention, which placed the number of annual new cases at 12 million.1
- The new estimate is higher primarily because improved detection techniques have identified asymptomatic (or "silent") infections that were undercounted in the past. When previous underestimation is taken into account, the new estimate most likely reflects a slight overall decrease in the actual number of new STD cases.1
- About two-thirds of the 15.3 million new cases in 1996 are attributable to two infections-trichomoniasis and human papilloma virus (HPV). Trichomoniasis can increase risk for preterm labor, and HPV causes genital warts and is associated with cervical and other genital cancers.1
- By age 24, at least one in three sexually active people are estimated to have contracted an STD.1
| Estimated Incidence And Prevalence Of STDs In The U.S., 19961 |
| STD | Incidence | Prevalence |
| Chlamydia | 3 million | 2 million |
| Gonorrhea | 650,000 | -- |
| Syphilis | 70,000 | -- |
| Herpes | 1 million | 45 million |
| Human papilloma virus | 5.5 million | 20 million |
| Hepatitis B | 77,000 | 750,000 |
| Trichomoniasis | 5 million | -- |
| Bacterial vaginosis | No estimates | -- |
| HIV | 20,000 | 560,000 |
| Total | 15.3 million | -- |
Note: Incidence is the number of new cases in a given time period; prevalence is the total number of cases in the population. |
Incidence And Prevalence Of Curable STDs
- The number of new chlamydia cases reported has risen in recent years, but the increase is due mainly to better screening rather than more infections. Overall, as more infections have been detected and cured, the "true" number of new cases has fallen, from an estimated 4 million in the mid-1980s to an estimated 3 million in 1996.1
- Trichomoniasis or "trich" is among the most common curable STDs among young, sexually active women in the U.S., with about 5 million new cases annually.1
- Between 3% and 48% of sexually active young women requesting routine care at prenatal, family planning, or college health clinics are diagnosed with trichomoniasis.2
- Bacterial vaginosis (BV), a sexually associated infection, is the most frequent cause of vaginitis in sexually active women of reproductive age. Depending on the population studied, 17% of women in family planning settings to 37% among selected groups of pregnant women have BV.3
- Because there is no established surveillance system for BV, there are no national estimates for its incidence or prevalence.1
- New gonorrhea cases have declined over the last two decades, from 1 million in 1977 to 650,000 in 1996. However, rates remain disproportionately high among teens and minorities.1
- After rising steadily during the late 1980s, syphilis rates are now at their lowest levels in two decades, at 70,000 new cases annually, leading public health authorities to consider efforts toward complete syphilis elimination.1
Incidence And Prevalence Of Incurable STDs
- One million people become infected with HSV-2 each year. Most herpes infections do not cause noticeable symptoms but still can be contagious. A significant number of people also get genital herpes from HSV-1, the virus the causes oral herpes, so the total prevalence for herpes is even higher.1
- The number of people infected with genital herpes (HSV-2 virus), has increased 30% in the last two decades, to at least 45 million people. Genital herpes now affects more than 1 in 5 Americans over the age of 12.1
- There are 5.5 million people infected each year by HPV. At least 20 million people are thought to have contagious HPV.1
- About two-thirds of the total current hepatitis B (HBV) cases are spread sexually; 77,000 new sexually transmitted HBV cases occur each year.4 There are approximately 750,000 currently infectious people with sexually acquired HBV in the U.S.1
- The annual number of new HIV cases in the U.S. has been stable for several years, with about half of new cases-20,000 infections per year-acquired through sexual transmission. About 560,000 Americans have been infected with HIV as a result of sexual transmission.1
Impact Of STDs On Women
- All groups of people are potentially at risk for STDs, but women, teens, and minorities have been disproportionately affected by them.1
- Complications of STDs are more severe and more frequent among women than men. Once infected, for example, women are more susceptible to reproductive cancers and infertility.5
- STDs are less likely to produce symptoms in women, and therefore are less likely to be diagnosed until serious problems develop. Up to 85% of chlamydial infections in women are asymptomatic compared to 40% in men.5
- Women are biologically more susceptible than men to becoming infected if exposed to an STD. For example, a woman's risk of contracting gonorrhea from one act of unprotected intercourse may be as high as 90%, while the risk to a man is about 20-30%.5
- The risk of contracting HIV from one act of intercourse has been estimated to be eight times higher from man to woman as it is from woman to man.6
- Only one out of ten women (12%) between the ages of 18-44 reported that a health provider had raised the subject of STDs other than HIV/AIDS at their first visit as part of their routine reproductive health care.7
Impact On Teens And Young Adults
- About a quarter of all new STD cases occur in teens 15-19 years old, and two-thirds of cases occur in people ages 15-24.8
- Teenagers are at high risk for acquiring an STD because they are more likely to have multiple partners, they may be more likely to have unprotected intercourse, and because there is a higher prevalence of STDs among teens than among adults.5
- Compared to older adult women, female teenagers are also more susceptible to cervical infections, such as gonorrhea and chlamydia, due to their immature cervix.8
- Chlamydia is more common among teenagers than among adult men and women; in some studies, up to 30-40% of sexually active teenage women were infected with chlamydia.5
Consequences Of STDs
- Although many STDs are curable, many are not, and all can lead to serious and enduring health consequences.5
- People with an active syphilis, genital herpes, or chancroid infection, or who have chlamydia, gonorrhea, or trichomoniasis are 3 to 5 times more likely to contract HIV if exposed than other people.8
- Millions of women, men and children are affected by long-term complications of STDs, including a variety of cancers, infertility, ectopic pregnancy and miscarriage, and other chronic diseases.5
- At least 15% of all infertile American women are infertile because of tubal damage caused by pelvic inflammatory disease (PID), resulting from an untreated STD.5
Direct Medical Costs Of STDs
- The public and private costs of STDs are tremendousCa conservative estimate of the direct medical costs of STD treatment for all estimated cases in the United States per year is at least $8.4 billion.1
- The $8.4 billion estimate does not include nonmedical indirect costs, such as lost wages and productivity (due to illness), out-of-pocket costs, or costs related to transmission to infants.1
- HIV incurs half of all direct medical costs related to STDs, at $4.5 billion annually.1
- HPV incurs the highest direct medical costs of all STDs other than HIV, at $1.6 billion annually.1
- Curable STDs incur nearly $2 billion a year in direct costs, primarily due to PID ($1.1 billion), followed by trichomoniasis ($375 million) and chlamydia ($375 million).1
Public Knowledge And Personal Concern About STDs
- When asked to name STDs they have heard of, very few Americans can name the two most common STDs: HPV (8% men, 13% women) or trichomoniasis (2% men, 3% women).9
- Only a third of women (34%) and a quarter of men (22%) name chlamydia-the most common bacterial STD in women and the leading preventable cause of infertility in the U.S.9
- A third of Americans (36%) are not aware that having an STD increases a person's risk of becoming infected with HIV.9
- Few men (24%) and women (33%) know that a woman is more likely to get an STD from an infected man than vice versa.9
- While at least one in three Americans will get an STD in their lifetime, the majority of men (74%) and women (69%) think the rate is one in ten Americans or fewer.9
- Perhaps because they dramatically underestimate the size of the STD epidemic, only a handful of men (14%) and women (8%) believe they are personally at risk of getting an STD.9
- Sixty-one percent of men and 48% of women have never been tested for an STD other than HIV/AIDS.9
- Only about a third of adults who say they have had an STD say they revealed that fact to their current or most recent partner before they had sexual intercourse (28% men, 34% women) .9
References
1. STDs in America: How Many Cases and At What Cost? 1998, Menlo Park, CA. Kaiser Family Foundation and American Social Health Association.
2. Cotch MF, Pastorek JG, Nugent RG, et. al. Trichomonas vaginalis associated with low birth weight and preterm delivery. Sex Transm Dis 1997; 24:353-360.
3. Sobel JD. Vaginitis. N Engl of Med 1997;337:1896-1903.
4. Sabin K. Surveillance of hepatitis B in the US. CDC, Atlanta, website: cdc.gov/ncidad/diseases/hepatitis, June 3, 1998.
5. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. 1996, Washington, DC. The Institute of Medicine, National Academy Press.
6. Padian NS, Shiboski SC, Glass SO, et al. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: Results from a ten-year study. American Journal of Epidemiology. 1997;146:350-57.
7. Talking About STDs With Health Professionals: Women's Experiences. 1997, Menlo Park, CA. Kaiser Family Foundation.
8. Donovan P. Testing Positive: Sexually Transmitted Disease and the Public Health Response. 1993, New York, NY. The Alan Guttmacher Institute.
9. The Kaiser Family Foundation/Glamour 1998 Survey of Men and Women on Sexually Transmitted Diseases. 1998, Menlo Park, CA. Kaiser Family Foundation.
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