Sexually Transmitted Diseases: The Facts
Introduction
Until recently, prevention programs for sexually transmitted diseases (STDs) focused primarily on gonorrhea and syphilis. In the 1970s, however, the spectrum of sexually transmitted diseases expanded to include Chlamydia trachomatis, genital herpes, hepatitis, human papilloma virus (genital warts) and others. The list continues to grow in the 1980s with the notable addition of the acquired immune deficiency syndrome (AIDS). The identification and surveillance of STDs is particularly difficult because asymptomatic carrier rates are high (higher than 70% for females with genital herpes or chlamydia), inexpensive diagnostic tests are not available and national reporting systems do not exist for many STP's. Outside of AIDS, mortality is rare from STDs, but morbidity is high. Each year, 2.5 million teenagers are affected with an STD. Over 1 million women have episodes of pelvic inflammatory disease (PID) each year, resulting in involuntary infertility to an estimated 200,000 women. The economic costs of PID were estimated at over $2.6 billion in 1984. Prevention efforts focused on education, detection, treatment of contacts, prophylaxis for neonates and research for vaccines, have had limited success, but must continue.
Prevalence
Chlamydia
An estimated 3 to 4 million Americans suffer from a Chlamydia trachomatis infection each year, making chlamydial infections the most prevalent of all sexually transmitted diseases in the U.S.
Chlamydia trachomatis causes approximately 50% of the reported cases of nongonococcal urethritis in men, or about 2.5 times the number of cases caused by Neisseria gonorrhea. An estimated 1.5 million urethral chlamydial infections occur annually.
Chlamydia trachomatis infection of the endocervix is 2.6 times more common than N. gonorrhea infection of the endocervix.
Chlamydia causes approximately 50% of the estimated 500,000 cases of acute epididymitis seen each year in the U.S., and is the leading cause of epididymitis among men under 35 years of age.
20%-30% of patients visiting sexually transmitted disease clinics have chlamydial infections.
25%-50% of women and 15-30% of men with gonococcal infections also have chlamydial infections.
Sexually active women under 20 years of age have chlamydial infection rates 2-3 times higher than those for women over 20 years of age.
The prevalence of urethral chlamydial infection among homosexual men is approximately 1/3 the prevalence among heterosexual men, but 4%-8% of hemosexual men seen in STD clinics have rectal chlamydial infections.
An estimated 336,600 infants are born to women with chlamydial infections; 33% of those infants, or 119,800 infants, develop neonatal chlamydial infections.
Gonorrhea
In 1984, 878,556 cases of gonorrhea were reported for a rate of 374.8 cases per 100,000 population. The actual incidence may be as much as twice the reported incidence.
