Facts on Sexually Transmitted Infections in the United States

August 2006

Overview

• STIs are not new; even HIV, the most recently recognized infection, has been around for more than two decades.  Many STIs or their manifestations have been recognized for centuries.

• STIs are caused by bacterial, viral or parasitic pathogens that are acquired through sexual activity.

• At one end of the spectrum is HIV/AIDS, which is considered to be fatal but is treatable with antiretroviral drugs and can extend an infected individual’s life by years. Other viral STIs, such as hepatitis B and herpes, are also incurable, but are treatable with much less medical care required and fewer side effects.

• At the other end of the spectrum are many of the most common STIs—bacterial infections, such as chlamydia, gonorrhea and syphilis—which are treatable and curable.

• Left untreated, chlamydia and gonorrhea may lead to serious complications, including infertility and chronic pain; syphilis may result in death. In addition, some STIs increase a person’s vulnerability to getting HIV.

• Many STIs are “silent,” in that they cause few symptoms. Without symptoms, many STIs can be diagnosed only through testing, yet routine screening is not widespread.

Challenges of Measuring STIs

• Data collection may be incomplete because some STIs (such as herpes and HIV) are not part of a national reporting system, because some STIs (such as chlamydia and HPV) can be asymptomatic and go undetected, and because surveys intended to measure the prevalence of STIs have not been based on representative samples of the U.S. population.

• It is difficult to measure trends in the incidence and prevalence of STIs because of changes in reporting systems and the availability of increasingly accurate testing methods.

• Only chlamydia, gonorrhea, syphilis, hepatitis A and hepatitis B are required to be reported to state health departments and the U.S. Centers for Disease Control and Prevention (CDC).

• In 2004, the CDC reported 929,462 chlamydia diagnoses and 330,132 gonorrhea diagnoses. However, since most chlamydia and gonorrhea cases go undiagnosed or are not reported, the true number of new infections is probably much greater.[5] 

• In 2004, the most infectious stages of syphilis—primary and secondary—were diagnosed in nearly 8,000 Americans, and hepatitis B virus (HBV) infections in 60,000. An estimated 1.25 million people in the United States have chronic HBV.[6]

• Although other STIs are not required to be reported to the CDC, estimates are available for some. The CDC estimates that one out of five adolescents and adults have had a genital herpes infection, [7] and 7.4 million new cases of trichomoniasis occur each year.[8]

• The CDC also estimates that 20 million people are currently infected with HPV, 6.2 million Americans get a new HPV infection each year and at least 50% of sexually active individuals will acquire an HPV infection at some point in their lives.[9] Most HPV infections cause no clinical problems and resolve on their own without treatment. (As many as 91% of new infections clear up within two years.) [10] Some strains of HPV may lead to persistent infection that can progress to cervical cancer if left untreated, however this outcome is largely preventable with effective screening.

HIV/AIDS

• Since 1981, when the first cases of AIDS were identified, 1.4 million Americans have been infected with HIV, including more than 500,000 who have already died. Roughly 40,000 new HIV infections occur each year—a number that has remained stable since the early 1990s.[11]

• An estimated 1–1.2 million U.S. individuals are living with HIV. As many as one in four individuals with HIV may be unaware of their status.[12]

• One-half of men and women aged 15–44 report that they have been tested at least once (other than through blood donation); 15% in the past 12 months.[13]

• In 2004, women accounted for 27% of HIV/AIDS diagnoses among adolescents and adults, and males for 73%. However, this gap is slowly closing.[14] 

• Heterosexual transmission accounts for a large proportion of newly diagnosed HIV cases among women. Seventy-six percent of women in whom HIV was diagnosed between 2001 and 2004 contracted the virus through heterosexual intercourse.[15]

DISPARITIES

• In 2004, the overall rate of chlamydia infection among women (485 cases per 100,000 females) was more than three times the rate among men (147 per 100,000).[16] 

• The rate of chlamydia among black women (1,722 per 100,000) was nearly eight times the rate among white women (227 per 100,000). The rate among black men (645 per 100,000) was more than 11 times that of white men (57.3 per 100,000).[17]

• Blacks remain the group most heavily affected by gonorrhea. In 2004, the gonorrhea rate among blacks was 19 times the rate among whites. [18] 

• Although blacks make up only approximately 13% of the U.S. population, they accounted for one-half of the estimated new HIV/AIDS diagnoses in 2004.[19]

STIs AMONG TEENS AND YOUNG ADULTS

• Although teens and young adults represent only 25% of the sexually active population, 15–24-year-olds account for nearly half of all STI diagnoses each year.[20]

• Rates of gonorrhea, chlamydia and syphilis are above average among young people.[21]

• Together, HPV, trichomoniasis and chlamydia represent nearly nine in 10 new STIs among 15–24-year-olds.[22]

PREVENTION AND TREATMENT

• The three ways to avoid STIs are to abstain from sex, to be in a long-term, mutually monogamous relationship with a partner who has been tested and does not have an STI, and to use condoms consistently and correctly.

• Male latex condoms have been proven effective in preventing the most serious STI (HIV), the most easily transmitted STIs (gonorrhea, chlamydia and HPV) and unplanned pregnancy. However, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STI.[23]

• Access to health care services, including STI screening and treatment, is critical, because not all STIs can be prevented, even with perfect condom use, and because so many STIs are asymptomatic and can cause long-term health risks if undetected and untreated.

HOW MUCH DO STIs COST?

• Direct medical costs associated with STIs in the United States are estimated at $13 billion annually.[24]

• More than $8 billion is spent each year to diagnose and treat STIs and their complications. This figure does not include HIV. [25]

References

© copyright 1996-2009, Guttmacher Institute

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