Other Sexually Transmitted Diseases (STDs)

Chancroid

Since 1987, reported cases of chancroid declined steadily until 2001. Since then, the number of cases reported has fluctuated (Figure 44, Table 1). In 2008, 25 cases of chancroid were reported in the United States. Only nine states reported one or more cases of chancroid in 2008 (Table 42). Although the overall decline in reported chancroid cases most likely reflects a decline in the incidence of this disease, these data should be interpreted with caution since Haemophilus ducreyi, the causative organism of chancroid, is difficult to culture and, as a result, this condition may be substantially under-diagnosed.^1,2

Human Papillomavirus (HPV)

Persistent infection with high-risk human papillomavirus (HPV) can lead to development of anogenital cancers (i.e., cervical cancer). In June 2006, a quadrivalent HPV vaccine was licensed for use in the United States. The vaccine provides protection against types 6, 11, 16, and 18. Types 6 and 11 are associated with genital warts while types 16 and 18 are oncogenic types associated with anogenital cancers.

Sentinel surveillance for cervical infection with high-risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, or 68 was conducted in 26 STD, family planning and primary care clinics in six locations (Boston, Baltimore, New Orleans, Denver, Seattle and Los Angeles) as part of an effort to estimate national burden of disease and inform prevention efforts such as vaccine programs in the United States. Testing was performed using a commercially available test for high-risk HPV DNA (Hybrid Capture 2, Qiagen, Gaithersburg, MD). Results from 2003–2005 document an overall high-risk HPV prevalence of 23%. Prevalence in STD clinics was 27%, 26% in family planning clinics, and 15% in primary care clinics. Prevalence by age group was 35% in those 14 to 19 years of age; 29% in those 20 to 29 years of age; 13% in those 30 to 39 years of age; 11% in those 40 to 49 years of age; and 6.3% in those 50 to 65 years of age.³

National population-based data were also obtained from NHANES, examining prevalence in the civilian, non-institutionalized female population of the United States, 2003–2004, of both high-risk HPV and low-risk HPV including types 6 and 11, which are responsible for approximately 90% of anogenital warts (Figure 45). The overall HPV prevalence of high- and low-risk types, was 26.8% (95% confidence interval (CI): 23.3–30.9) among U.S. females 14 to 59 years of age. HPV vaccine preventable types 6 or 11 (low-risk types) or 16 or 18 (high-risk types) were detected in 3.4% of female participants; HPV-6 was detected in 1.3% (95% CI: 0.8–2.3), HPV-11 in 0.1% (95% CI: 0.03–0.3), HPV-16 in 1.5% (95% CI: 0.9–2.6), and HPV-18 in 0.8% (95% CI: 0.4–1.5) of female participants.⁴

Data from the National Disease and Therapeutic Index (NDTI) suggest that incidence of genital warts (Figure 46) as measured by initial visits to physicians’ offices, may be increasing. The NHANES 1999–2004 survey years demonstrated that 5.6% (95% CI: 4.9–6.4) of sexually active 18–59 year olds self-reported a history of a genital wart diagnosis.⁵

Pelvic Inflammatory Disease (PID)

For data on PID, see the Special Focus Profile on Women and Infants.

Herpes Simplex Virus (HSV)

Case reporting data for genital HSV are not available. Trend data are based on estimates of the initial office visits in physicians’ office practices for these conditions from the NDTI (Figure 47 and Table 43).

National trend data on the seroprevalence of HSV-2 among those 14 to 49 years of age from the NHANES survey years 1999–2004 were compared with survey years 1988–1994. Seroprevelance decreased from 21% (95% CI: 19.1–23.1) in 1988–1994 to 17.0% (95% CI: 15.8–18.3) in 1999–2004. These data along with data from NHANES survey years 1976–1980, indicate that blacks had higher seroprevalence than whites for each survey period and age group⁷ (Figure 48). In 1999–2004, the overall percentage of survey participants who reported having been diagnosed with genital herpes was 3.8%.⁶

While HSV-2 seroprevalence is decreasing, most persons with HSV-2 have not been diagnosed. Increasing visits for genital herpes, as suggested by NDTI data, may indicate increased recognition of infection.

Trichomoniasis

Case reporting data are not available for trichomoniasis and trend data for this infection is limited to estimates of initial physician office visits from NDTI (Figure 49 and Table 43). NHANES data from 2001–2004 demonstrated an overall prevalence of 3.1% (95% CI: 2.3–4.3), with the highest prevalence observed among blacks 13.3% (95% CI: 10.0–17.7).⁷

¹ Schulte JM, Martich FA, Schmid GP. Chancroid in the United States, 1981–1990: Evidence for underreporting of cases. MMWR 1992;41(no. SS-3):57–61.

² Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. J Infect Dis 1998;178:1795–8.

³ Datta SD, Koutsky L, Ratelle S, et al. Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003–2005. Ann Intern Med 2008 Apr 1;148(7):493–500.

⁴ Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, Markowitz LE. Prevalence of HPV infection among females in the United States. JAMA 2007 Feb 28;297(8):813–9.

⁵ Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts among 18- to 59-year-olds in the United States, national health and nutrition examination survey, 1999–2004. Sex Transm Dis 2008 Apr;35(4):357–60.

⁶ Xu F, Sternberg MR, Kottiri BJ, McQuillan G, Lee FK, Nahmias AJ, Berman SM, Markowitz LE. Trends in Herpes Simplex Virus Type 1 and Type 2 seroprevalence in the United States. JAMA 2006 Aug 23/30 (8):964–973.

⁷ Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman, S, Markowitz LE. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001–2004. Clin Infect Dis 2007 Nov 15;45(10):1319–26.