STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported STDs among some racial or ethnic minority groups when compared with rates among whites. Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health status, such as poverty, access to quality health care, health care-seeking behavior, illicit drug use, and living in communities with high prevalence of STDs. Acknowledging the disparity in STD rates by race or ethnicity is one of the first steps in empowering affected communities to organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of STDs reported to state and local health departments (see Interpreting STD Surveillance Data in the Appendix). In many state and local health jurisdictions, reporting from public sources (e.g., STD clinics) is thought to be more complete than reporting from private sources. Because minority populations may use public clinics more than whites, differences in rates between minorities and whites may be increased by this reporting bias.>¹ However, prevalence data from population-based surveys, such as NHANES and Add Health, confirm the existence of marked STD disparities in some minority populations.^2,3

Completeness of Race/Ethnicity Data

Cases for which information is unknown are redistributed according to the distribution of cases in which race or ethnicity is known to adjust for missing case report data. This process may exacerbate any reporting bias.

Chlamydia—In 2009, 26.0% of chlamydia case reports were missing race or ethnicity data, ranging by state from 0.1% to 59.5% (Table A1).

Gonorrhea—In 2009, 20.1% of gonorrhea case reports were missing information on race or ethnicity data, ranging by state from 0.0% to 41.8% (Table A1).

Syphilis—In 2009, 2.0% of syphilis case reports were missing information on race or ethnicity data, ranging from 0.0% to 19.7% among states with 10 or more cases of P&S syphilis (Table A1).

Observations

Chlamydia

Chlamydia rates based on reported cases increased during 2008–2009 among blacks, whites, and Hispanics (Table 11B). Among Asians/Pacific Islanders and American Indians/Alaska Natives, rates decreased slightly. During 2005–2009, chlamydia rates increased by 26.3% among blacks, 3.9% among American Indians/Alaska Natives, 13.4% among Hispanics, 0.4% among Asians/Pacific Islanders, and 17.9% among whites.

Blacks—In 2009, about 48% of all reported chlamydia cases occurred among blacks (Table 11A). Overall, the rate of chlamydia among blacks in the United States was more than eight times that among whites. The rate of chlamydia among black women was nearly eight times higher than the rate among white women (2,095.5 and 270.2 per 100,000 women, respectively) (Figure O, Table 11B). The chlamydia rate among black men was almost 12 times as high as the rate among white men (970.0 and 84.0 cases per 100,000 men, respectively).

American Indians/Alaska Natives—In 2009, the chlamydia rate among American Indians/Alaska Natives was 776.5 cases per 100,000 population, a decrease of 1.5% from the 2008 rate of 788.3. Overall, the rate of chlamydia among American Indians/Alaska Natives in the United States was more than four times that among whites.

Asians/Pacific Islanders—In 2009, the chlamydia rate among Asians/Pacific Islanders was 149.0 cases per 100,000 population, a slight decrease from the 2008 rate of 149.3. The overall rate among Asians/Pacific Islanders was lower than the rate among whites.

Hispanics—In 2009, the chlamydia rate among Hispanics was 504.2 cases per 100,000 population, which is a small increase from the 2008 rate of 494.8 cases and nearly three times higher than the rate among whites (178.8).

Gonorrhea

During 2008–2009, gonorrhea rates decreased 12.0% in whites, 10.6% in blacks, 9.6% in Hispanics, and 8.1% in Asians/Pacific Islanders. The gonorrhea rate in American Indians/Alaska Natives increased 5.5% (Figure 22, Table 21B).

Blacks—In 2009, about 71% of all reported cases of gonorrhea occurred among blacks (Table 21A). The rate of gonorrhea among blacks in 2009 was 556.4 cases per 100,000 population (Table 21B), which was 20.5 times higher than the rate among whites. This disparity has changed little in recent years (17.6 times higher in 2005 and 20.1 times higher in 2008) (Figure P, Table 21B). This disparity was larger for black men (25.8 times higher) than for black women (17.0 times higher) (Figure Q).

As in 2008, the disparity in gonorrhea rates for blacks in 2009 was larger in the Midwest and Northeast (28.4 and 26.7 times higher, respectively) than in the South or the West (16.2 and 13.9 times higher, respectively) (Figure R).

Considering all racial, ethnic, and age categories, gonorrhea rates were highest for blacks aged 15–19 and 20–24 years in 2009. Black women aged 15–19 years had a gonorrhea rate of 2,613.8 cases per 100,000 women. This rate was 16.7 times higher than the rate among white women in the same age group (156.7).

Black men aged 15–19 years had a gonorrhea rate of 1,316.4 cases per 100,000 men, which was 38.3 times higher than the rate among white men in the same age group (34.4). Among men and women aged 20–24 years, the gonorrhea rate among blacks was 17.8 times higher than the rate among whites (2,356.7 and 132.2, respectively) (Table 21B).

American Indians/Alaska Natives—In 2009, the gonorrhea rate among American Indians/Alaska Natives was 113.3 cases per 100,000 population, which was 4.2 times higher than the rate among whites. This disparity was similar to that in recent years (3.7 times higher in 2005) (Figure P, Table 21B). The disparity between gonorrhea rates for American Indians/Alaska Natives and whites was larger for American Indian/Alaska Native women (4.5 times higher) than for American Indian/Alaska Native men (3.6 times higher) (Figure Q).

In 2009, the disparity in gonorrhea rates for American Indians/Alaska Natives was slightly larger in the West and Midwest (4.7 times higher in both regions) than in the Northeast or South (3.5 and 3.0 times higher, respectively) (Figure R).

Asians/Pacific Islanders—In 2009, the gonorrhea rate among Asians/Pacific Islanders was 18.1 cases per 100,000 population, which was lower than the rate among whites (Figure P, Table 21B). This difference is larger for Asian/Pacific Islander women than for Asian/Pacific Islander men (Figure Q). In 2009, rates among Asians/Pacific Islanders were again lower than rates among whites in all four regions of the United States (Figure R).

Hispanics—In 2009, the gonorrhea rate among Hispanics was 58.6 cases per 100,000 population, which was higher than the rate among whites. This disparity was similar to that in recent years (Figure P, Table 21B) and was higher for Hispanic men than for Hispanic women. The disparity in gonorrhea rates for Hispanics was larger in the Northeast (4.1 times higher) than in the South (2.2 times higher), the Midwest (1.9 times higher), or the West (1.7 times higher) (Figure R).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred primarily among men who have sex with women only (MSW) and minority populations.^4,5 During the 1990s, the rate of P&S syphilis declined among all racial and ethnic groups (Figure 33). During 2005–2009, the rate increased among all racial and ethnic groups except American Indians/Alaska Natives (Table 34B).

Blacks—During 2008–2009, the rate of P&S syphilis among blacks increased 11.6% (from 17.2 to 19.2 cases per 100,000 population). In 2009, 52.4% of all cases reported to CDC were among blacks and 30.4% of all cases were among whites (Table 34A).

Compared with whites, the overall 2009 rate for blacks was 9.1 times higher, while the 2008 rate was 7.8 times higher (Table 34B). In 2009, the rate of P&S syphilis among black men was 8 times higher than the rate among white men; the rate among black women was more than 20 times higher than the rate among white women (Figure S).

In some age groups, particularly black men and women aged 15–19 years and 20–24 years, disparities have increased markedly in recent years as rates of disease have increased (Figures T and U). During 2005–2009, rates among men aged 15–19 years increased the most among black men (167%) (Table 34B). During the same period, rates among black men aged 20–24 years increased 212% (from 30.2 to 94.2 cases per 100,000 population); this increase was the highest reported regardless of age, sex, or race/ethnicity. The 2009 rate among men aged 15–19 years was 26 times higher for blacks than for whites.

Among black women aged 15–24 years, rates increased more than twofold during 2005–2009. In 2009, rates were 29 times higher for black women aged 15–19 years than for white women of the same age.

Recent trends in syphilis rates in young black men are of particular concern given data indicating high HIV incidence in this population.⁶

American Indians/Alaska Natives—During 2008–2009, the rate of P&S syphilis among American Indians/Alaska Natives increased 4.3% (from 2.3 to 2.4 cases per 100,000 population). In 2009, 0.4% of all cases reported to CDC were among American Indians/Alaska Natives (Table 34A). Compared with whites, the 2009 rate of P&S syphilis for American Indians/Alaska Natives was 1.1 times higher (Table 34B).

Asians/Pacific Islanders—During 2008–2009, the rate of P&S syphilis among Asians/Pacific Islanders increased 6.7% (from 1.5 to 1.6 cases per 100,000 population). In 2009, 1.6% of all cases reported to CDC were among Asians/Pacific Islanders (Table 34A). Compared with whites, the 2009 rate of P&S syphilis for Asians/Pacific Islanders was 0.8 times higher (Table 34B).

Hispanics—During 2008–2009, the rate of P&S syphilis among Hispanics decreased 2.2% (from 4.6 to 4.5 cases per 100,000 population). In 2009, 15.1% of all cases reported to CDC were among Hispanics (Table 34A). Compared with whites, the 2009 rate of P&S syphilis for Hispanics was 2.1 times higher (Table 34B).

Congenital Syphilis

In 2009, the rate of congenital syphilis (which is based on the mother’s race/ethnicity) was 34.9 cases per 100,000 live births among blacks and 12.0 cases per 100,000 live births among Hispanics. These rates are 12.9 and 4.4 times higher, respectively, than the rate among whites (2.7 cases per 100,000 live births) (Figure V, Table 41).

1 Miller WC. Epidemiology of chlamydial infection: are we losing ground? Sex Transm Infect. 2008;84:82-6.

2 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. 2007;147(2):89-96.

3 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004;291(18):2229-36.

4 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941 through 1993. Sex Transm Dis. 1996;23:16-23.

5 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. The changing epidemiology of syphilis. Sex Transm Dis. 2005;32(Suppl 10):S4-10.

6 Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system — United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:985-9.