IV Information on Sexually Transmitted Diseases STDs

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					Sherman-Denison Area Epidemiologic Profile, 2004-2005




IV. Information on Sexually-Transmitted Diseases (STDs)
In addition to direct markers of HIV infections in your community (HIV infections, AIDS
cases, living with HIV), STDs can be used as surrogate markers, indicating unprotected
sex in your planning area. Below, we present the highlights of the number of cases and
case rates for three reportable STDs, chlamydia, gonorrhea, and syphilis. More detailed
data on these STDs can be found in the appendix tables.

Historically, chlamydia cases are higher in women due to targeting of resources; most of
the chlamydia screening funds come from the infertility project, which naturally targets
women of childbearing age. Other factors that affect the higher number of chlamydia
cases reported among women are that women routinely have gynecological visits and that
symptoms are more pronounced in women than in men.

Gonorrhea and syphilis cases are reported with equal vigor for both men and women.
However, syphilis cases have become less useful due to syphilis elimination efforts, with
the low number of cases making any useful conclusions difficult. With that caveat,
syphilis has recently shown an increase, primarily among M/MS in Texas, a trend which
is being monitored closely by state and local health authorities.




IV. STD Case Information                                                               1
Sherman-Denison Area Epidemiologic Profile, 2004-2005


Comparison of Cases and Case Rates for Chlamydia,
Gonorrhea, and Syphilis in the Sherman-Denison Area.

    •                Of the STDs illustrated in Figure IV.1, chlamydia had the largest number of cases
                     reported, between 320 and 500 cases per year since 1999. Reported cases rose
                     from 1999 to 2001 and fell from 2001 to 2003.
    •                Gonorrhea cases remained constant at just under 200 cases reported each year
                     between 1999 and 2003 (Figure IV.1).
    •                Eleven or fewer primary, secondary and early latent syphilis cases were reported
                     each year from 1999 to 2003 in the Sherman-Denison area (Figure IV.1).

Figure IV.1. Number of STD cases reported by year of report for the Sherman-Denison
area.
                     600



                     500



                     400
    Cases Reported




                                 Chlamydia
                     300         Gonorrhea
                                 Primary, Secondary, and Early Latent Syphilis

                     200



                     100



                        0
                               1999           2000            2001               2002   2003

                                                        Year Reported




IV. STD Case Information                                                                            2
Sherman-Denison Area Epidemiologic Profile, 2004-2005


                                  •    Chlamydia case rates peaked in 2001 at 277 cases / 100,000 and fell to a low of
                                       178 cases / 100,000 in 2003.

                                  •    The gonorrhea case rate was approximately 100 cases / 100,000 between 1999
                                       and 2003 (Figure IV.2).

                                  •    Primary, secondary and early latent syphilis case rates were less than 7 cases /
                                       100,000 (Figure IV.2).

Figure IV.2. STD case rate by year of report for the Sherman-Denison area.
                                  300
Cases Reported / 100,000 People




                                  250



                                  200
                                               Chlamydia
                                               Gonorrhea
                                  150          Primary, Secondary, and Early Latent Syphilis



                                  100



                                      50



                                      0
                                             1999           2000            2001               2002   2003

                                                                      Year Reported

                                       Chlamydia cases account for the majority of STD infections reported since 1999
                                       (Figure IV.1).
                                       There were no significant differences in trends when looking at STD data when
                                       comparing cases reported per year (Figure IV.1) and case rates per year of report
                                       (Figure IV.2).


Comparison of Cases and Case Rates between Men and Women
for Chlamydia, Gonorrhea, and Syphilis

                                  •    The number of chlamydia cases reported were highest in women (Figure IV.3A),
                                       between 280 and 450 cases reported, compared with just over 50 cases reported in
                                       men. The number of cases reported in men was relatively constant in each year
                                       examined, but there has been a general decline in cases reported in women since
                                       2001.


IV. STD Case Information                                                                                              3
Sherman-Denison Area Epidemiologic Profile, 2004-2005


    •        The number of gonorrhea cases reported in women was higher than men,
             approximately 110 cases reported each year compared to 70 cases reported each
             year in men between 1999 and 2003 (Figure IV.3B).
    •        Primary, secondary, and early latent cases reported per year were relatively
             constant among men and women, less than 5 cases reported per year since 1999
             (Figure IV.3C).

Figure IV.3. Number of STD cases reported by year of report for the Sherman-Denison
area, by sex.
                                                  500
                                                        A                                         Chlamydia Men
                       Chlamydia Cases Reported




                                                                                                  Chlamydia women
                                                  400


                                                  300


                                                  200


                                                  100


                                                    0
                                                  140   B                                     Gonorrhea men
             Gonorrhea Cases Reported




                                                                                              Gonorrhea women
                                                  120

                                                  100

                                                  80

                                                  60

                                                  40

                                                  20

                                                   0
                                                        C                                 P, S, & EL Syphilis men
                                                  25
                                                                                          P, S, & EL Syphilis women
        P, S, & EL Syphilis




                                                  20
         Cases Reported




                                                  15


                                                  10


                                                   5


                                                   0
                                                            1999   2000       2001         2002           2003

                                                                          Year Reported


IV. STD Case Information                                                                                              4
Sherman-Denison Area Epidemiologic Profile, 2004-2005


    •          Case rates for chlamydia were steady in men from 1999 to 2003, approximately
               60 cases / 100,000 men (Figure IV.4A). Among women, the case rates rose from
               1999 to 2001, and then fell to a low of 306 cases / 100,000 women in 2003.
    •          Case rates for gonorrhea declined slightly for both men and women (Figure
               IV.4B). In women, rates declined from 125 cases / 100,000 in 1999 to 100 cases /
               100,000 in 2003. In men, the case rates declined from 100 to 66 cases / 100,000
               from 1999 to 2003, respectively.
    •          Syphilis case rates were similar in men and women, less than 7 cases / 100,000
               each, each year (Figure IV.4C).

Figure IV.4. STD case rate by year of report for the Sherman-Denison area, by sex.
                                     600
                                           A                                         Chlamydia men
        Chlamydia Cases Reported /




                                                                                     Chlamydia women
                                     500
             100,000 People




                                     400

                                     300

                                     200


                                     100


                                      0
                                           B                                         Gonorrhea men
        Gonorrhea Cases Reported /




                                     200
                                                                                     Gonorrhea women
             100,000 People




                                     150


                                     100



                                     50



                                      0
                                     25    C                                 P, S, & EL Syphilis men
        Reported / 100,000 People




                                                                             P, S, & EL Syphilis women
        P, S, & EL Syphilis Cases




                                     20


                                     15


                                     10


                                      5


                                      0
                                               1999   2000       2001         2002           2003

                                                             Year Reported

IV. STD Case Information                                                                                 5
 Sherman-Denison Area Epidemiologic Profile, 2004-2005


                               There were no significant differences in the trends for STD cases reported (Figure
                               IV.3) and STD case rates (Figure IV.4) when stratifying cases between men and
                               women.

 Comparison of Cases and Case Rates between Race and Ethnic
 Categories for Chlamydia

                           •   White women had the highest number of chlamydia cases reported from 1999 to
                               2003, between 150 and 200 cases reported each year (Figure IV.5B).
                           •   African American women had the next highest number of reported chlamydia
                               cases, about 70 cases reported per year since 1999 (Figure IV.5B).
                           •   Men in each of the three race or ethnic categories had less than 30 cases reported
                               each year (Figure IV.5A).

 Figure IV.5. Number of chlamydia cases reported by year of report for the Sherman-
 Denison area, by race or ethnic category and sex.



                               250
                                     A Men                Anglo/white      B Women
                                                          Black
                                                          Hispanic


                               200
Chlamydia Cases Reported
       Cases Reported




                               150




                               100




                               50




                                0
                                     1999   2000   2001   2002      2003   1999   2000   2001   2002   2003

                                                                Year of Report




 IV. STD Case Information                                                                                      6
                             Sherman-Denison Area Epidemiologic Profile, 2004-2005


                                            •    Black women have the highest reported case rate, declining from 1,600 cases /
                                                 100,000 in 2000 to 1,300 cases / 100,000 in 2003 (Figure IV.6B).
                                            •    Hispanic women had the next highest case rate, between 600 and 900 cases /
                                                 100,000 from 1999 to 2002 (Figure IV.6.B).
                                            •    Case rates for White women were relatively constant and below 260 cases /
                                                 100,000 each year (Figure IV.6B).
                                            •    In men, case rates were highest among Blacks, over 200 cases / 100,000 each year
                                                 (Figure IV.6A). White and Hispanic men had rates around 150 and 40 cases /
                                                 100,000 each year, respectively.

                             Figure IV.6. Chlamydia case rate by year of report for the Sherman-Denison area, by
                             race or ethnic category and sex



                                            1800
                                                      A Men                Anglo/white      B Women
                                                                           Black
                                            1600                           Hispanic
Chlamydia Cases Reported / 100,000 People
      Cases Reported / 100,000 People




                                            1400


                                            1200


                                            1000


                                                800


                                                600


                                                400


                                                200


                                                 0
                                                      1999   2000   2001   2002      2003   1999   2000   2001   2002   2003

                                                                                 Year of Report

                                                 The number of cases in each of the three race and ethnic categories was higher in
                                                 women than in men (Figures IV.5B and 6B).
                                                 Black men and women had the highest case rates among any race or ethnic group
                                                 examined, while the largest number of cases was in Whites (Figures IV.5 and 6).
                                                 Cases and case rates in men were lower than the lowest case rate for women
                                                 (Figure IV.6)

                             IV. STD Case Information                                                                           7
Sherman-Denison Area Epidemiologic Profile, 2004-2005




Comparison of Cases and Case Rates between Race and Ethnic
Categories for Gonorrhea

                   •        White women had the highest number of gonorrhea cases reported among all race
                            and ethnic categories, between 36 and 66 cases reported each year (Figure IV.7B).
                            Black women had the next highest number of cases reported, approximately 40
                            cases per year. Fewer than 10 gonorrhea cases were reported in Hispanic women
                            each year.

                   •        Among men, Blacks had the largest number of gonorrhea cases reported, between
                            24 and 60 reported from 1999 and 2003 (Figure IV.7A). White men had the next
                            highest case load, between 6 and 25 cases reported each year, followed by
                            Hispanic men with less than 10 cases reported each year.

Figure IV.7. Number of gonorrhea cases reported by year of report for the Sherman-
Denison Area, by race or ethnic category and sex.
 Gonorrhea Cases Reported




IV. STD Case Information                                                                                   8
  Sherman-Denison Area Epidemiologic Profile, 2004-2005


                                            •   Blacks had the highest gonorrhea case rates between 1999 and 2003 (Figure
                                                IV.8A and B). Among men, the rates varied from 400 to 1,000 cases / 100,000
                                                men. In women, the rate was more consistent, approximately 700 to 800 cases /
                                                100,000 women.
                                            •   White men and women had the next highest case rate (Figure IV.8A and B).
                                            •   Among both Hispanic men and women the rate was between 25 and 75 cases /
                                                100,000 and 45-150 cases / 100,000 in women (Figure IV.8A and B).

  Figure IV.8. Gonorrhea case rate by year of report for the Sherman-Denison area, by
  race or ethnic category and sex.



                                                1200
                                                                             Anglo/white
                                                                             Black
Gonorrhea Cases Reported / 100,000 People




                                                                             Hispanic

                                                1000
     Cases Reported / 100,000 People




                                                 800



                                                 600



                                                 400



                                                 200



                                                  0
                                                       1999   2000   2001   2002      2003   1999   2000   2001   2002   2003

                                                                                 Year of Report


                                                Although White women had the highest number of cases among women, Black
                                                women had the highest case rate (Figures 7 and 8).
                                                Black men had the highest number of cases among men and Black men and
                                                women had the highest case rates among all race or ethnic categories.




  IV. STD Case Information                                                                                                      9
Sherman-Denison Area Epidemiologic Profile, 2004-2005




Comparison of Cases and Case Rates between Race and Ethnic
Categories for Syphilis

There were too few cases to evaluate syphilis cases broken down by race or ethnicity.
Detailed number of cases and case rates can be found in the appendix tables.

Comparison of Cases and Case Rates between Age Groups for
Chlamydia

    •   In both men and women, the 15 to 24 age group had the largest number of
        chlamydia cases reported (Figure IV.11A and B). In men, there was a constant
        number of cases reported between 1999 and 2003, between 25 and 40 cases. For
        women, there was a slight increase in cases reported from 1999 to 2001, from 280
        to 360 cases, respectively, followed by a decline to 240 cases reported in 2003.

    •   The only other age group with a significant number of cases reported was the 25
        to 34 age group in women, with approximately 50 cases reported each year
        (Figure IV.11B).




IV. STD Case Information                                                             10
Sherman-Denison Area Epidemiologic Profile, 2004-2005


Figure IV.11. Number of chlamydia cases reported by year of report for the Sherman-
Denison area, by age and sex.



                                  A Men                 Under 15 years old     B Women              Under 15 years old
                                                        Ages 15 to 24                               Ages 15 to 24
                            400                         Ages 25 to 34                               Ages 25 to 34




                            300




                            200
 Chlamydia Cases Reported




                            100
      Cases Reported




                              0
                                  C Men                   Ages   35   to 44    D Women                Ages   35   to 44
                                                          Ages   45   to 54                           Ages   45   to 54
                            400                           Ages   55   to 64                           Ages   55   to 64
                                                          Ages   65   and up                          Ages   65   and up




                            300




                            200




                            100




                              0
                                  1999    2000   2001     2002        2003     1999   2000   2001     2002        2003

                                                                 Year of Report




IV. STD Case Information                                                                                                   11
Sherman-Denison Area Epidemiologic Profile, 2004-2005




    •   In both men and women, the 15 to 24 year old age group had the highest
        chlamydia case rate (Figure IV.12A and B). In men, the rate declined from 315
        cases / 100,000 in 2000 to 190 cases / 100,000 men in 2003. In women, the rate
        increased from 2,200 cases / 100,000 in 1999 to approximately 3,000 cases /
        100,000 in 2001. After 2001, the rate in women fell to 1,800 cases / 100,000 by
        2003.

    •   The only other age group with a significant case rate was the 25 to 34 age group.
        In women, this rate declined from 470 cases / 100,000 in 2000 to 350 cases /
        100,000 women in 2003 (Figure IV.12A and B). In contrast, the chlamydia rate
        increased in men during the same time period from 36 to 130 cases / 100,000.




IV. STD Case Information                                                              12
Sherman-Denison Area Epidemiologic Profile, 2004-2005


Figure IV.12. Chlamydia case rate by year of report for the Sherman-Denison area, by
age and sex.



                                                         A Men                 Under 15 years old   B Women              Under 15 years old
                                                                               Ages 15 to 24                             Ages 15 to 24
                                                                               Ages 25 to 34                             Ages 25 to 34

                                                  3000




                                                  2000
      Chlamydia Cases Reported / 100,000 People
           Cases Reported / 100,000 People




                                                  1000




                                                     0
                                                         C Men                   Ages 35 to 44      D Women                Ages 35 to 44
                                                                                 Ages 45 to 54                             Ages 45 to 54
                                                                                 Ages 55 to 64                             Ages 55 to 64
                                                                                 Ages 65 and up                            Ages 65 and up
                                                  3000




                                                  2000




                                                  1000




                                                     0
                                                         1999    2000   2001     2002     2003      1999   2000   2001     2002     2003

                                                                                      Year of Report




IV. STD Case Information                                                                                                                      13
Sherman-Denison Area Epidemiologic Profile, 2004-2005




        There were no significant differences in trends between cases and case rates when
        chlamydia cases are compared by age group (Figures IV.11 and IV.12).
        Women had the largest number of cases and case rates compared to men in all age
        groups examined.
        The 15 to 24 year old age group had the largest number of cases and the highest
        case rate in both men and women, followed by the 25 to 34 year old age group.


Comparison of Cases and Case Rates between Age Groups for
Gonorrhea

    •   In men and women, the 15 to 24 age group had the largest number of gonorrhea
        cases reported (Figure IV.13A and B). In men, there was a decline in the number
        of cases reported between 1999 and 2003, from approximately 60 to 30 cases.
        For women, the number of cases reported from 1999 to 2003 was relatively
        constant, between 74 and 94 cases reported each year.

    •   The age group with the next highest number of cases reported was the 25 to 34
        age group (Figure IV.13A and B). In men, the number of cases reported
        increased from 15 to 25 cases reported in 1999 and 2003, respectively. In
        women, the number of cases reported each year varied from 9 to 22.




IV. STD Case Information                                                              14
Sherman-Denison Area Epidemiologic Profile, 2004-2005


Figure IV.13. Number of gonorrhea cases reported by year of report for the Sherman-
Denison Area, by age and sex.


                               120   A Men                 Under 15 years old     B Women              Under 15 years old
                                                           Ages 15 to 24                               Ages 15 to 24
                                                           Ages 25 to 34                               Ages 25 to 34


                               100



                                80



                                60



                                40
    Gonorrhea Cases Reported




                                20
           Cases Reported




                                 0
                               120   C Men                   Ages   35   to 44    D Women                Ages   35   to 44
                                                             Ages   45   to 54                           Ages   45   to 54
                                                             Ages   55   to 64                           Ages   55   to 64
                                                             Ages   65   and up                          Ages   65   and up
                               100



                                80



                                60



                                40



                                20



                                 0
                                     1999    2000   2001    2002         2003     1999   2000   2001    2002         2003

                                                                  Year of Report




IV. STD Case Information                                                                                                      15
Sherman-Denison Area Epidemiologic Profile, 2004-2005




    •   In men and women, the 15 to 24 year old age group had the highest gonorrhea
        case rate (Figure IV.14A and B). The case rate for men declined from 420 cases /
        100,000 men in 1999 to approximately 220 cases / 100,000 in 2003. In women,
        the case rate was between 600 and 770 cases / 100,000.

    •   The 25 to 34 year old age group had the next highest case rate among the age
        groups examined (Figure IV.14A and B). In men, the case rate increased from
        100 cases / 100,000 in 1999 to 200 cases / 100,000 in 2003. The case rate for
        women varied between 90 and 210 cases / 100,000.




IV. STD Case Information                                                             16
Sherman-Denison Area Epidemiologic Profile, 2004-2005


Figure IV.14. Gonorrhea case rate by year of report for the Sherman-Denison Area, by
age and sex.


                                                        A Men                 Under 15 years old   B Women              Under 15 years old
                                                                              Ages 15 to 24                             Ages 15 to 24
                                                  800                         Ages 25 to 34                             Ages 25 to 34




                                                  600
      Gonorrhea Cases Reported / 100,000 People




                                                  400
       Cases Reported / 100,000 People




                                                  200




                                                   0
                                                        C Men                   Ages 35 to 44      D Women                Ages 35 to 44
                                                                                Ages 45 to 54                             Ages 45 to 54
                                                  800                           Ages 55 to 64                             Ages 55 to 64
                                                                                Ages 65 and up                            Ages 65 and up




                                                  600




                                                  400




                                                  200




                                                   0
                                                        1999    2000   2001    2002      2003      1999   2000   2001    2002      2003

                                                                                     Year of Report




IV. STD Case Information                                                                                                                     17
Sherman-Denison Area Epidemiologic Profile, 2004-2005




        There were no significant differences in the trends for gonorrhea cases reported
        and case rates (Figures IV.13 and IV.14).
        The 15 to 24 year old age group had the largest number of cases and highest case
        rate among the age groups examined.
        In the 15 to 24 year old age group, women had the largest number of gonorrhea
        cases reported, and the highest case rate.


Comparison of Cases and Case Rates between Age Groups for
Syphilis

There were too few cases to evaluate syphilis cases broken down by age group. Detailed
number of cases and case rates can be found in the appendix tables.




IV. STD Case Information                                                             18

				
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