The high prevalence of STDs in African American communities makes it more likely that a person will meet a new sexual partner with an infection. A big part of high prevalence may be due to social conditions, including a lack of access to good and timely health care, and relatively high levels of poverty and incarceration, Dr. Douglas said.
The South, which perennially has the highest rate of gonorrhea, had an increase in cases of about 5% between 2003 and 2006, but saw no change in 2007. Rates held relatively steady in the Northeast and Midwest during 2003-2007. The rate of gonorrhea in the West declined slightly in 2007 after it increased 29% during 2003-2006.
▸ Syphilis. The rate of primary and secondary syphilis went into a steep, 90% decline during the 1990s and in 2000 reached the lowest rate of the disease that has been reported since 1941. But the rate of primary and secondary syphilis has increased 81% from 2.1 cases per 100,000 in 2001 to 3.8 cases per 100,000 in 2007. Nationally, 11,466 cases were reported to the CDC in 2007. The rate of congenital syphilis grew by 28% during 2005-2007, with 339 reported cases in 2005 and 430 in 2007.
Disparities in syphilis rates have shrunk for black individuals from 29 times the rate in whites in 1999 to 7 times the rate in whites in 2007. But the disparity has been widening again since 2003.
While the South and urban areas of other regions maintain most of the U.S. burden of primary and secondary syphilis, the estimated proportion of cases attributable to MSM rose from 4% in 2000 to 62% in 2004. This estimate increased to 65% in 2007 after the CDC requested in 2005 that all state health departments report the gender of sex partners for people with syphilis.
Even though many syphilis infections in MSM are being transmitted inside the boundaries of relationships in which both partners are known to be HIV-infected, syphilis can still produce substantial morbidity in this group, Dr. Douglas noted.
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'The fact that [increases in STD rates] are continuing at such a dramatic level is really the major area of concern.' DR. DOUGLAS