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Genital Herpes
An estimated 724,000 new cases of genital herpes, are reported annually in the U.S. with a cumulative prevalence of over 20 million infected persons.
An estimated 3%-5% of infants born through an infected birth canal will acquire a neonatal herpes infection. The incidence of neonatal herpes infection is estimated to be between 1 in 3,000 and 1 in 20,000 live births.
Human Papilloma Virus
The incidence and prevalence of human papilloma virus infections (genital warts) is unknown; however, it is estimated that nearly 12 million visits to private physicians offices occurred in 1984 for genital warts.
Public and Professional Awareness
In 1982, 66% of metropolitan school systems provided systematic instruction on sexually transmitted disease.
6.7% of single sexually active females aged 20-24, a group at high risk of contracting sexually transmitted diseases, used condoms as a method of birth control in 1982.
Rates of teenage venereal disease were noted to increase after implementation of legislation that decreased classroom education in veneral disease. The trend reversed when the legislation was rescinded.
Service Delivery
The U.S. Department of Health and Human Services allocated $73,136,900 in 1984 for sexually transmitted disease control, a 17% increase over the 1983 level of funding.
The total cost of PID and PID-associated ectopic pregnancy and infertility exceeded $2.6 billion in 1984.
In 1984, there were an estimated 10 million visits to private physicians for vaginitis and 1 million visits for male urethritis.
It is estimated that over 2.5 million outpatient visits for PID are made each year, and 267,200 hospitalizations for PID occur yearly.
Significant Trends
Gonorrhea
The 1984 gonorrhea rate of 374.8 cases/100,000 population is 2.4 times the 1964 rate of 159.0, but 12.5% lower than the 1974 rate of 428.2.
Penicillin-resistant gonorrhea was first noted in the U.S. in 1976 when 98 cases were reported. Since then infection due to penicillinase producing Neisseria gonorrhea increased to a high of 4,464 cases in 1982, then declined to 4,122 cases in 1984.
Syphilis
From 1964 to 1984 the rate of syphilis (all stages) declined by 50% from 60.4 to 29.8 per 100,000. However, the rates of primary and secondary syphilis for 1964 (12.1) and 1984 (12.2) remain the same.
Chlamydia
Chlamydial trachomatis is not a notifiable disease in this country; however, in England where nongonococcal urethritis is reportable and is caused by chlamydia in 50% of cases it is estimated that the incidence of chlamydial infections doubled in the 10 years from 1972 to 1982. Sentinel studies in this country show that chlamydia now accounts for 2.6 times as many endocervical infections and 1.4 times as many urethral infections as N. gonorrhea.
Pelvic Inflammatory Disease
Setween 1970 and 1977, the rates of PID among women aged 15-44 rose 33%, then declined slightly to level off at a rate that is 27% above the 1970 rate.
Genital Herpes
The number visits to private physicians’ offices for genital herpes infections nearly tripled in the ten years up to 1984, when 450,000 visits occurred.
Human Papilloma Virus
From 1965 to 1984, visits to private physicians’ offices for genital warts (caused by human papilloma virus) increased fivefold to nearly 12 million visits per year.
Special Issues
Chlamydia
Chlamydia trachomatis infection is the most common of all sexually transmitted diseases in the United States, causing approximately 4.65 million infections each year. Detection is difficult since 70% of females are assymptomatic and since no inexpensive diagnostic test is widely available. The CDC is recommending treatment of presumptive cases despite lack of confirmation of diagnosis, as well as screening of high-risk groups.
Asymptomatic Carriers of Infection
The spread of sexually transmitted disease is difficult to control since many carriers of infection have no symptoms. 70% of lower genital tract infections in women with Chlamydia trachomatis cause no symptoms. 30% of men and women with gonorrhea can be assymptomatic carriers. It is estimated that less than 25% of patients with genital herpes infections have symptoms. Preliminary results from one study suggest that 71% of cases of primary genital herpes were acquired from a partner who had no symptoms at the time of exposure.
Cervical Cancer
Cervical dysplasia or carcinoma-in-situ increases with increasing number of sexual partners and earlier age of first intercourse. The causal role of genital herpes and human papilloma virus to cervical cancer is under investigation.
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