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STI management and control in North America IUSTI region
  1. Charlotte A Gaydos
  1. Correspondence to Dr Charlotte A Gaydos, Division of Infectious Diseases, Johns Hopkins University, 855 North Wolfe Street, Room 530, Rangos Building, Baltimore, MD 21205, USA; cgaydos{at}jhmi.edu

https://doi.org/10.1136/sextrans-2011-050287

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    Introduction

    In the USA, approximately 19 million new cases of sexually transmitted infections (STIs) occur annually,1 primarily affecting adolescents and young adults.2 Direct and indirect costs to the USA for STIs are estimated to be $10–17 billion dollars per year (table 1).3 Issues of health inequity and health disparities make STIs a prime target for management and control. STIs present numerous barriers to routine clinical care and diagnosis because of the associated stigma, costs and confidentiality issues. Furthermore, even if tested, many infected patients (30%–74%) never return for routine test results or are lost to follow-up for treatment.4

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    Table 1

    Estimated annual burden and cost of STDs in the USA

    In Canada, between 1997 and 2007, both the number and rate of reported cases increased for chlamydia, gonorrhoea and infectious syphilis.5 All three STIs increased more dramatically among middle-aged adults.

    Age and health disparities

    Age

    Youth of the USA represents the most vulnerable population and bears much of the burden of sexually transmitted disease (STDs). Studies indicate that one in four sexually active adolescents will acquire an STD (figure 1). The chlamydia rate in the young adolescents is astounding: 3329.3/100 000 and 3273.9/100 000 in 15–19 and 20–24 years women, respectively, versus 1234.0 and 511.7/100 000 for ages 25–29 and 30–34 years, respectively.2

    Figure 1

    Chlamydia prevalence in sexually active women 14–24 years in the USA by age and race. NH, non-Hispanic.

    In Canada, between 1997 and 2007, chlamydia rates increased by 86.8% among adults aged 15–29 years (p<0.0001) and 165.9% among adults aged 40 to 59 years old (p<0.0001).5 Similarly, the increases for gonorrhoea were 133.3% (p<0.0001) and 210.2% (p<0.0001), respectively. Syphilis rates increased fivefold among younger adults compared with an increase of 11-fold among middle-aged adults (p<0.0001) since 1997.5 The reported rate ratios (younger:middle age) decreased over time for chlamydia (p<0.0001), gonorrhoea (p<0.0001) and syphilis (p=0.005). Men …

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