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Sexually transmitted diseases in Americans aged 10 to 24

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Below is part of the report released on July 17 by the Centers for Disease Control and Prevention that addresses the sexually transmitted diseases among persons aged 10 to 24 in the United States.

HIV/AIDS

In 2006, a total of 2,194 persons (668 females and 1,526 males) in the United States aged 10--24 years received a diagnosis of AIDS, and a cumulative total of 9,530 persons (3,914 females and 5,616 males) were living with AIDS. The majority of persons aged 10--24 years who received an AIDS diagnosis in 2006 were young adults aged 20--24 years (71% of females and 80% of males), and 72% of total diagnoses were received by males (1,526 of 2,194 total diagnoses). However, among persons aged 10--14 years, the majority of AIDS diagnoses (61%) were received by females.

The number of young persons living with HIV/AIDS† in the 38 areas with stable (i.e., confidential name-based) HIV reporting also is presented (Tables 4 and 5). In 2006, a total of 5,396 young persons (1,540 females and 3,856 males) received a diagnosis of HIV/AIDS, and a cumulative total of 21,890 young persons were living with HIV/AIDS in these 38 areas (9,024 females and 12,866 males). As with AIDS diagnoses, the majority of HIV/AIDS diagnoses occurred among young adults aged 20--24 years (1,049 [68%] of 1,540 females and 2,922 [76%] of 3,856 males) and were male (3,856 [71%] of 5,396 total diagnoses). Among youths aged 10--14 years, more diagnoses were received by females than by males (44 [70%] and 19 [30%], respectively).

Sexually Transmitted Diseases

Adolescents and young adults aged 15--24 years have high rates for the most common STDs. Persons in this age group have been estimated to acquire nearly half of all incident STDs although they represent only 25% of the sexually active population (25). Reasons for the increased rates include biologic susceptibility, risky sexual behavior, and limited access to health care (23).

Cases of chlamydia, gonorrhea, and syphilis diagnosed in the United States are reported to CDC via NNDSS. Of these three STDs, for which federally funded ccontrol programs exist, chlamydia is the most frequently reported among all age groups of young persons. In 2006, among youths aged 10--14 years, 12,364 cases of chlamydia were reported in females and 1,238 in males; among adolescents aged 15--17 years, 130,569 cases were reported in females and 23,665 in males; among adolescents aged 18--19 years, 162,823 cases were reported in females and 35,155 in males; and among young adults aged 20--24 years, 284,763 cases were reported in females and 93,035 in males (Tables 4 and 5). Chlamydia screening is not recommended for males, so the consistently higher reported rates of chlamydia among females probably reflects compliance with recommendations for chlamydia screening for all sexually active females aged <26 years (30) and thus underestimates the disease burden among males. Population-based NHANES data demonstrate that prevalence of chlamydia among adolescents aged 14--19 years is somewhat greater among females (4.6%; 95% confidence interval [CI] = 3.7--5.8) than among males (2.3% [CI = 1.5--3.5]) (4). However, the trend is the opposite among young adults aged 20--29 years, for whom chlamydia prevalence is greater among males (3.2%; CI = 2.4--4.3) than among females (1.9%; CI = 1.0--3.4) (4).

Gonorrhea was the second most commonly reported STD in 2006. Among youths aged 10--14 years, 3,574 cases were reported in females and 675 cases in males; among younger adolescents aged 15--17 years, 30,703 cases were reported in females and 11,242 in males; among older adolescents aged 18--19 years, 35,701 cases were reported in females and 18,877 in males; among young adults aged 20--24 years, 61,665 cases were reported in females and 49,304 in males (Tables 4 and 5).

Of the three STDs for which federally funded control programs exist, primary and secondary syphilis is the least frequently reported STD. In 2006, among youths aged 10--14 years, 11 cases were reported in females and two in males; among younger adolescents aged 15--17 years, 96 cases were reported in females and 94 in males; among older adolescents aged 18--19 years, 137 cases were reported in females and 238 in males; and among young adults aged 20--24 years, 299 cases were reported in females and 1,083 in males.

NHANES data for 2003--2004 indicate that the prevalence of HPV DNA was 24.5% (CI = 19.6--30.5) among females aged 14--19 years and 44.8% (CI = 36.3--55.3) among females aged 20--24 years (Table 4). The overall prevalence of HPV DNA among females aged 14--24 years was 33.8%, representing approximately 7.5 million females with HPV infection in the United States (7). NHANES data for 1999--2004 indicated that prevalence of HSV-2 among persons aged 14--19 years was 2.3% (CI = 1.7--3.2) among females and 0.9% (CI = 0.5--1.5) among males (Table 5) (7).

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HIV/AIDS

Rates for AIDS and HIV/AIDS diagnoses and for living with AIDS and HIV/AIDS have been tabulated by age group, sex, and race/ethnicity (Tables 10--15). In 2006, non-Hispanic blacks experienced the highest rates of AIDS and HIV/AIDS diagnoses and the highest rate for living with AIDS and HIV/AIDS across all age groups. Rates among non-Hispanic blacks were three to five times higher than those among Hispanics, the population that had the second highest rates. For example, 141.7 per 100,000 non-Hispanic black males aged 15--19 years were living with HIV/AIDS compared with 39.8 per 100,000 Hispanic males that same age. Further, 129.5 per 100,000 non-Hispanic black females aged 15--19 years were living with HIV/AIDS compared with 40.2 per 100,000 Hispanic females aged 15--19 years. AI/ANs and non-Hispanic whites experienced the next highest rates, whereas API experienced the lowest rates of HIV/AIDS. For example, among males aged 15--19 years, the rates were 6.7 per 100,000 population for non-Hispanic whites, 7.3 per 100,000 population for AI/AN, and 4.7 per 100,000 population among APIs.

The frequency of HIV/AIDS diagnoses in 2006 by age, transmission category, sex and race/ethnicity has been calculated (Tables 16 and 17). Among females of all ages and racial/ethnic populations, the primary transmission category was heterosexual contact, followed by injection-drug use (IDU). Among males of all age groups and racial/ethnic populations, the primary transmission category was men who have sex with men (MSM). For non-Hispanic black males and for Hispanic males, the second most important transmission category was heterosexual contact; for non-Hispanic white males, it was IDU.

The frequency of persons aged 10--24 years who were living with HIV/AIDS in 2006 has been calculated by transmission category, age group, and sex (Table 18). The primary transmission category for persons aged 10--17 years was perinatal (92.5% among males aged 10--14 years and 90.1% among females aged 10--14 years). Among persons aged 20--24 years, the primary transmission category was MSM for males (74.9%) and heterosexual sex for females (78.7%). The frequency of persons aged 10--24 years who were living with AIDS in 2006 also has been calculated by transmission category, age group, and sex (Table 19). The patterns were similar to those for persons living with HIV/AIDS (i.e., the primary transmission category for youths and adolescents was perinatal transmission). Among males aged 20--24 years, the primary transmission category was MSM; among females, it was heterosexual.

Sexually Transmitted Diseases

Substantial disparities in STD rates exist among racial and ethnic populations (Tables 10--15). In 2006, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups. Among adolescents aged 15--19 years, the highest rates of chlamydia occurred among non-Hispanic black females (8,858.1 cases per 100,000 population), compared with non-Hispanic black males (2,195.4 cases per 100,000 population) and non-Hispanic white females (1,374.9 cases per 100,000 population) (Tables 12 and 13). A similar pattern among adolescents aged 15--19 years was recorded for gonorrhea, with the highest rates occurring among non-Hispanic black females (2,829.6 cases per 100,000 population), compared with non-Hispanic black males (1,467.6 cases per 100,000 population) and non-Hispanic white females (208.3 cases per 100,000 population) (Tables 12 and 13). The pattern varied slightly for syphilis, with non-Hispanic black males aged 20--24 years experiencing the highest rates (41.0 cases per 100,000 population), compared with non-Hispanic black females (14.8 cases per 100,000 population) and non-Hispanic white males (3.7 cases per 100,000 population) of the same age (Tables 14 and 15).

AI/AN and Hispanic young persons also experienced high rates of sexually transmitted diseases. For example, among females aged 20--24 years, rates for chlamydia were 5,008.5 cases per 100,000 population among AI/AN females and 3,301.5 cases per 100,000 population among Hispanic females, and gonorrhea rates were 634.8 cases per 100,000 population among AI/AN females and 326.7 cases per 100,000 population among Hispanic females (Table 14). Among males aged 20--24 years, syphilis rates were 6.3 cases per 100,000 population among AI/AN males and 9.2 cases per 100,000 population among Hispanic males (Table 15). Chlamydia, gonorrhea, and syphilis rates also are provided for youths aged 10--14 years (Tables 10 and 11), but the rates are substantially lower compared with older age groups. In this age group, the highest rates occurred among non-Hispanic black females: 462.2 cases per 100,000 population for chlamydia, 168.6 cases per 100,000 population for gonorrhea, and 0.6 cases per 100,000 population for syphilis.

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