Sexually Transmitted
Diseases

Background

Although much progress has been made, sexually transmitted diseases (STD) rates are 50-100 times higher in the United States than those in other industrialized nations. STDs have a tremendous impact on the health of adolescents and young adults, and their complications are severe and costly. In women, STDs can lead to pelvic inflammatory disease (PID), potentially fatal ectopic pregnancies, infertility, and cancer of the reproductive tract. In infants infected by their mothers, STDs can result in physical deformities, mental retardation, and death.

STDs play an important role in the sexual transmission of HIV infection. The risk behaviors for HIV also place people at risk for over 20 sexually transmitted diseases. There is strong scientific evidence that STDs increase the potential for acquiring HIV infection.

With assistance from the Centers for Disease Control and Prevention (CDC), the WV STD Program continues to support disease detection, treatment, and prevention. The program now covers chlamydia screening in all STD and family planning clinics. Short-term goals include a non-culture, single-specimen procedure for obtaining gonorrhea and chlamydia specimens. Long-term goals include addressing viral STDs such as HIV, herpes, and Hepatitis B.

The Objectives

OBJECTIVE 19.1 Contain primary and secondary syphilis to an incidence of no more than 1.2 cases per 100,000 people.

UPDATE Since 1987, the incidence of primary and secondary syphilis has ranged from a low of 0.49 cases per 100,000 population in 1988 to a high of 1.62 in 1991 (see Figure 1). The 1995 incidence was 0.72. The year 2000 incidence is projected to be 0.57. The CDC has determined the disease to be "eradicated" (fewer than 10 per 100,000) in West Virginia, although it has not been "eliminated" as a public health concern.

OBJECTIVE 19.2 Contain congenital syphilis to an incidence of no more than 0.9 per 10,000 live births.

UPDATE The rate of congenital syphilis in West Virginia remains below the year 2000 objective of no more than 0.9 per 10,000 live births. Only one confirmed case of congenital syphilis was reported from 1987 through 1995. There have been two probable cases of congenital syphilis during that same time frame. The year 2000 objective has been achieved.

OBJECTIVE 19.3 Contain gonorrhea to an incidence of no more than 75.8 cases per 100,000 population.

UPDATE Since 1987, the incidence rate of gonorrhea has ranged from a high of 83.7 cases per 100,000 population in 1987 to a low of 39.4 cases reported in 1993 (see Figure 2). At the present rate of decline, the year 2000 incidence rate is forecast to be 28.6 cases per 100,000 population, substantially below the target objective of 75.8. This objective has been achieved. New, more expensive screening technologies are being sought by the WV STD Program that would increase the yield in the public screening program, thereby decreasing the incidence of the disease and its subsequent consequences.

Populations At Risk for STDs in West Virginia

Chlamydia: A Decreasing Problem

Chlamydia rates now exceed those of syphilis and gonorrhea in West Virginia. In 1990, the state legislature mandated chlamydia as a reportable disease. In late 1991, the STD Program notified laboratories and health care providers of the mandatory reporting requirement. Despite those efforts, officials with the STD Program estimated chlamydia to be severely underreported in the early 1990s. To address the issue, the STD and family planning programs developed a major statewide initiative to identify and target efforts toward unreported and undiagnosed cases. Implementation began in 1994 with chlamydia screening efforts being provided in 183 STD and family planning clinics statewide.

The chlamydia initiative has been an astounding success as the disease began a downward trend only 18 months into the project. The current rate of decrease has been about 10% a year. Economically, the initiative is saving over $800,000 annually that would have been used to treat pelvic inflammatory disease, infertility, or ectopic pregnancies caused by chlamydia. The STD Program is now working to refine the initiative.

Meeting the Objectives

Health Promotion Channels
for Achieving Objectives:

Worksites
Schools
Public Health Programs
Networks
Health Care System
Higher Education

The Director of the Division of Surveillance and Disease Control, which houses the WV STD Program, will be the contact person for policies and strategies in addressing Objectives 19.1 through 19.3. In order to meet the objectives and confine the annual incidence of sexually transmitted diseases by the year 2000, the following strategies will be continued. To reach all segments of the population. the health promotion channels to the community that are listed in the box above will be used.

Sexually Transmitted Diseases - Meeting the Objectives

Lead Entity:
West Virginia STD Program
Division of Surveillance & Disease Control

Plan Coordinator:
Loretta Haddy, MA, MS, Director
Division of Surveillance & Disease Control
WV Bureau for Public Health
(304) 558-5358/FAX (304) 558-6335

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