Rural Center for AIDS/STD Prevention

RAP Time

(Volume 3, No. 1, January 8, 1999)

Issue Contents

Panel Estimates That 15.3 Million New STD Cases Occur Each Year in the United States

Sexually transmitted diseases (STDs) have a profound impact on the people in the United States. In 1988 the Centers for Disease Control and Prevention estimated 12 million annual new STD infections in the U.S. A panel of health experts convened by the American Social Health Assocation for the Kaiser Family Foundation recently calculated that the actual number of new U.S. cases of STDs is approximately 15 million annually.

Estimating is Difficult
Estimating how many STD cases occur is not a simple task. Most STDs cause no noticeable symptoms and thus are often undiagnosed. Routine screening is not widespread and social stigma often inhibits frank discussion between health care providers and patients about STD risk and the need for testing.

Only three STDs—gonorreha, syphilis, and chlamydia—are nationally reportable diseases. No national reporting is required for the other five major STDs: genital herpes, human papillomavirus (HPV), hepatitis B, HIV and trichomoniasis.

The panel developed a methodology for weighing the strength of available data, based on the completeness and consistency of source materials. It was not possible to estimate the number of individuals the cases affect, as one person may contract multiple infections.

Outcomes of the Study
Major findings of the estimates include:

  • The panel estimated that 15.3 million new infections occured in the U.S. in 1996. This is larger than the previous 12 million estimate because of improved detection techniques.
  • The estimates for HPV and trichomoniasis have increased sharply as a result of new detection and estimation methods and now account for two-thirds of new cases.
  • The incidences of chlamydia, gonorrhea, and syphilis were found to have fallen, due in large part to national control programs.
  • Estimated known sexual transmissions of herpes, hepatitis B, and HIV/AIDS were generally found to be holding steady over the last decade.
  • The estimated cumulative totals for the four viral STDs were: 45 million Americans with herpes, 20 million with HPV, 750,000 with hepatitis B, and 560,000 with HIV.
  • Direct medical costs for treatment of all estimated cases was estimated to be $8.4 billion per year in the U.S.

The panel's estimates do not reflect an increase in the STD epidemic, but rather a more accurate count. Overall, the actual number of STD cases probably decreased slightly. Better detection methods and national control programs have resulted in more STDs being treated. Further, behavior change resulting from effective prevention education has had a positive impact on the spread of STDs.

SOURCE: American Social Health Association. (1998). Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation. (call: 1-800-656-4533).

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Sex Partner's HIV/STD Risk Behavior Often Understimated

A person's perceptions about their sex partners' HIV/STD risk behavior may affect his/her sexual behavior. One hundred heterosexual couples were assessed to determine the false perceptions held by one partner about the HIV/STD risk behavior of the other partner.

More than one-third of the sample underestimated their sex partner's HIV/STD risk behavior. Males frequently underestimated their partner's use of crack in the last three months and their partner's lifetime history of injection drug use. Females frequently underestimated their partner's use of crack and of sex with another man.

The findings indicate that people may unknowingly be at-risk for HIV/STD infection from their main sex partner. Underestimating the sex partner's HIV/STD-risk behavior may be related to lack of communication between partners about disease risk or deception about past behaviors.

SOURCE: Ellen, J. M., et al. (1998). Individual's perceptions about their sex partners' risk behavior. Journal of Sex Research, 35, 328-332.

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Young Gay and Bisexual Men Perceive Less Threat of HIV

Nearly 300 gay or bisexual men were surveyed to assess beliefs concerning the efficacy of new drug treatments for HIV/AIDS on their HIV-risk behaviors.

Twenty percent reported unprotected anal receptive (UAR) intercourse in the past six months. These men were significantly younger and less educated than the remainder of the sample (those men who had not reported engaging in UAR intercourse in the past six months.) Men engaging in UAR intercourse were also more likely to report having traded sex for money or drugs.

Men recently engaging in UAR intercourse were more likely than the rest of the sample to believe that new AIDS treatments reduce the threat of HIV transmission. More than one-fifth of the men recently engaging in UAR intercourse believed that having sex with someone who had an undetectable viral load was safe. Men engaging in UAR intercourse were also more likely to be less worried about unsafe sex because of new HIV treatments.

SOURCE: Kalichman, S. C., et al. (1998). AIDS treatment advances and behavioral prevention setbacks. Health Psychology, 17. 546-550.

Alcohol Use Related to Multiple Sexual Partners in Youth

Data on 8,450 males and females aged 14-22 who participated in the 1992 Youth Risk Behavior Survey were examined. As the number of reported alcohol-related behaviors increased, the adjusted proportion of youth who recently had multiple partners increased from 8% to 48% among females and 23% to 61% among males.

SOURCE: Santelli, J. S., et al. (1998). Multiple sexual partners among U.S. adolescents and young adults. Family Planning Perspectives, 30, 271-275.

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Fear Linked to Delay in HIV Testing

Most of 1810 HIV-negative persons who had been tested for HIV reported some delay in getting tested. Fear of learning that one is infected with HIV and belief that one in unlikely to have been exposed to HIV were the most frequent reasons for testing delay or no testing.

SOURCE: CDC. (1998). HIV testing among populations at risk for HIV infection--Nine states, November 1995-December 1996. MMWR, 47, 1086-1089.