Priority Area: Infectious Disease - Sexually Transmitted Diseases

The Burden of Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are a leading category of reported communicable diseases in the State, with Chlamydia, gonorrhea and syphilis accounting for most. Estimating the true incidence of STD cases is difficult because often infected persons do not have noticeable symptoms that would cause them to be tested, routine screening programs are not widespread, and viral STDs are not reportable. These limitations lead to undercounting of STDs. In a 1998 report, a panel of experts conducted a study for the Kaiser Family Foundation, and calculated that the actual number of new cases of STDs is approximately 15 million annually with 1 million new STD cases in New York State alone.

The Centers for Disease Control and Prevention (CDC) report, "Sexually Transmitted Disease Surveillance 2008", found that women and minorities in particular are more likely to have STDs. Nearly 19 million new sexually transmitted infections occur each year, and almost half of those affect 15- to 24-year-olds. STDs, including Chlamydia, gonorrhea, syphilis, herpes, and human papillomavirus, significantly impact the health of New York State (NYS) citizens, pose a substantial economic burden, and contribute to reproductive health problems (e.g., infertility, pelvic inflammatory disease, and ectopic pregnancy).

Sexual abstinence is the only way to prevent acquiring STDs. There are ways to reduce the risks of being infected with STDs in sexually active persons. For these reasons, STD control programs across NYS that conduct public health activities aim to: educate the public on safer sex behaviors; prevent the spread of STDs through counseling and treatment of those infected; and provide health services to partners of persons infected with STDs.

Objectives

• By the year 2013, reduce the proportion of adolescents and young adults in New York State (NYS) with Chlamydia trachomatis infections to:
  • No more than 3.0 percent in females aged 15 to 24 years attending family planning clinics.^* (Baseline: 5.0 percent)^**
  • No more than 3.0 percent in females aged 15 to 24 years attending STD clinics.^*(Baseline: 12.2 percent) ^**
  • o No more than 3.0 percent in males aged 15 to 24 years attending STD clinics.^* (Baseline: 15.7 percent) ^**
• By the year 2013, reduce the gonorrhea case rate in NYS to no more than 19.0 per 100,000.^* (Baseline: 90.7 per 100,000 population) ^**
• By the year 2013, eliminate sustained domestic transmission of primary and secondary syphilis in NYS^*:
  • Target: 0.2 cases per 100,000 population^* (Baseline: 3.2 per 100,000 population) ^**

^* Healthy People 2010 Objective

^** Data Source: STD Surveillance System, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Indicators for Tracking Public Health Priority Areas

Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.

• State and County Indicators For Tracking Public Health Priority Areas

Data and Statistics

Annual STD Statistical Abstracts: Links to New York State Department of Health Annual Sexually Transmitted Diseases Reports.

Strategies – The Evidence Base for Effective Interventions

• Centers for Disease Control and Prevention. Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR 2008:57( No. RR-9).

  Has integrated recommendations for services provided to partners of persons with human immunodeficiency virus, syphilis, gonorrhea, and chlamydial infection. These recommendations are used at the state and local levels to help plan, implement, and evaluate partner services for infected persons and their partners.

  Centers for Disease Control and Prevention. Program Operations Guidelines for STD Prevention.

  A resource to assist in the design, implementation, and evaluation of STD prevention and control programs. These guidelines are used by state and local STD programs to help target STD prevention priorities and resources and to plan future STD management and prevention efforts.

  National Guidelines for Internet-based STD and HIV Prevention Assessing the Power of the Internet for Public Health (pdf, 133 pages).

  Guide developed by the National Coalition of STD Directors (NCSD) that outlines promising practices for using the internet for STD prevention and provides guidance for developing internet-based program for partner notification, outreach and health communications.

Reports and Resources

• Brochures available through the Department of Health on Bacterial Vaginosis; Chancroid; Chlamydia; Genital Warts (HPV); Diseases That Can be Spread through Sex; Gonorrhea; Granuloma Inguinale; Hepatitis; Herpes; Lymphogranuloma venereum; Nongonnococcal Urethritis (NGU); Pelvic Inflammatory Disease; Pubic lice (Pediculosis); Scabies; STD & HIV Facts; STD Wallet Card; Syphilis; Syphilis Wallet Card; Trichomoniasis; Yeast Infection (Candida); What you Need to Know about the Links between HIV and STDs. These can be ordered by with the STD education materials order form.
• Centers for Disease Control and Prevention STD fact sheets.
• Treatment and Laboratory Guidelines:
  • Health Advisory: Fluoroquinolones are no longer recommended for the treatment of gonorrhea in the United States (pdf, 4 pages)
  • CDC STD Treatment Guidelines 2006
  • New York State Addendum for Congenital Syphilis Treatment Guidelines
  • 2002 Laboratory Guidelines - Screening Tests To Detect Chlamydia trachomatis and Neisseria gonorrhoeae Infections
• Training and Reference:
  • National Network of STD/HIV Prevention Training Centers
  • CDC STD 101 in a Box - Ready to Use Presentations
  • The Practitioner's Handbook for the Management of STDs- Seattle STD/HIV Prevention Training Center

Return on Investment

• The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, 2000. H. Chesson et al, Perspectives on Sexual and Reproductive Health 2004; Volume 36 (1), 11-19.

  Synthesized the existing literature on STD costs to estimate the lifetime medical cost per case of eight major STDs among 15-24-year olds. The large number of infections acquired by persons aged 15-24 and the high costs per case of viral STDs, particularly HIV, create a substantial economic burden.

  Does Funding for HIV and Sexually Transmitted Disease Prevention Matter? Evidence from Panel Data. H. Chesson et al, Evaluation Review 2005; Volume 29(1), 3-23.

  Study, which subscribers can review online, provided evidence that funding for STD and HIV prevention has a discernable impact on new cases of STDs. The authors found that greater amounts of federal STD and HIV prevention funding in a given year are associated with reductions in reported gonorrhea rates at the state level in following years. Because gonorrhea is a marker for risky sexual behavior, the findings are likely generalizable to other STDs, including HIV.

  Estimated Effectiveness and Cost-Effectiveness of Federally-Funded Prevention Efforts on Gonorrhea Rates in the United States, 1971-2003, Under Various Assumptions About the Impact of Prevention Funding (pdf, 5 pages). H. Chesson et al, Sexually Transmitted Diseases 2006; Volume 33(10), S140-S144.

  Study examined the impact of federally-funded STD prevention efforts over the past 33 years, estimating that approximately 32 million cases of gonorrhea were avoided from 1971 to 2003 as a result of prevention efforts. The study demonstrated that STD prevention programs paid for themselves. Savings realized by preventing gonorrhea exceeded the STD prevention program expenditures by more than $3.7 billion during the 33-year period.

  The Economic Value of Reductions in Gonorrhea and Syphilis Incidence in the United States, 1990-2003. H. Chesson et al, Preventive Medicine 2006; Volume 43, 411-415

  Study estimates that reductions in new cases of gonorrhea and syphilis from 1990 to 2003 saved $5.0 billion in direct medical costs. Authors calculated that the total direct medical cost of gonorrhea and syphilis was $3.8 billion over the 14-year period, compared to $8.9 billion if STD rates had remained at their 1990 levels. Because gonorrhea and syphilis infection are known to increase the risk of HIV transmission, a significant portion ($3.9 billion) of the total savings ($5.0 billion) reflected HIV infections that were averted due to reduced gonorrhea and syphilis rates.

  Sexually Transmitted Infections Among California Youth Estimated Incidence and Direct Medical Cost, 2005 (pdf, 12 pages) P. Jerman et al, Californian Journal of Health Promotion 2007, Volume 5 (3), 80-91.

  The purpose of this study was to estimate the incidence and the direct medical cost of sexually transmitted infections (STIs) among young persons in California and each of its 58 counties, and to better inform discussions about statewide policies and local resources needed for STI prevention and control efforts.

  Formulas for Estimating the Costs Averted by Sexually Transmitted Infection (STI) Prevention Programs in the United States. H. Chesson et al, Cost Effectiveness and Resource Allocation 2008 May 23; Volume 6(10). (pdf, 5 pages)

  The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their programs and can facilitate the assessment of the cost-effectiveness of their activities.

Partners

Partners include federal, state, and local STD programs and community partner organizations that are engaged in STD prevention and control activities.

• Centers for Disease Control and Prevention
• STD Clinics in New York State
• American Social Health Organization

More Information

Bureau of STD Control
Room 1168, Corning Tower, Empire State Plaza
Albany, New York 12237
Email: stdc@health.state.ny.us
Telephone: 518-474-3598
Fax: 518-474-3491