topbrandingbar
corner.gif
Government Information Departments and Agencies NJ Business Portal MY New Jersey NJ people NJ Home Page

CHS Home Page CHS Data CHS Reports List of CHS tables and reports CHS topics from A-Z CHS Links CHS Frequently Asked Questions Search the CHS pages

Update Healthy New Jersey 2000
Second Update and Review

Priority Area 7
Prevent And Control Sexually Transmitted Diseases

Introduction

Sexually transmitted diseases (STDs) continue to be a major health problem in New Jersey. More than 20 organisms and syndromes are transferred through sexual contact, including genital herpes, HIV and hepatitis B. The Department has chosen to concentrate on addressing syphilis, gonorrhea and chlamydia due to the greater incidence and prevalence of these diseases.

The year 2000 objectives for most types of syphilis are likely to be met, but the outlook for other STD objectives is uncertain.

Outlook for Reaching Specific Objectives:
  Achieve target: Likely Unlikely Uncertain
7A. Reduction in syphilis:      
    the total population
X
   
    minorities
X
   
7B. Reduction in congenital syphilis for:      
    total population  
X
 
    minorities    
X
7C. Reduction in gonorrhea for the total population    
X
7D. Reduction in chlamydia for the total population    
X

Data Update

7A. Reduce primary and secondary syphilis incidence per 100,000 population to:

65.0 for minorities

Achieve target:LikelyUnlikelyUncertain
the total population
X
minorities
X

Incidence Rates Of Primary And Secondary Syphilis
Year Total Minorities
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
10.0
8.8
9.8
14.2
19.5
22.0
14.1
7.7
4.2
3.0
2.4
2.2
N/A*
N/A*
N/A*
N/A*
N/A*
N/A*
N/A*
34.4
17.1
13.1
9.9
7.8

Since 1990, the incidence rate of primary and secondary syphilis for the population as a whole has been on the decline. The year 2000 objective was achieved in 1992 and has continued to decline since then.

Breaking the available data down by race to produce a minority incidence rate is problematic, due to a high proportion of cases where race was not reported. Data on incidence in the minority population for years prior to 1992 have been found to be invalid. Incidence rates for minorities in recent years have declined, and are well below the target established at the beginning of this decade, when reliable minority data were not available. Minority rates, despite their decline, remain higher than rates for the total population.

7B. Reduce congenital syphilis incidence per 100,000 live births to:

30.0 for the total population
100.0 for minorities

Achieve target:LikelyUnlikelyUncertain
the total population
X
minorities

X

Incidence Rates Of Congenital Syphilis
Year Total Minorities
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997**
2.8
9.2
10.6
5.1
10.7
63.5
33.8
88.0
142.6
153.0
100.1
118.9
88.5
4.5
22.0
46.7
19.3
43.2
248.4
N/A*
N/A*
N/A*
N/A*
N/A*
316.5
213.3
*Not available.
**Data for the 1997 are provisional.

The data above indicate a sharp increase in the reported incidence of congenital syphilis from 1989 to 1990. This was due in large part to changes by the Centers for Disease Control and Prevention in the guidelines for classifying and reporting cases of the disease. The new definition includes stillbirths and all infants whose mothers have untreated or inadequately treated syphilis at delivery. Thus, an increase in total reported cases of congenital syphilis was anticipated. However, the trend since this change reflects continuing and large increases in the incidence of congenital syphilis in the total population, making it unlikely that the year 2000 target will be reached.

Minority syphilis rates for the period 1991 through 1995 are not available. However, data for 1996 and preliminary data for 1997 indicate the rate is well above the target level but declining. Therefore, achievement of the year 2000 objective is uncertain.

7C. Reduce gonorrhea incidence per 100,000 population to:

100.0 for the total population

Achieve target:LikelyUnlikelyUncertain


X

Incidence Rates Of Gonorrhea
Year Percent
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
261.0
257.3
223.5
212.7
183.5
190.5
135.3
89.0
82.1
66.1
72.3
109.2

The incidence rate of gonorrhea had been declining until 1995, when it began rising again. For four years (1992 through 1995), the rate had been below the year 2000 objective of 100 cases per 100,000 population. However, the 1996 rate was once again above the target. This apparent increase is likely due to a change in the surveillance system in 1995 from a provider-based system to a laboratory-based system. Subsequent years of data are needed to determine if this apparent increase is due to the change in the surveillance system or if the incidence of gonorrhea is truly no longer declining.

7D. Reduce chlamydia trachomatis incidence per 100,000 population to:

170.0 for the total population

Achieve target:LikelyUnlikelyUncertain


X

Incidence Rates Of Chlamydia
Year Rate
1991
1992
1993
1994
1995
1996
22.1
50.5
34.9
23.2
51.0
153.6

Since there was no requirement to report cases of chlamydia until 1990, the first year for which data are available is 1991. In 1995, surveillance moved from a provider-based system to a laboratory-based system, causing a dramatic increase in the number of cases reported, resulting in an apparently higher incidence rate. Subsequent years of data will be required to determine what the trend in chlamydia incidence is, as well as an appropriate target for improvement. The original objective was borrowed from Healthy People 2000, which used a target incidence rate for non-gonococcal urethritis, since there was no national chlamydia surveillance system at that time.

Discussion

The incidence of primary and secondary syphilis is highest in those aged 25 through 29. Syphilis rates increased substantially from 1986 through 1990, coinciding with an increase in crack cocaine usage. The more recent decrease in syphilis may be due in part to sexual behavior changes in response to the HIV epidemic. Evidence increasingly confirms an association between genital ulcer disease, including infectious syphilis, and spread of HIV through sexual contact. HIV prevention and syphilis control activities build upon and support each other.

Gonorrhea is the key indicator of progress in reducing STDs among populations with the highest disease rates. Incidence is highest among those aged 15 through 19. Despite the recent upward turn in incidence rates for gonorrhea, the number of cases declined almost 60 percent between 1985 and 1996.

Chlamydia is the most common sexually transmitted bacterial pathogen in the United States, causing an estimated four million acute infections each year. In New Jersey, chlamydia is thought to be two to three times more common than gonorrhea. Uncomplicated chlamydia infection may exhibit no symptoms or signs of infection. Left untreated, however, chlamydia infection can cause serious complications. Because chlamydia is most prevalent in women and children, the screening of sexually active women is recommended by the U.S. Prevention Health Services Guidelines as a routine element of primary care.

The Department uses surveillance, prevention and treatment to control STDs. It supports forty-five sexually transmitted disease clinics throughout the twenty-one counties of New Jersey, as well as funding education and screening services in a variety of other public health settings. To bolster its surveillance system the Department moved to direct reporting of test results by laboratories. Positive results are sent to local clinics for follow-up. Neonatal and prenatal positive results have the highest priority, in order to prevent congenital syphilis.

Table of Contents

 
State Privacy Notice legal statement DOH Feedback Page New Jersey Home

 
department: njdhss home | index by topic | programs/services
statewide: njhome | my new jersey | people | business | government | departments | search

Copyright © State of New Jersey, 1996-2003
Department of Health
P. O. Box 360
Trenton, NJ 08625-0360

Last Updated: