West Virginia Bureau for Public Health

Division of Surveillance & Disease Control

350 Capitol Street, Room 125, Charleston, WV 25301
304.558.2195 800.642.8244

STD Surveillance: How many cases are there?


              The following narrative presents a comparison of West Virginia data for chlamydia, gonorrhea, and syphilis for calendar years 2008 and 2007. Tables containing 2004 through 2008 data can be viewed by clicking the links below, which require the Adobe Acrobat Reader to view. Analyzing this data may help identify overall trends in the state and can be beneficial in reducing the incidence of sexually transmitted diseases in West Virginia.

 

§ Chlamydia, Gonorrhea, and Syphilis Cases in West Virginia by County 2008 – 2009

§ Chlamydia, Gonorrhea, and Syphilis Cases in West Virginia by Age and Sex 2004 – 2008

§ Chlamydia, Gonorrhea, and Syphilis Rates in West Virginia by Age and Sex 2004 – 2008

§ Chlamydia, Gonorrhea, and Syphilis Cases and Rates in West Virginia by Race and Sex 2004 – 2008

§ Chlamydia, Gonorrhea, and Syphilis Cases in West Virginia by County and Sex 2004 – 2008

§ Chlamydia, Gonorrhea, and Syphilis Rates in West Virginia by County and Sex 2004 – 2008

 

Chlamydia (Chlamydia trachomatis)

  

            Chlamydia is the most frequently reported infectious disease in West Virginia with every county in the state reporting at least one case during the calendar year (CY) 2008. Five of West Virginia’s 55 counties, with a total of approximately 30 percent of the state’s population, consistently reported 48.5 percent of all chlamydia infections in 2008. Four of these five counties, Berkeley, Cabell, Mercer and Monongalia, are considered “border” counties, and four of the these five counties, Berkeley, Cabell, Kanawha and Monongalia, are the most populated counties in the state. Four of the state’s largest universities are located in Cabell, Kanawha, and Monongalia counties.

In CY 2008, 3,300 cases (rate of 181.9) of chlamydia infections were reported in West Virginia, representing a 3.4 percent increase compared to 3,193 in CY 2007 (rate of 176.4). Of the 3,300 cases, 1,563 (47.4 percent) were reported by the West Virginia Office of Laboratory Services (WVOLS), and 1,737 (52.6 percent) were reported by private providers and laboratories. The WVOLS performed 36,952 tests for chlamydia regardless of the patient’s state of residence, of which 1,636 (4.4 percent) were positive.

Women accounted for 75.0 percent (2,475 cases) of all reported chlamydia infections in West Virginia in CY 2008. The case rate for women (267.3) was nearly three times higher than that of men (92.8). The case rate for chlamydia infections in men had a 9.7 percent increase from CY 2007 (84.6) to CY 2008 (92.8), compared to a 1.1 percent increase for women from CY 2007 (264.4) to CY 2008 (267.3). The increase in case rates of men may reflect the availability of a less invasive test method and the increased efforts in partner services.

Chlamydia infections in West Virginia disproportionately affect women in the early reproductive stage of life. In CY 2008, 60.2 percent (1,988 cases) of all reported infections occurred in women ages 15 – 24 years. According to the Centers for Disease Control and Prevention (CDC), young women ages 15 – 19 years have the highest rate of chlamydia infections in the nation, followed by women ages 20 – 24 years. However, local data for CY 2008 indicates a reversal of these two age groups in West Virginia. Thirty-one percent (1,033 cases) of all reported infections in CY 2008 occurred in women ages 20 – 24 years, closely followed by women ages 15 – 19 years, which accounted for 28.9 percent (955 cases) of all reported infections. Men ages 20 – 24 years ranked third with 10.2 percent (336 cases), closely followed by women ages 25 – 29 years with 9.7 percent (321 cases).

Chlamydia infections have occurred in all races and in all ethnic groups in West Virginia; however, African Americans have consistently been disproportionately affected. African Americans, despite accounting for approximately 3.5 percent of the state’s population, represented 17.5 percent (578 cases) of the infections reported in CY 2008. The rate of chlamydia infections for African American men (835.6) was 16.8 times that of Caucasian men (49.7) and 3.7 times that of Hispanic men (226.0). Four chlamydia infections were reported for Asian/Pacific Islanders, and no chlamydia infections were reported for American Indian/Alaska Native men in 2008. The rate of chlamydia infections for African American women (972.4) was 4.9 times that of Caucasian women (198.5) and 3.3 times that of Hispanic women (299.2). The rates for Asian/Pacific Islander women and for American Indian/Alaska Native women were 208.5 and 51.5 respectively.

 

Gonorrhea (Neisseria gonorrhoeae)

 

              Gonorrhea is the second most frequently reported infectious disease in West Virginia with 42 of the 55 counties in the state reporting at least one case during 2008. The top five reporting counties, Berkeley, Cabell, Kanawha, Mercer, and Raleigh, reported the majority of gonorrhea infections in 2008 (66.7 percent) and all but Berkeley County are located in the southern half of the state. Two of these counties, Cabell (153 cases) and Kanawha (183 cases), reported 45.2 percent of all gonorrhea infections in the state in 2008. Since 2003, these same two counties, with a total of approximately 16 percent of the state’s population, consistently reported the highest number of all gonorrhea infections in the state. Three of the state’s largest universities are located in Cabell and Kanawha counties.

The number of reported cases of gonorrhea in CY 2008 declined for the third time in the last five years. In CY 2008, 744 cases (rate of 41.0) were reported, which is a 20.3 percent decrease compared to 934 cases in CY 2007 (rate of 51.6). Of the 744 cases, 309 (41.5 percent) were reported by the WVOLS, and 435 (58.5 percent) were reported by private providers and laboratories. The WVOLS performed 36,950 tests for gonorrhea regardless of the patient’s state of residence, of which 337 (0.9 percent) were positive.

Women accounted for 56.9 percent (423 cases) of all reported gonorrhea infections in West Virginia in CY 2008. The case rate for women (45.7) was not significantly different than that of men (36.1). The case rate for gonorrhea infections in men had a 25.4 percent decrease from CY 2007 (48.4) to CY 2008 (36.1), compared to a 16.3 percent decrease for women from CY 2007 (54.6) to CY 2008 (45.7).

Like chlamydia, gonorrhea infections in West Virginia disproportionately affect women in the early reproductive stage of life. In CY 2008, 38.8 percent (289 cases) of all reported infections occurred in women ages 15 – 24 years. A similar trend for chlamydia infections in West Virginia is observed for gonorrhea infections as well. Twenty-three percent (173 cases) of all reported infections in CY 2008 occurred in women ages 20 – 24 years, closely followed by women ages 15 – 19 years, which accounted for 15.6 percent (116 cases) of all reported infections. Like chlamydia infections, men ages 20 – 24 years ranked third with 14.8 percent (110 cases) of gonorrhea cases, followed by women ages 25 – 29 years with 10.1 percent (75 cases).

African Americans have consistently been disproportionately affected. African Americans, despite accounting for approximately 3.5 percent of the state’s population, represented 34.7 percent (258) of the cases reported in CY 2008, nearly twice that of chlamydia infections. The rate of gonorrhea infections for African American men (481.8) was 31.9 times that of Caucasian men (15.1), and 25.6 times that of Hispanic men (18.8).  No cases of gonorrhea infection were reported for Asian/Pacific Islander or American Indian/Alaska Native men in CY 2008. The rate of gonorrhea infections for African American women (319.9) was 9.9 times that of Caucasian women (32.3), 6.4 times that of Hispanic women (49.9), and 6.7 times that of Asian/Pacific Islander women (48.1).

 

Syphilis (Treponema pallidum)

  

            Syphilitic infections account for a much smaller proportion of reportable infectious disease cases in West Virginia. During CY 2008, eight counties in West Virginia, Berkeley, Brooke, Harrison, Kanawha, Marion, Marshall, Ohio and Upshur, reported a total of 13 cases of primary or secondary (P&S) syphilis. During CY 2008, eight counties in West Virginia, Berkeley, Cabell, Harrison, Jefferson, Kanawha, Marion, Monongalia, and Ohio, reported a total of 16 cases of early latent (EL) syphilis.

The number of reported cases of early syphilis (P&S and EL) in West Virginia in CY 2008 (29 cases) has increased 93.3 percent compared to CY 2007 (15 cases). Of the 29 cases of early syphilis reported, 12 (41.4 percent) were reported by the WVOLS and 17 (58.6 percent) were reported by private providers and laboratories. The WVOLS performed 7,464 RPR tests for syphilis, of which 61 (0.8 percent) were reactive.

Men accounted for 72.4 percent (21 cases) of all reported early syphilis in West Virginia in CY 2008, and since CY 2003, men have accounted for the majority of the syphilis cases (range of 55.5 – 83.3 percent) compared to syphilis cases for women. While early syphilis rates remain significantly lower for women than for men in the United States, the rate for men has increased substantially. It has been suggested that the increased transmission of P&S syphilis among the men who have sex with men (MSM) population may be responsible for the increase. In CY 2008, disease intervention interviews revealed that 13 of the 21 men reported MSM activity (61.9 percent), and five of the 13 were co-infected with HIV (38.5 percent).

In CY 2008, four cases of neurosyphilis were confirmed, all in men. Disease intervention interviews revealed that three of the four men (75.0 percent) reported MSM activity, and two of the four men are co-infected with HIV (50.0 percent).

According to the CDC, the national rate for early syphilis among women has increased over the past few years. Case rates for West Virginia women (0.1 – 0.5) remained steady in CY 2004 – 2007 until CY 2008, when the case rate tripled (0.9) as compared to 2007 (0.3). Although the rate among West Virginia women has been low since CY 2003, the CY 2008 reflects a significant increase in case rates among women in the state.

In CY 2008, 34.5 percent (10 cases) of all reported early syphilis infections occurred in individuals ages 40 – 44 years, followed by the 20 – 24 years age group with 25.0 percent (six cases), and the 25 – 29 and 35 - 39 years age groups with 13.8 percent (four cases) each. The 15 – 19 years age group accounted for 10.4 percent (three cases). The 30 – 34 and 50 – 54 years age groups accounted for 3.4 percent (one case) each. During CY 2007, however, the 15 – 19 years age group reported the majority of the infections with 33.3 percent (five cases), followed by the 35 – 39 years age group with 20.0 percent (three cases), and the 45 – 49 and  50 – 54 years age groups with 13.3 percent (two cases) each. 

By race in CY 2008, Caucasians accounted for the majority of early syphilis infections in West Virginia with 82.8 percent (24 cases), followed by African Americans with 17.2 percent (five cases). During CY 2007, Caucasians reported 73.3 percent (11 cases) of all syphilis infections, followed by African Americans with 20.0 percent (three cases). Since CY 2004, reporting for race/ethnicity has consistently revealed that Caucasians account for the majority of syphilis infections in West Virginia, followed by African Americans.

 

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