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2017-2018 Border Health Status Report to the Legislature

SEXUALLY TRANSMITTED INFECTIONS


Sexually transmitted infections (STIs) are the most commonly reported communicable diseases in California and in the California border region. In the past five years, the rates for STI have increased in the United States and California, as well as the California border region. STIs can generally be treated and cured if diagnosed early; however, STIs often do not cause symptoms. Consequently, there is a high probability of individuals not seeking proper treatment, thus potentially leading to serious health complications. Moreover, because STIs are often asymptomatic, and therefore their identification is dependent on screening, the true burden of disease is many times greater than the actual number of reported cases (Satterwhite et al., 2013). Furthermore, some STI cases have demonstrated resistance to antibiotics, and the amount of antibiotic-resistant STI cases is expected to continue to increase. This report will discuss the burden of two reportable bacterial STIs in Imperial and San Diego counties: gonorrhea and syphilis (primary, secondary, and congenital), which are among the most commonly reported STIs in California and the U.S.

Combined data of STIs from 2016-2017 are displayed in Fig. 6.1. We examine each category according to the number of cases and rates in the following graphs (Fig. 6.1) (CHIS, 2016-2017).

In San Diego County, the rate for gonorrhea was 165 per 100,000 (10,947 cases); meanwhile, in Imperial County, the rate was 87 per 100,000 (327 cases), as compared with California, which had a rate of 177 per 100,000 (140,005 cases) (Fig. 6.2) (CDPH, 2019). Both the California border region and California have reached the Healthy People 2020 goal of fewer than 252 new cases per 100,000 among individuals 15-44 years of age (Fig. 6.2) (Healthy People 2020, 2019).

In 2016-2017, the African-American population in San Diego County, Imperial County and California had higher rates of gonorrhea than the White and Latino populations. In San Diego County, African-Americans had a rate of 349 per 100,000 (1,108 cases), and in Imperial County, the rate was 74 per 100,000 (seven cases), as compared with California, which had a rate of 519 per 100,000 (23,640 cases) (Fig. 6.3) (CDPH, 2019).  ​

Compared with females during 2016-2017, males had a higher rate of infection in San Diego County and California, but not in Imperial County. In San Diego County, the rate was 236 per 100,000 (7,866 cases) among males and 93 per 100,000 (3,056 cases) among females; in Imperial County, the rate was 81 per 100,000 (155 cases) among males and 93 per 100,000 (172 cases) among females. In California, the rate was 238 per 100,000 (94,020 cases) among males and 114 per 100,000 (45,490 cases) among females (Fig. 6.4) (CDPH, 2019).  ​​

During 2016-2017, the rate of primary and secondary syphilis in San Diego County was 17 per 100,000 (1,111 cases). Imperial County had a rate of 9 per 100,000 (32 cases), and California had a rate of 16 per 100,000 (12,560 cases) (Fig 6.5) (CDPH, 2019).  ​​

African-Americans in San Diego County, Imperial County and California had higher rates of primary and secondary syphilis than those among the White and Latino populations. In 2016-2017, in San Diego County, African- Americans had a rate of 32 per 100,000 (102 cases), Latinos had a rate of 19 per 100,000 (425 cases), and Whites had a rate of 15 per 100,000 (453 cases). In Imperial County, the rate for Latinos was 9 per 100,000 (27 cases), and that for Whites was 6 per 100,000. There were no cases among African-Americans in Imperial County. As compared with the rate in California of 35 per 100,000 (1,603 cases) among African-Americans, the rate for Latinos was 9 per 100,000, and that for Whites was 6 per 100,000 (Fig. 6.6) (CDPH, 2019).​​

During 2016-2017, males had a higher rate than females of primary and secondary syphilis in the border region and California. In San Diego County, the rate among males was 32 per 100,000 (1,064 cases), and the rate among females was 1 per 100,000 (47 cases); in Imperial County the rate among males was 13 per 100,000 (25 cases), and that among females was 4 per 100,000 (seven cases). In California, the rate among males was 28 per 100,000 (10,953 cases) and the rate among females was 4 per 100,000 (1,605 cases) (Fig. 6.7) (CDPH, 2019).

The rates for congenital syphilis in the California border region and in California have been steadily increasing in the past five years. In 2016-2017, the rate was 24 per 100,000 live births (20 cases) in San Diego County. Imperial had a rate of 48 per 100,000 (three cases). California had a rate of 51 per 100,000 (497 cases) (Fig. 6.8) (CDPH, 2019). The rates in San Diego County, Imperial County and California were greater than the Healthy People 2020 goal of fewer than 10 new cases per 100,000 live births for congenital syphilis (Healthy People 2020, 2019).

In a comparison by race/ethnicity, the rates of congenital syphilis were higher among African-Americans than Latinos and Whites in San Diego County and California. There were no cases among African-Americans or Whites in Imperial County (Fig. 6.9) (CDPH, 2019).  ​
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