Reported chlamydia and gonorrhea are decreasing among young Black women: Good news or bad news? A narrative review.

Abstract

ABSTRACT\nSince 2010, reported chlamydia and gonorrhea rates decreased among Black women aged 15-19 years and were stable for Black women 20-24 in the United States. Rates increased for older Black women 25-39 and all White women. The Black:White rate ratio decreased across age groups. We examined whether trends in reported rates reflected changing prevalence or changing screening. We analyzed trends in reported chlamydia and gonorrhea rates during 2010 to 2018 among women in the United States aged 15-39 years by age and race/ethnicity subgroup, state, and reporting source. Most jurisdictions reported decreased chlamydia and gonorrhea rates among Black teens and increased rates among White teens and older women. Between 2010 and 2018, public clinics reported fewer cases, especially among young Black women, that were not restored by increases elsewhere. We reviewed literature on trends in screening, prevalence, and sequelae. Family planning clinics annual reports showed chlamydia tests among women <25 decreased by 541,573 tests (-38%) in 2018 compared with 2010 and the number of women visiting STD clinics had decreased 50% by 2016 compared with 2010. Prevalence of chlamydia in a sentinel population (Job Corps) was unchanged for Black women <25 and increased for Whites 20-24. Sequelae trends using data from a large all-payer ED database were mixed: PID decreased while ectopic pregnancy increased. Decreases in testing at public clinics likely missed diagnoses among young Black women, a group traditionally at highest risk, and in need of more testing. Innovative approaches to screening are needed.