The CDC's Sexually Transmitted Disease Surveillance 2014 report presents statistics and trends for sexually transmitted diseases (STDs) in the United States through 2014. The annual publication is intended as a reference document for policy makers, program managers, health planners, researchers, and others who are concerned with the public health implications of these diseases.

The report finds that the national incidence and prevalence estimates suggest the age group of 15-24 year olds acquire half of all new STD infections and that as many as 1 in 4 sexually active adolescent female have an STD (i.e. chlamydia or HPV). Other important points include:

• Compared with older adults, sexually active adolescents aged 15-19 years and young adults aged 20-24 years are at higher risk of acquiring STDs for a combination of behavioral, biological, and cultural reasons
• For some STDs, such as chlamydia, adolescent females may have increased susceptibility to infection because of cells on the surface of the cervix are more susceptible to infection
• Higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention and management services, including cost, lack of transportation, long wait times, inconvenient clinic hours, embarrassment, method of specimen collection, and confidentiality concerns

California's Rankings and relevant data for reported rates and reported cases of STDs in 2014:

• Chlamydia: California is ranked 22^nd in the Nation for reported rates with 176,308 cases at a rate of 459.9 per 100,000 population vs. a national rate of 456.1.
• Gonorrhea: California is ranked 15^th with a rate of 118.5 per 100,000 population vs. a national rate of 110.7.
• All Stages of Syphilis: California's rate is 29.8 per 100,000 and the US has a total rate of 20.1 per 100,000.
  • In selected Metropolitan Statistical Areas (MSAs) : the region of San Francisco, Oakland, Hayward has a staggering rate of 46.6 per 100,000, and the Los Angeles, Long Beach, and Anaheim area have a rate of 36.1 whereas other counties are as low as 15.8 (San Jose, Sunnyvale, Santa Clara) and 16.7 (Sacramento, Roseville, Arden-Arcade) per 100,000 population.
• Primary and Secondary Syphilis: California is ranked 4^th in the Nation with 3,835 cases and a rate of 10.0 per 100,000 population- the other states ranked worse had rates between 12.3-12.8. The national rate is 6.3
  • Los Angeles County is ranked #1 with the highest number of reported cases (1,204) in 2014 out of all U.S. counties and independent cities, although it did not have the highest rate.
  • San Francisco County is ranked 4^th and had a very high rate of 56.1 per 100,000 population.
• Early Latent Syphilis: California's 2014 rate is 8.9 per 100,000 population and the US total was 6.2.
  • There are large disparities in cases within California. In selected MSAs: the region of San Francisco, Oakland, Hayward had a high rate of 18.6 per 100,000, and the Los Angeles, Long Beach, and Anaheim area have a rate of 12.3 ,whereas other CA counties are as low as 3.0 per (San Jose, Sunnyvale, Santa Clara) and 3.3 (Sacramento, Roseville, Arden-Arcade) per 100,000 population.

STD Data in California Relevant to MCH issues:

• Chlamydia rates in California's women have increased in the past four years from 102,654 cases and a rate of 547.8 cases per 100,000 population to 115,339 and a rate of 598.6.
• California is at least doing better than the national average for rates of Gonorrhea among women: 83.1 per 100,000 population vs. the U.S. rate of 101.3.
• Primary and Secondary Syphilis among women in California is at a very low rate of 1.7 per 100,000, however the CA rate among men is significantly higher at 18.4 per 100,000 population.
• Congenital Syphilis: California unfortunately ranks very high in Congenital Syphillis, it is 4^th in the nation with 99 cases in 2014 and a rate of 19.7 per every 100,000 live births compared to the US total reported as 11.6 per every 100,000 live births.

The report states that u

ntreated early syphilis in pregnant women can result in perinatal death of the infant in up to 40% of cases and,

can lead to infection of the fetus in 80% of cases

if acquired during the 4 years before pregnancy.

California has seen an increase in syphilis cases among women, pregnant women, and newborns over the past two years. The CDPH even released an advisory this past summer regarding the increasing rates of Syphilis among women in California and the threat that it poses to our MCH populations. If you are looking for provider resources for your counties, check out the CDC's recommendations for treating congenital syphilis.