Could Decreasing Disparities in Gonorrhea Rates between Blacks and Whites Be Due to Decreased Availability of STD Clinic Services in the United States?

Background:
The differential reported rates of gonorrhea between Blacks and non-Hispanic whites are the largest disparity in reported rates of any infectious disease in the US. In 1997, gonorrhea rates were 32 times higher among Blacks than Whites, while in 2006, rates were 18 times higher. Over the last 15 years, there has been a decline in access to STD care services at many community STD clinics as a result of clinic closures, decreasing hours, and increasing clinic fees. By contrast, gonorrhea screening in non-STD clinical settings has increased among young women, concomitant with increased chlamydia screening.

Objective:
To examine US gonorrhea cases reported from STD clinics and non-STD clinics between 1997 and 2006 by race/ethnicity, age and sex.

Method:
Using data reported to the Centers for Disease Control and Prevention, changes in cases by reporting source were examined over time.

Result:
Between 1997 and 2006, there was a 40% increase in gonorrhea cases reported from non-STD clinics and a 22% decline in cases from STD clinics. However, changes in the number of cases reported from STD clinics over time varied substantially by race/ethnicity: among Blacks there was a 32% decline, compared with an increase among Whites and Hispanics (8% and 10% respectively). In addition, Blacks saw a smaller increase in the number of cases reported from non-STD clinics than other racial/ethnic populations (Blacks 45% increase, Whites 97% and Hispanics 143%). Changes in reporting sources over time were similar by sex and age within a racial/ethnic population.

Conclusion:
In contrast to other race/ethnicities, among Blacks, regardless of gender or age, there was a substantial decline in gonorrhea cases reported from STD clinics and a much smaller increase in cases reported from non-STD clinics.

Implications:
Possible differential changes in access to diagnostic STD services for Blacks in the US need further exploration.