(Farley et al., 1990; Rolfs et al., 1990). The reemergence of syphilis in this new context rendered traditional prevention efforts less effective (Andrus et al., 1990).
Gonorrhea infections in the United States are becoming increasingly resistant to routine antibiotic treatment; this has resulted in increasingly expensive treatments as effective therapeutic options become more limited. As of 1976, all gonorrhea infections were curable by penicillin (Aral and Holmes, 1991). Since then, antibiotic-resistant strains have increased steadily to 2 percent of gonorrhea infections in 1987 and to 30 percent of gonorrhea infections in 1994 (CDC, DSTDP, 1995). The Gonococcal Isolate Surveillance Project of the Centers for Disease Control and Prevention (CDC) measures national trends in gonorrhea antibiotic resistance. The proportion of isolates resistant to penicillin has increased steadily since monitoring began in 1988 (CDC, DSTDP, 1995) (Figure 2-2). In 1994, approximately 30 percent of gonococcal isolates were resistant to tetracycline, penicillin, or both; these antibiotics represent traditional, effective, low-cost treatment for gonorrhea. In addition, resistance to the newer quinolone antibiotics has been documented in the Western Pacific and Southeast Asia and in several U.S. states, indicating that some currently recommended treatment regimens may soon become inadequate (CDC, 1994a; GDHR, Epidemiology and Prevention Branch, 1995).
Chlamydial genital infection is the most common bacterial STD in the United States; of the more than 4 million cases estimated to occur annually, 2.6 million cases occur among women (CDC, DSTDP, 1995). As many as 85 percent of infections in women and 40 percent of infections in men may be asymptomatic and will not be identified without screening (Fish et al., 1989; Judson, 1990; Stamm and Holmes, 1990). Uncomplicated chlamydial infections can be easily treated with antibiotics (CDC, 1993); however, primarily as a result of unrecognized and untreated cervical infections, more than one million women each year develop pelvic inflammatory disease (Rolfs et al., 1992).
Complications of STDs are greater and more frequent among women than men for a number of reasons (Wasserheit and Holmes, 1992). Women are biologically more likely to become infected than men if exposed to a sexually transmitted pathogen. STDs are also more likely to remain undetected in women, resulting in delayed diagnosis and treatment, and these untreated infections are more likely to lead to complications.