Progress toward the 1990 objectives for sexually transmitted diseases: good news and bad

The problem of sexually transmitted diseases (STDs) in the United States has been growing, in both scope and complexity, at an alarming rate. As evidence of the emergence of these diseases as a primary national concern, the Surgeon General has designated them as 1 of 15 priority areas in which further actions are required to improve the health of the American people. The key targets for the 1990 objectives for the nation in the STD area include reducing the incidence of gonorrhea; gonococcal pelvic inflammatory disease; and primary, secondary, and congenital syphilis. This report updates progress toward these objectives. There is good news with respect to the continuing success of proven methods in preventing and controlling both gonorrhea and syphilis. However, the picture is less bright with respect to control of other STDs that have gained new prominence--Chlamydia, herpesvirus, human papillomavirus, and human T-cell lymphotropic virus type III infections. Escalating interest in STDs reflects more recent appreciation of their relation to reproductive outcomes. STD organisms clearly have a far-reaching effect on the nation's population, including the capacity to reproduce, the rate of perinatal infection, the incidence of genital cancers, and the occurrence of acquired immune deficiency syndrome (AIDS). Some major hurdles still must be faced before the 1990 objectives can be successfully met. The population at risk will remain large, fueling the STD epidemic and taxing existing resources. Public sector support may not keep up with inflation, much less keep pace with the expanding spectrum of sexually transmitted disease. From a public health vantage, however, the opportunities for further advances in controlling STDs have never been greater.