Reported Chlamydia and Gonorrhea Are Decreasing Among Young Black Women: Good News or Bad News? A Narrative Review

Since 2010, reported chlamydia and gonorrhea rates decreased among Black women aged 15 to 19 years and were stable for Black women aged 20 to 24 years in the United States. Rates increased for older Black women aged 25 to 39 years 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 from 2010 to 2018 among women in the United States aged 15 to 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 younger than 25 years decreased by 541,573 tests (-38%) in 2018 compared with 2010 and the number of women visiting sexually transmitted disease clinics had decreased 50% by 2016 compared with 2010. Prevalence of chlamydia in a sentinel population (Job Corps) was unchanged for Black women younger than 25 years and increased for Whites aged 20 to 24 years. Sequelae trends using data from a large all-payer emergency department database were mixed: pelvic inflammatory disease decreased, whereas 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.