title: Declining trends in the proportion of non-viral sexually transmissible infections reported by STD clinics in the US, 2000-10.
abstract: Background Recent budget shortfalls may have resulted in decreases in the number of sexually transmissible infections (STIs) reported from sexually transmitted disease clinics (STDCs) in the United States (US). The objective of this study was to examine the proportion of cases reported from STDCs for three non-viral STIs in the last decade.
  
  
  METHODS
  Data from the national surveillance database on primary and secondary (P&S) syphilis, gonorrhoea and chlamydia cases for 2000-10 were extracted. The percentage of cases reported by STDCs for the nation and for each of the 48 contiguous states were then computed. Finally, the χ(2) trend test for proportions was used to determine the annual average decrease/increase in the percentage of cases reported by STDCs for the nation and for each state.
  
  
  RESULTS
  RESULTS demonstrate that the average annual declines in the proportion of P&S syphilis, gonorrhoea, and chlamydia cases reported from STDCs were 1.43% (P<0.01), 1.31% (P<0.01), and 0.31% (P<0.01), respectively. Additionally, most of the states with statistically significant trends (P<0.05) in the proportion of cases reported by STDCs had negative slopes: 86% (25/29) for P&S syphilis, 89% (34/38) for gonorrhoea, and 63% (27/43) for chlamydia.
  
  
  CONCLUSIONS
  These results document the declining role of STDCs in STI prevention and control efforts in the US. Further studies are needed to assess the direct or indirect impact of the decline in the proportion of cases from STDCs on the overall STI control and prevention efforts in the US and its implications for the future.
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA.
authors.forename: Kwame
authors.initials: K
authors.lastname: Owusu-Edusei
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA.
authors.forename: Bianca J
authors.initials: BJ
authors.lastname: Sayegh
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA.
authors.forename: Alesia J
authors.initials: AJ
authors.lastname: Harvey
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nelson