Official United States statistics for fiscal 1969 showed the highest incidence of both gonorrhea and early syphilis in the most populous areas, especially the big cities, and in the southern states. For primary and secondary syphilis the states and territories showing the highest levels were the entire east west belt of southern states except California (the only one somewhat below the average), plus New York, Maryland, and Illinois. For gonorrhea the above average rates applied to California, Missouri, Arkansas, Tennessee, and Virginia as well as to the southernmost states; but Arizona, New Mexico, Oklahoma, Louisiana, Alabama, and North Carolina had rates somewhat lower than the national average. The Canal Zone and the Virgin Islands showed high rates for both diseases; Puerto Rico had a low rate for gonorrhea but a very high one for early syphilis, while the opposite was true for Alaska. Some of these differences may reflect different patterns of reporting and different availability of clinical facilities; but a detailed sociological medical study would be needed to explain them and would probably be rewarding.

A similar point is illustrated by the most recent rates (issued under date of August, 1970) for a sampling of our largest cities, which are all high but have curious variations:

RATES PER 100,000 FOR JANUARY MARCH 1970

Another pattern for the United States, relating both to early infectious syphilis and to gonorrhea, is the distribution of new cases by age, sex, and skin color. Divided into the four groups, white and non white for both male and female, and distributed by age, we find the incidence much higher for nonwhites and higher for males, with the curve beginning below age 10 and reaching peak incidence in the age group 20 24, but continuing well beyond age 50. The high rates for nonwhites are doubtless determined by economic rather than by racial factors, with their roots, as I said before, in the relative inaccessibility or inadequacy of clinics, the lack of VD education (as well as other kinds) and other offshoots of poverty. The data show clearly that although both absolute numbers and rates have been advancing more slowly among nonwhites for gonorrhea and actually going down for syphilis, the great bulk of both diseases is still found in this portion of the population. Sex differences are more marked for gonorrhea than for syphilis, as we would expect from the diagnostic problem in women; yet curiously enough, while the ratio of male to female at all ages among reported cases for the calendar year 1969 was approximately 3:1 for gonorrhea, it was still as high as 1.9:1 for primary and secondary syphilis. (see UNITED STATES VD STATISTICS PART III)