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Current Epidemiology of Selected STDs

Current Epidemiology of Selected STDs. Prepared by Bradley Stoner, MD, PhD, Medical Director and Deloris Rother, MPH, Project Manager St. Louis STD/HIV Prevention Training Center for STD 101 March 12, 2012. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

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Current Epidemiology of Selected STDs

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  1. Current Epidemiology of Selected STDs Prepared by Bradley Stoner, MD, PhD, Medical Director and Deloris Rother, MPH, Project Manager St. Louis STD/HIV Prevention Training Center for STD 101 March 12, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

  2. What we’ll cover today • Diseases • Chlamydia • Gonorrhea • Syphilis • Viral STDs • HSV-2, HPV • Other STDs • Chancroid, trich • Special Populations • Adolescents • MSM

  3. What is epidemiology? • Distribution and determinants of disease within a population • Who, what, and where • Part of the core function of public health • Assessment • Assurance • Policy development • Why is this important? • Lets us know where disease is occurring, and who is getting it • Lets us plan for control and prevention activities

  4. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Chlamydia

  5. Epidemiology of Chlamydia • Incidence • 1,307,893 cases reported in 2010 • Largest no. of cases ever reported to CDC for any condition • Most frequently reported STD in US • Case rate = 426.0 per 100,000 population • 5.1% increase over the previous year • Rates 2.5x higher in females • Higher screening rates in women • But male screening is increasing due to urine-based testing

  6. Epidemiology of Chlamydia • High prevalence among • Family planning clinics (8.0%) • Prenatal clinics (7.2%) • National job training program (11.4% women, 7.2% men) • Adolescent corrections (14.5% women, 6.5% men)

  7. Chlamydia—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 750 Men 625 Women Total 500 375 250 125 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.

  8. Chlamydia—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 500 400 300 200 West Midwest Northeast 100 South 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  9. Chlamydia—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 422.6 per 100,000 population.

  10. Chlamydia—Rates by County, United States, 2010 Rate per 100,000 population <300.0 (n = 1,962) 300.1–400.0 (n = 418) >400.0 (n = 762)

  11. Chlamydia—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700 Age 774.3 3,378.2 15–19 1,187.0 3,407.9 20–24 25–29 598.0 1,236.1 30–34 309.0 530.9 153.2 35–39 220.1 40–44 91.3 94.7 45–54 39.3 32.8 10.9 55–64 9.3 65+ 2.8 2.1 Total 233.7 610.6

  12. Chlamydia—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 1500 American Indians/Alaska Natives Asians/Pacific Islanders Blacks 1200 Hispanics Whites 900 600 300 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  13. Chlamydia—Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 800 700 600 500 Non-STD Clinic, Men Non-STD Clinic, W omen 400 STD Clinic, Men 300 STD Clinic, W omen 200 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  14. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2010 NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15–24 years screened during 2010.

  15. Chlamydia—Trends in Positivity Rates Among Women Aged 15–24 Years Tested in Family Planning Clinics, by U.S. Department of Health and Human Services (HHS) Region, Infertility Prevention Project, 2006–2010 * 2009 percent positivity for Region VI previously published in the 2009 Surveillance report has been corrected.

  16. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Gonorrhea

  17. Epidemiology of Gonorrhea • Incidence • 309,341 cases reported in 2010 • Downward trend between 1975-1996, then plateau until 2006 • 2009 rate was lowest since national reporting began • Case rate = 100.8 per 100,000 population • 2.8% increase over the previous year • Slightly higher rates in females • Women highest rates age 15-24 year olds • Men highest rates 20-24

  18. Epidemiology of Gonorrhea • Proportion of gonococcal infections caused by resistant organisms is increasing • Incidence remains high in some groups defined by geography, age and race/ethnicity, or sexual orientation

  19. Gonorrhea—Rates, United States, 1941–2010 Rate (per 100,000 population) 500 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 Year

  20. Gonorrhea—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 400 Men Women Total 300 200 100 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year

  21. Gonorrhea—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 300 West Midwest 250 Northeast South 200 150 100 50 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  22. Gonorrhea—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 99.6 per 100,000 population.

  23. Gonorrhea—Rates by County, United States, 2010 Rate per 100,000 population <19.0 (n = 1,408) 19.1–100.0 (n = 1,107) >100.0 (n = 627)

  24. Gonorrhea—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 750 600 450 300 150 0 0 150 300 450 600 750 Age 253.4 570.9 15–19 421.0 560.7 20–24 241.3 226.3 25–29 146.5 107.5 30–34 85.1 48.2 35–39 64.2 23.8 40–44 45–54 34.1 9.0 1.9 11.0 55–64 2.4 0.5 65+ 94.1 106.5 Total

  25. Gonorrhea—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 600 500 400 American Indians/Alaska Natives 300 Asians/Pacific Islanders Blacks Hispanics 200 Whites 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  26. Gonorrhea—Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 200 Non-STD Clinic, Men Non-STD Clinic, Women STD Clinic, Men 160 STD Clinic, Women 120 80 40 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  27. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2010 * States/areas not meeting minimum inclusion criteria. NOTE: Includes states and outlying areas that reported positivity data on at least 500 women aged 15–24 years who were screened during 2010.

  28. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel Sites and Regional Laboratories, United States, 2010

  29. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and Ciprofloxacin Resistance Among GISP Isolates, 2010 6.9% 2.0% 0.6% 1.8% 2.9% Susceptible 9.4% PenR TetR 3.5% QRNG 72.8% PenR/TetR PenR/QRNG TetR/QRNG PenR/TetR/QRNG NOTE: PenR = penicillinase producing Neisseriagonorrhoeaeand chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR = chromosomally and plasmid mediated tetracycline-resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

  30. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea Among GISP Participants, 1988–2010 Percentage 100 Other Tetracyclines Penicillins Ofloxacin 80 Ciprofloxacin 60 Cefixime Ceftriaxone 250 mg 40 20 Spectinomycin Ceftriaxone 125 mg Other Cephalosporins 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NOTE: For 2010, “Other” includes no therapy (1.2%), azithromycin 2 g (1.7%), and other less frequently used drugs.

  31. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeaeIsolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990–2010 Percentage 20 Resistance Intermediate Resistance 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year NOTE: Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) >1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125–0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.

  32. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention SYPHILIS

  33. Epidemiology of Syphilis • Incidence • 13,774 cases (primary and secondary) reported in 2010 • Annual increase from 2001-2009 • 2010 represents first decrease in 10 years (1.6%) • Case rate = 4.5 per 100,000 population • 2.2% lower than 2009 rate • 21% decrease in women • 1.3% increase in men • Congenital syphilis rates decreased 15% since 2008

  34. Epidemiology of Syphilis (cont’d) • Rates remain high in: • Some urban areas throughout the U.S. • Rural areas in the South • Common co-occurrence of syphilis and HIV in men who have sex with men (MSM)

  35. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2010 Cases (in thousands) 600 Primary and Secondary 500 Early Latent Total Syphilis 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 Y ear

  36. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.5 per 100,000 population.

  37. Primary and Secondary Syphilis—Rates by County, United States, 2010 Rate per 100,000 population <0.2 (n = 2,167) 0.21–2.2 (n = 383) >2.2 (n = 592) NOTE: In 2010, 2,167 (69.0%) of 3,141 counties in the United States reported no cases of primary and secondary syphilis.

  38. Primary and Secondary Syphilis—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 10 West Midwest 8 Northeast South 6 4 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  39. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 25 20 15 10 5 0 0 5 10 15 20 25 Age 5.6 3.0 15–19 21.9 4.5 20–24 19.2 3.0 25–29 15.8 2.0 30–34 12.7 1.4 35–39 13.8 1.0 40–44 8.5 0.8 45–54 0.2 2.7 55–64 0.6 0.0 65+ 7.9 1.1 Total

  40. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 25 American Indians/Alaska Natives Asians/Pacific Islanders 20 Blacks Hispanics Whites 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  41. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 10 Non-STD Clinic, Men Non-STD Clinic, Women 8 STD Clinic, Men STD Clinic, Women 6 4 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  42. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, United States, 1990–2010 Rate (per 100,000 population) Rate Ratio (log scale) 16:1 25 Male Rate Female Rate 20 Total Rate 8:1 Male-to-Female Rate Ratio 15 4:1 10 2:1 5 1:1 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year

  43. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) 25 Age Group 30–34 15–19 20 35–39 20–24 40–44 25–29 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  44. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) 6 Age Group 15–19 30–34 5 20–24 35–39 25–29 40–44 4 3 2 1 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

  45. STD Surveillance Network (SSuN)—Primary and Secondary Syphilis and HIV—Proportion of MSM* with Primary and Secondary Syphilis Who Are Co-infected with HIV, 2010 Percentage 100 90 80 70 60 50 40 30 20 10 0 San Francisco Los Angeles Seattle Denver Chicago New Orleans Richmond Baltimore Philadelphia New York City Hartford/New Haven * MSM = men who have sex with men. NOTE: Includes sites that reported data on at least 5 MSM with P&S syphilis in 2010.

  46. Primary and Secondary Syphilis—Reported Cases* by Stage, Sex, and Sexual Behavior, United States, 2010 Cases 6,000 Primary Secondary 5,000 4,000 3,000 2,000 1,000 0 Women MSM† MSW† * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information. † MSW = men who have sex with women only; MSM = men who have sex with men.

  47. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and Race/Ethnicity,† United States, 2010 Cases 3,000 Whites 2,500 Blacks Hispanics Other 2,000 1,500 1,000 500 0 Women MSM‡ MSW‡ * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information; 2.0% of reported male cases with sex of sex partner data were missing race/ethnicity data. † No imputation was done for race/ethnicity. ‡ MSW = men who have sex with women only; MSM = men who have sex with men.

  48. Primary and Secondary Syphilis—Percentage of Reported Cases* by Sex, Sexual Behavior, and Selected Reporting Sources, 2010 Percentage Correctional Facility 40 HIV Counseling and Testing Site Private Physician/HMO† 35 STD Clinic 30 25 20 15 10 5 0 MSW† Women MSM† * Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information, and 2.7% of reported male cases with sex of sex partner data were missing source of information data. † HMO = health maintenance organization; MSW = men who have sex with women only; MSM = men who have sex with men.

  49. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates of Primary and Secondary Syphilis Among Women, United States, 2001–2010 CS* cases (in thousands) P&S* rate (per 100,000 women) 0.8 4 CS Cases P&S Rate 0.6 3 0.4 2 0.2 1 0.0 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year * CS = congenital syphilis; P&S = primary and secondary syphilis.

  50. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention GENITAL Herpes

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