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Sexually Transmitted Disease (STD) Surveillance Report, 2003

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  1. Sexually Transmitted Disease (STD) Surveillance Report, 2003 Minnesota Department of Health STD Surveillance System

  2. Introduction • This slide set describes new cases of chlamydia, gonorrhea, and syphilis in Minnesota by person, place, and time. • The slides display data from cases diagnosed through 2003 and reported to the Minnesota Department of Health (MDH) STD Surveillance System. • Data analyses exclude federal and private prisoners.

  3. Introduction • STD Surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population. • STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions.

  4. Interpreting STD Surveillance Data • Factors that impact the completeness and accuracy of the data include: • Level of STD screening and individual test-seeking behavior • Sensitivity of diagnostic tests • Compliance with case reporting • Timeliness of case reporting • Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the factors described above. • For example, in 2002 MDH added an active component to the previously passive STD Surveillance System. As a result, compliance with reporting improved and the number of chlamydia and gonorrhea cases reported to MDH increased by at least 7% and 5%, respectively, between 2001 and 2002 as an artifact of reporting.

  5. National Context

  6. United States: State-Specific Chlamydia Rates, 2002 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2002 Surveillance Slides. STDs in Minnesota: Annual Review

  7. United States: State-Specific Gonorrhea Rates, 2002 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2002 Surveillance Slides. STDs in Minnesota: Annual Review

  8. United States: State-Specific P&S Syphilis Rates, 2002 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2002 Surveillance Slides. STDs in Minnesota: Annual Review

  9. Overview of STDs in Minnesota STDs in Minnesota: Annual Review

  10. STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 1993-2003 * P&S = Primary and Secondary

  11. STDs in Minnesota:Number of Cases Reported in 2003 • Total of 14,111 STD cases reported to MDH in 2003: • 10,714 Chlamydia cases • 3,202 Gonorrhea cases • 195 Syphilis cases (all stages)

  12. CHLAMYDIA STDs in Minnesota: Annual Review

  13. 2003 Minnesota Chlamydia Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Polk Cook Clearwater St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Aitkin Wadena Carlton Rate per 100,000 persons Crow Wing Otter Tail Wilkin 0 - 75 Pine Todd Morrison 76 - 150 Grant Douglas Mille Lacs Kanabec Traverse 151 - 300 Benton Stevens Pope > 300 Stearns Isanti Chisago Big Stone Sherburne Swift Anoka City of Minneapolis 755 City of St. Paul 618 Suburban 156 Greater Minnesota 131 Wright Kandiyohi Meeker Lac qui Parle Chippewa Washington Hennepin Ramsey McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Goodhue Lyon Redwood Le Sueur Nicollet Rice Wabasha Brown Pipestone Murray Blue Earth Cottonwood Waseca Steele Dodge Olmsted Winona Watonwan Rock Nobles Jackson Martin Faribault Freeborn Fillmore Houston Mower Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area.

  14. Chlamydial Infections in Minnesotaby Residence at Diagnosis, 2003 Total Number = 10,714 Greater MN 28% Minneapolis 27% St. Paul 17% Suburban 29% Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  15. Chlamydia Rates by GenderMinnesota, 1993-2003

  16. Chlamydia Rates by AgeMinnesota, 1993-2003

  17. Chlamydia Rates by Race/Ethnicity Minnesota, 1993-2003 * Persons of Hispanic ethnicity can be of any race.

  18. Chlamydia Rates by Race/Ethnicity Excluding BlacksMinnesota, 1993-2003 * Persons of Hispanic ethnicity can be of any race.

  19. GONORRHEA STDs in Minnesota: Annual Review

  20. 2003 Minnesota Gonorrhea Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Polk Cook Clearwater St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Aitkin Wadena Carlton Rate per 100,000 persons Crow Wing Otter Tail Wilkin 0 -19 Pine Todd 20 - 100 Morrison Grant Douglas Mille Lacs Kanabec Traverse > 100 Benton Stevens Pope Stearns Isanti Chisago Big Stone Sherburne City of Minneapolis 359 City of St. Paul 200 Suburban 40 Greater Minnesota 20 Swift Anoka Wright Kandiyohi Meeker Lac qui Parle Chippewa Washington Hennepin Ramsey McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Goodhue Lyon Redwood Le Sueur Nicollet Rice Wabasha Brown Pipestone Murray Blue Earth Cottonwood Waseca Steele Dodge Olmsted Winona Watonwan Rock Nobles Jackson Martin Faribault Freeborn Fillmore Houston Mower Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area.

  21. Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2003 Total Number = 3,202 Greater MN 14% Minneapolis 43% Suburban 25% St. Paul 18% Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  22. Gonorrhea Rates by GenderMinnesota, 1993-2003

  23. Gonorrhea Rates by AgeMinnesota, 1993-2003

  24. Gonorrhea Rates by Race/Ethnicity Minnesota, 1993-2003 * Persons of Hispanic ethnicity can be of any race.

  25. Gonorrhea Rates by Race/Ethnicity Excluding BlacksMinnesota, 1993-2003 * Persons of Hispanic ethnicity can be of any race.

  26. PRIMARY & SECONDARY SYPHILIS STDs in Minnesota: Annual Review

  27. 2003 Minnesota P&S Syphilis Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Polk Cook Clearwater St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Aitkin Wadena Carlton Crow Wing Otter Tail Wilkin Rate per 100,000 persons Pine Todd Morrison 0 – 0.2 Grant Douglas Mille Lacs Kanabec Traverse 0.21 – 4.0 Benton Stevens Pope > 4.0 Stearns Isanti Chisago Big Stone Sherburne Swift City of Minneapolis 5.5 City of St. Paul 1.7 Suburban 0.8 Greater Minnesota 0.2 Anoka Wright Kandiyohi Meeker Lac qui Parle Chippewa Washington Hennepin Ramsey McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Goodhue Lyon Redwood Le Sueur Nicollet Rice Wabasha Brown Pipestone Murray Blue Earth Cottonwood Waseca Steele Dodge Olmsted Winona Watonwan Rock Nobles Jackson Martin Faribault Freeborn Fillmore Houston Mower Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area.

  28. Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2003 Total Number = 47 Greater MN 11% Minneapolis 45% Suburban 34% St. Paul 11% Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  29. Primary & Secondary Syphilis Rates by AgeMinnesota, 1993-2003

  30. Primary &Secondary Syphilis Rates by GenderMinnesota, 1993-2003

  31. Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 1993-2003 * Persons of Hispanic ethnicity can be of any race.

  32. Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 1997-2003 * Persons of Hispanic ethnicity can be of any race.

  33. ADOLESCENTS & YOUNG ADULTS 15-19 year olds 20-24 year olds

  34. Chlamydia disproportionately impacts adolescents & young adults Chlamydia Cases in 2003 (n = 10,714) MN Population in 2000 (n = 4,919,479)

  35. Gonorrhea disproportionately impacts adolescents & young adults Gonorrhea Cases in 2003 (n = 3,202) MN Population in 2000 (n = 4,919,479)

  36. Characteristics of adolescents & young adults diagnosed with chlamydia and/or gonorrhea in 2003(n=8,692)

  37. Characteristics of adolescents & young adults diagnosed with chlamydia and/or gonorrhea in 2003 (Continued) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  38. Chlamydia Rates for Adolescents & Young Adultsby Gender in Minnesota, 1993-2003

  39. Gonorrhea Rates for Adolescents & Young Adultsby Gender in Minnesota, 1993-2003

  40. EMERGING TRENDS: • - Resurgence of Syphilis • - Drug Resistant Gonorrhea STDs in Minnesota: Annual Review

  41. Resurgence of Syphilis among Gay/Bisexual Men in Minnesota STDs in Minnesota: Annual Review

  42. Early Syphilis* Cases by Stage at Diagnosis Minnesota, 1993-2003 * Early Syphilis includes primary, secondary, and early latent stages of syphilis

  43. Increase in Early Syphilis* among Gay/Bisexual Men Minnesota, 2002-2003 • 92 early syphilis cases diagnosed in 2003, compared with: • 82 cases in 2002 • 49 cases in 2001 • 71 cases among gay/bisexual men in 2003, compared with: • 56 gay/bisexual men in 2002 • 5 gay/bisexual men in 2001 • Characteristics of the 2003 gay/bisexual male cases (n=71): • 79% White • 77% live in Hennepin County • Average age = 37 • 42% HIV+ * Early Syphilis includes primary, secondary, and early latent stages of syphilis

  44. Chicago Seattle (King County) Los Angeles New York City San Francisco Boston Miami Houston St. Louis Washington D.C. Baltimore Atlanta Ft. Lauderdale Similar Increase in Syphilis among Gay/Bisexual Men in Other U.S. Cities

  45. What’s Being Done in Minnesota? • MDH launching awareness campaigns (e.g., Health Notices, press releases) • Encouraging physicians to screen gay/bisexual men at least annually • Community-based programs intensifying outreach activities to reach gay/bisexual men • MDH implementing innovative prevention strategies (e.g., internet banners, partnering with venues) • MDH Partner Services Program following up on cases and sex partners

  46. Increasing Prevalence of Drug-Resistant Gonorrhea in Minnesota STDs in Minnesota: Annual Review

  47. Background Information • CDC-recommended antibiotic treatments for gonorrhea: • Ceftriaxone • Single dose therapy, administered by injection • Relatively expensive • Cefixime • Single dose therapy, administered orally • Production discontinued in 2002; No longer available • Ciprofloxacin, Ofloxacin, Levofloxacin (Quinolones) • Single dose therapy, administered orally • Spread of quinolone-resistant N. gonorrhoeae (QRNG) threatens the efficacy of fluoroquinolones as the frontline treatment for gonorrhea

  48. Prevalence of Quinolone-Resistant N. Gonorrhoeae (QRNG) 1990s QRNG prevalent in Asia, >40% in some countries 2000 Hawaii discontinues use of fluoroquinolones following increase in QRNG prevalence from 1.4% in 1997 to 9.5% in 1999 2001 California discontinues use of fluoroquinolones after reaching QRNG prevalence of 5% in 2001 2002 CDC recommends non-quinolone therapy for infections acquired in HI, CA, and other areas with high QRNG prevalence 2003 Increases in QRNG reported in other U.S. states (e.g., MI, MA) especially among gay/bisexual men

  49. Prevalence of QRNG in Minnesota

  50. Implications of Increasing QRNG • Options for treatment of gonorrhea will be essentially limited to one class of drugs (cephalosporins) • Only two cephalosporins are currently recommended by CDC for treatment of gonorrhea: Cefixime and Ceftriaxone • Cefixime is no longer available in the United States • Ceftriaxone has to be administered via injection and is more expensive than quinolones