Gonorrhea Morbidity, Missouri, 2008 • In 2008, there were 8,014 reported gonorrhea cases. • Of these, 57% were in females, 65% were among Black, non-Hispanic persons, and 63% were in persons aged 15-24 years. • Rates among Black, non-Hispanic persons were 26 times those in White, non-Hispanics.
Gonorrhea Morbidity, Missouri, 2008 • The greatest number of cases (962) was reported among Black Females aged 15-19 years. • The case rate in this group was 3,047 per 100,000. 22 times greater than the overall case rate. • Among Black Females 20-24 years of age, the rate was 3,380 per 100,000. 25 times greater than the overall case rate.
Gonorrhea Morbidity, Missouri, 2008 In 2008, St. Louis City, St. Louis County, and Jackson County reported 5,966 gonorrhea cases. This represented 74.4% of all reported cases.
National Rankings by Cases2007 Missouri: #8 St. Louis City: #20 Jackson County: #21 St. Louis County: #28
Unofficial National Rankings by Rates2007 St. Louis City: easily #1 (742.3) Jackson County: (385.2) St. Louis County: (230.6) The second highest rate among counties/independent cities ranked by cases was Orleans County, LA at 684.5
GC in MOEpi Investigations In Missouri, priority has been given to syphilis and HIV for Partner Services. In 2008, there were 369 cases reported of early syphilis and 588 cases of newly reported HIV Disease. When time permits or as 700/900 morbidity goes down (never), it is expected that GC follow up would increase.
GC in MOEpi Investigations Four DIS jurisdictions (agencies) perform GC investigations: Kansas City Health Department St. Louis City Health Department St. Louis County Department of Health Missouri Department of Health & Senior Services (DHSS)
GC in MOEpi Investigations Missouri has a total of 43 staff that spend a percentage of their time as a STD/HIV DIS. • 15 in KC (also work other communicable diseases) • 4 in STL Co • 9 in STL City (mostly HIV and CD focused, minimal STD) • 15 DHSS (Outstate & STL City)
GC in MOEpi Investigations KCHD Interview Criteria STD clinic: • GS positive males • positives returning for treatment Epi Impact in 2008 Cases interviewed 955 Contact index 0.7
GC in MOEpi Investigations St. Louis City Interview Criteria ConnectCare clients • GS positive males • Positives returning for treatment Epi Impact in 2008 Cases interviewed 132 Contact index 1.2
GC in MOEpi Investigations St. Louis County Interview Criteria • Select circumstances Epi Impact in 2008 Cases interviewed 9 Contact index 0.8
GC in MOEpi Investigations DHSS Outstate MO Interview Criteria • Co-infected with 700 and/or 900 • provider request Epi Impact in 2008 Cases interviewed 46 Contact index 1.5
GC Screeing in MOSTD and IPP Providers ~80 IPP Providers 114 Local Public Health Agencies 3 dedicated full time STD clinics Use dual screening test (Gen Probe Aptima) 85,000 tests per year (55% IPP) IPP MOA Requires provision of Partner Services to GC/CT positive clients: • Partner elicitation • Partner notification • Three phone calls • Letter • Referral to DIS for assistance
GC in MOTreatment Verification KC, St. Louis County, and DHSS conducts follow-up for all inadequate treatment reported • Cipro – FR assigned to DIS • Other inadequate treatment – phone follow-up to provider • No treatment – select follow-up
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