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Gonorrhea Increases In Washington State: Analyses for intervention planning May 2011. Mark R. Stenger Infectious Disease & Reproductive Health Assessment Unit, Washington State Department of Health. Objectives. Describe GC incidence trends and recent increases
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Gonorrhea Increases In Washington State:Analyses for intervention planningMay 2011 Mark R. Stenger Infectious Disease & Reproductive Health Assessment Unit, Washington State Department of Health
Objectives • Describe GC incidence trends and recent increases • Describe gender and behavioral trends • Describe treatment trends • Describe trends and changes in partner management • Describe HIV co-morbidity among GC cases • Discuss Program Response - interventions
Historical Context - Gonorrhea Cases and Incidence Rate Washington State 1920 - 2010
Gonorrhea Cases and Incidence Rate Washington State 1996 - 2010
Gonorrhea Incidence Rate by Race and Hispanic Ethnicity Washington State 2001 - 2010 Gonorrhea Incidence Rate by Non-Hispanic Race Washington State 2001 - 2010 Gonorrhea Incidence Rate by Hispanic Ethnicity Washington State 2001 - 2010
Gonorrhea Incidence Rate By Census Tract Washington State 2010
Gonorrhea Aberration Reporting SystemWashington State 2009-2011 2011 Mantel-Haenszel Chi-Square test of trend for cases by week significant at <.0001
Gonorrhea Incidence Rate by Gender Washington State 1996 - 2010
Gonorrhea Cases by Genderby Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Male Gonorrhea Cases by Age Groupby Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Percent of Male Gonorrhea Cases Reporting MSM-risk by Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Male Gonorrhea Cases by Age Group And MSM Risk Washington State 2010
Gonorrhea Cases by MSM, MSW & Female By Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
MSM Gonorrhea Cases by Age Groupby Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
HIV Status of MSM Diagnosed with GC and Incidence of GC among HIV+ MSM Gonorrhea Cases by Reported HIV Statusby Quarter, Washington State 2008 – 2011* Incidence of Gonorrhea among PLWHA, Washington State 1994 – 2010 *Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Percent of Cases with Treatment Reported by Quarter for All Cases 2009 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Treatment Reported 1992 – 2010
Proportion of MSM Treated with Ceftriaxone By Quarter, 1992 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Percent of All GC Cases Interviewed By Quarter 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Programmatic Response: State Level • GC ‘Summit’ in November 2010 • Four counties in Puget Sound metropolitan area • GISP • STD clinic staff • Provider Advisory – Revised Treatment Guidelines • Pro-active identification of repeaters (<120 days from previous infection) • Referral to local staff for partner management • Public Health - Seattle & King County, Harborview STD Clinic • Provider Advisory – Revised Treatment Guidelines • Culturing all MSM at all anatomic sites in the clinic • SSuN GC treatment failure surveillance • Susceptibility testing and follow-up with patients with elevated alert values • Renewed partner management focus on MSM GC
Acknowledgements • Roxanne Kerani, PhD • Public Health – Seattle & King County • STD Control Program • Mark Aubin • Manager, STD Services Section • Washington State Department of Health
Mean Number of Period Partners* Reported by MSM Cases by Quarter, 2008 - 2010 Number of partners reported in previous 2 months, Includes only cases completing interviews
Rectal GC Infections Reported by Quarter Washington State, 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011
Selected Venues Reported by Quarter for MSM Cases 2008 - 2010 Percent reporting having met sex partner in venue in last year, Includes only cases completing interviews
Percent of MSM Cases with History of GC In Previous Year, by Quarter 2009 - 2010