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Gonorrhea Prevention: Optimizing Strategies to Reduce Health Disparities. Kevin O’Connor, M.A. Chief, Program and Training Branch Division of STD Prevention Virginia DIS Training September 12, 2011. Division of STD Prevention.

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gonorrhea prevention optimizing strategies to reduce health disparities
Gonorrhea Prevention:Optimizing Strategies to Reduce Health Disparities

Kevin O’Connor, M.A.

Chief, Program and Training Branch

Division of STD Prevention

Virginia DIS Training

September 12, 2011

Division of STD Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

overview of discussion
Overview of Discussion
  • Why talk about gonorrhea now?
  • Epidemiologic trends
    • Health disparities
    • Drug resistant gonorrhea
  • Regional discussions on GC
  • GC Prevention Activities
    • Surveillance
    • Targeted Screening - public and private
    • Partner Services (multiple strategies)
    • Health promotion/risk reduction
  • The right strategies for your area?
gonorrhea overview
Gonorrhea Overview

Second most commonly reported STD

Profound health disparities among African Americans

Caused by a bacterium Neisseria gonorrhoeae

Asymptomatic in most women and some men

Symptoms: discharge from vagina or penis; and pain on urination. Most men have symptoms

Complications: infertility, chronic pelvic pain, ectopic pregnancy

If exposed, increased risk of HIV acquisition

Easily treated with antibiotics?

slide6

HEADLINES YOU’LL NEVER SEE:

Bono Responds to Gonorrhea Outbreak

slide8

- Profound health disparities - Antibiotic Resistance - Loss of fluoroquinolones and eventual emergence of cephalosporin-resistant GC - Opportunity for success? - GC identifies populations with multiple risks - learn from our historic successes - achieving success might not be that difficult

Why talk about

Gonorrheanow?

gonorrhea rates united states 1941 2009
Gonorrhea—Rates, United States, 1941–2009

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

gonorrhea case rates by sex 1990 2010
Gonorrhea case rates by sex, 1990–2010*

* 2010 data are preliminary.

slide12

Status Quo

1000 new infections per day

~ 300,000 cases/year

removing 1000 infections per day

gonorrhea rates by state united states and outlying areas 2009
Gonorrhea—Rates by State, United States and Outlying Areas, 2009

34.9

VT

NH

MA

RI

CT

NJ

DE

MD

DC

8.0

8.6

30.4

30.6

73.1

54.8

111.2

113.5

432.7

8.3

10.9

23.5

44.1

29.4

92.4

7.2

42.8

87.2

Guam

33.5

147.0

13.9

81.4

55.2

77.2

66.4

139.2

154.7

12.5

107.2

57.2

63.2

26.2

100.3

89.4

89.6

109.8

150.4

127.5

Rate per 100,000

population

128.3

50.0

156.2

185.7

54.5

246.4

141.3

160.8

<19.0

(n = 8)

120.4

19.1–100.0

(n = 24)

113.9

204.0

144.3

>100.0

(n = 22)

Virgin

Islands

104.7

Puerto Rico

5.8

49.0

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population.

gonorrhea rates by county united states 2009
Gonorrhea—Rates by County, United States, 2009

Rate per 100,000

population

<19.0

(n = 1,405)

19.1–100.0

(n = 1,129)

>100.0

(n = 607)

gonorrhea rates by age and sex united states 2009
Gonorrhea—Rates by Age and Sex, United States, 2009

Men

Rate (per 100,000 population)

Women

750

600

450

300

150

0

0

150

300

450

600

750

Age

10–14

5.0

25.3

15–19

250.0

568.8

20–24

407.5

555.3

25–29

238.9

229.4

30–34

145.0

106.2

35–39

85.6

47.6

60.8

22.9

40–44

45–54

33.6

8.7

2.1

11.4

55–64

65+

2.7

0.5

Total

92.2

105.7

gonorrhea rates by race ethnicity united states 2000 2009
Gonorrhea—Rates by Race/Ethnicity, United States, 2000–2009

Rate (per 100,000 population)

800

700

600

500

American Indians/Alaska Natives

Asians/Pacific Islanders

400

Blacks

300

Hispanics

Whites

200

100

0

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Year

slide19

Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2009

0.3

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.2

0.3

0.6

1.2

1.3

2.5

0.0

1.1

0.3

0.4

0.1

2.7

0.1

0.5

1.4

0.2

0.8

0.5

0.8

3.4

1.8

1.4

1.1

0.3

0.2

0.4

1.0

1.0

1.0

0.5

1.0

1.2

0.6

Positivity (%)

0.8

0.4

1.9

2.0

1.6

2.0

2.4

1.8

*

(n = 4)

2.1

2.0

<1.0

(n = 24)

0.2

1.2

1.0–1.9

(n = 16)

Virgin

Islands

2.0

Puerto Rico

0.1

>2.0

(n = 9)

0.5

* 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 2009.

slide22

After Cephalosporins: What Next?

Penicillin (in increasing doses)gone

Tetracyclines gone

Spectinomycin gone

Fluoroquinolones gone

Oral cephalosporins going?

Injectable cephalosporins (Ceftriaxone)

reported gonorrhea and chlamydia test volume infertility prevention project u s 2000 2010
Reported gonorrhea and chlamydia test volume*:Infertility Prevention Project, U.S., 2000–2010

*Total number of valid tests (positive and negative)

reported number of tests ipp by year
Reported number of tests* (IPP), by year

*Gonorrhea and chlamydia; positive and negative results only.

mmwr april 17 2009 58 14 362 365
Percentage of sexually active female enrollees aged 16−25 years* who were screened for Chlamydia trachomatis infection, by health plan type and year - Healthcare Effectiveness Data and Information Set, United States, 2000-2007MMWR, April 17, 200958(14);362-365

* 16-26 years during 2000-2002.

slide28

Gonorrhea positivity, women 15-24, family planning clinics, by race, Washington State IPP, 2007*

*Data Source: Center for Health Training, Seattle WA

ssun population based gonorrhea surveillance reported risks over 3 months by gonorrhea patients
SSuN Population-based Gonorrhea Surveillance – Reported Risks over 3 Months by Gonorrhea Patients
slide30
“Heterosexual men and women with GC tend to be younger and African American, and to have minimal risk behaviors other than more than one partner. In contrast, MSM with GC reported a greater number of sex partners, more sex with anonymous partners, more sex with partners met on the internet, and more frequent drug use. Such data suggest two markedly different GC epidemics among heterosexuals and MSM.”

Rietmeijer, et al, ‘Here Comes the Ssun’; PH Reports 2009 Supp. 2.; V. 124

national gonorrhea control program
National Gonorrhea Control Program

Implemented in 1972

Federal funding to state and local agencies

Establish screening programs for the detection of gonorrhea in asymptomatic women

Screening facilities included public and private agencies

Partner services

gonorrhea rates united states 1941 20091
Gonorrhea—Rates, United States, 1941–2009

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

I = Historic Gonorrhea Screening Program

slide33

National Gonorrhea Control Program

1973

Female ScreeningVD clinic

Screening/testing 4,356,670 582,922 GC + 132,387 (3%) 109,889 (19%)

Partner Services3 mos.Annual est.

Interviews 64,154 ~259,000

(3 mos. only: April – June 1973)

Contacts 61,439 ( 0.96 CI )Ct. examined 39,409 (~2/3)

Infected/treated 15,928 (.40) ~64,000

Epi Rx 18,063

historic gc control program case finding july 1972 june 1973
Historic GC Control ProgramCase Finding July 1972 – June 1973

STD

Clinic

Targeted

Screening

Partner

Services

110,000*

females

~ 13 %

64,000

~ 7 %

132,000

females

~ 15%

842,000

Cases reported in 1973

* Includes GC contacts

slide38

GC Regional Meetings

  • Smaller meeting → more discussion
  • Learn from peers
  • Emphasize epi & program improvement
  • Accommodate regional similarities
  • Outcome: short-term Action Plans
gonorrhea control optimizing strategies to reduce morbidity

Gonorrhea Control: Optimizing StrategiestoReduce Morbidity

1-day meetings held in each of the 10 HHS regions during 2009/2010

what guides the level of infection in a community
Anderson and May postulated that an STD will continue to spread in a community if the average probability of transmission per sex partner contact (times) the average duration of infection (times) the average number of sex partners per unit of time is greater than one.

R0 = (ß x D x C)

R0 -Average number of secondary cases generated in a population by a primary case

ß - Average probability of transmission per sexual contact

D – Averagedurationof infectiousness

C - Average number of sexual partners per unit time

What Guides the Level of Infection in a Community?

Source: STDs, Holmes et. al. , 3rd Ed., 1999 Chapter 3. Roy M. Anderson

slide44
2001 CDC Consultation on Gonorrhea

Recommendations for Programs

Screening

Partner services

Access to care

To view the Consultation report see resources at the ‘GC Control’ group at www.STDPreventionOnLine.org

key strategies
Key Strategies:

Surveillance

Screening

Treatment

Partner Services

Primary Prevention/risk reduction

Community Engagement

Key Health Care Providers

gonorrhea rates by county united states 20091
Gonorrhea—Rates by County, United States, 2009

Rate per 100,000

population

<19.0

(n = 1,405)

19.1–100.0

(n = 1,129)

>100.0

(n = 607)

slide49

Gonorrhea Cases by WI County

2008

1-100

101-1000

>1000

Wisconsin:

72 Counties

Douglas

26

Bayfield

Ashland

Vilas

4

Iron

Washburn

2

Sawyer

1

Burnett

3

Price

Florence

Oneida

3

Barron

Rusk

1

Marinette

8

Polk

4

Forest

2

Lincoln

3

Langlade

1

Taylor

Oconto

6

Chippewa

3

Dunn

5

St. Croix

9

Menominee

3

Marathon

26

Clark

Pierce

1

Shawano

6

Eau Claire

10

2 Door

Pepin

Waupaca

2

Wood

6

Portage

5

Kewaunee

4

Buffalo

Outagamie

67

Brown

294

Jackson

3

1

Trempealeau

Winnebago

73

Manitowoc

12

Juneau

7

Waushara

4

6,062 = Total Cases

Calumet

11

Monroe

16

LaCrosse

35

Adams

2

Marquette

1

Fond du Lac

44

1

GreenLake

Sheboygan

20

Vernon

Sauk

14

Columbia

14

Dodge

36

Richland

1

Ozaukee

19

21

Washington

Crawford

1

Milwaukee --- 4,063

Dane

453

Waukesha

81

Jefferson

18

Iowa

2

Grant

7

Green

3

Racine – 277

Rock

134

Walworth

15

LaFayette

1

Kenosha ---- 160

milwaukee city zip code areas
Milwaukee City Zip Code Areas

Zip Codes with Over 100

Reported Cases of GC in 2008:

Zip Code – Number of Cases

53206 – 548

53209 – 402

53210 – 400

53212 – 390

53218 – 376

53216 – 333

53208 – 312

53225 – 175

53205 – 149

53204 – 127

53224 – 116

53233 – 115

These 12 zip codes represent 57%

of all the gonorrhea reported

in Wisconsin in 2008.

Out of 4,032 cases reported from Milwaukee County in 2008

3,443 were reported from

the 12 zip codes in the

City of Milwaukee

noted in the table –

this represents 85.4% of the

reported cases in

Milwaukee County.

(12/43 Zip Code areas in Milwaukee City)

slide59

Top ZIP codes by Case Counts:

  • 19143: 454 cases
  • 19121: 306 cases
  • 19132: 297 cases
  • 19139: 286 cases (Rate: 542.9/100,000)
  • 19140: 277 cases (Rate: 447.9/100,000)
  • Top ZIP codes by Rate:
  • 19121: 815.8/100,000
  • 19138: 814.2/100,000 (161 cases)
  • 19132: 779.2/100,000
  • 19143: 693.6/100,000
  • 19123: 598.9/100,000 (56 cases)
milwaukee school based clinics update 2010
Milwaukee School Based Clinics Update 2010

Testing in 15 SBC began Jan 2009

Low volume of testing/positivity at first

Volume and positivity picking up

Higher-risk kids more comfortable with health center presence? Staff efforts?

slide63

GC Action Plans

Illinois: Maintain high quality systems already in place.

Review data: lab corps, IPP, FQHCs, WIC, state lab and push for greater HEDIS compliance.

Indiana: Evaluate data and concentrate on counties to focus efforts

Michigan: Promote HEDIS measure compliance, esp. in HMAs

Kentucky: Engage in a closer examination of our data. Examine screening coverage among sites we have some influence over in target area

Massachusetts: Zip code analysis of GC rates in Springfield, Boston and Brockton.

michigan identified need public sector
LHD requests for training and technical assistance (from asset inventory survey)

~ 50% - utilizing MDSS data to target surveillance

~ 50% - eliciting quality partner information

~ 25% - how to conduct effective physician visits

Role of MDCH in meeting these needs

Work with LHD STD programs to respond to need for TA.

Concentration on leveraging resources in the private medical community.

Expertise applied statewide with an economy of scale

Epidemiology, evaluation, training, capacity building

MichiganIdentified Need – Public Sector
michigan identified need private sector
In 2007, 53.3% of Michigan Medicaid Managed Care patients 16-20 were screened for chlamydia - 46.7% were not.

In 2006, only 1/3 of females 16-20, covered by commercial insurance were screened for chlamydia – 2/3 were not.

Role of MDCH in meeting these needs

Influence private providers statewide

Build on existing partnership with key provider groups

Michigan Identified Need – Private Sector
update on gc action plan progress tennessee
Update on GC Action Plan Progress Tennessee

An analysis of the past 10 years of GC data indicated that the number of cases

in women exceeded the number of cases in men starting in 2005 in Memphis

and approached the number of cases in men in 2008 in Nashville.

In reviewing what changes occurred that could account for the shift,

the only thing identified was a change that occurred in TennCare,

Tennessee’s Medicaid Program. Since the proportion of young women tested

for chlamydia annually is a HEDIS measure, TennCare began requiring

chlamydia testing for females ages 15 to 25 in their contracts with

Managed Care Organizations (MCOS) around 2004. Most MCOs are using

the dual test for GC/CT so the result was an increase in GC testing in young

women in this age group also. Because both the number of young women who are on TennCare and the amount of disease is significantly larger in Memphis than Nashville, the impact was seen in Memphis earlier..”

slide67

GC Action Plans

  • New York City: High school screening in HMA. Laboratory validation of NAAT for rectal and pharyngeal samples.
  • New York State: Expand screening in SBHC. Laboratory validation of NAAT for rectal and pharyngeal samples.
  • Ohio: Expand screening in two schools in Cleveland
  • Oklahoma: Look at ER data to see how that’s being utilized for screening.
  • Oregon:Develop a memo encouraging providers serving higher risk persons and communities.
gonorrhea control strategies
Gonorrhea Control Strategies

Partner Services

Who should you interview???

pregnant?

PID?

core area?

‘repeaters’?

MSM?

  • STD clinic patients?
  • symptomatic men?
  • women?
  • 15 and under?
slide70
Who should you interview???

pregnant?

PID?

core area?

‘repeaters’?

MSM?

STD clinic patients?

symptomatic men?

women?

15 and under?

Other

slide71
Who should you interview???

Rationale

pregnant? Prevent complications

PID? Prevent reinfection/ ID asymptomatic males

core area? Reach ‘core transmitter’ →→

‘repeaters’? Reach ‘core transmitter’ →→

MSM? HIV prevention/AR GC

STD clinic patients? Max. scale & timeliness

symptomatic men? Prevent PID/reach asymptomatic

Less work – they come to you

women? Reach asymptomatic men

15 and under? Child abuse/complications

partner services1
Partner Services

2008 Recommendations for Partner Services (MMWR):

“Prioritizing gonorrhea infected persons from core areas might offer an opportunity to reduce transmission on the community level”

“… an example of a core area is a zip code in which >50% of GC cases in the county are identified.”

View the Recommendations at: http://www.cdc.gov/mmwr/PDF/rr/rr5709.pdf

gonorrhea control strategies partner services
Gonorrhea Control StrategiesPartner Services

Essentially, you have to do enough to make a difference; but…

How much is enough???

5 %

25%

50%

100% of cases ??

partner services2
Partner Services

How much is enough???

Proportion of Cases interviewed

5 %

25%

50%

70%

100%

slide76

2008 Illinois Gonorrhea Rates

Rate per 100,000

Population

>300

> 100 - 300

>0 - 100

0

illinois reported gonorrhea cases in six lhds selected for the gc ps project in 2007
IllinoisReported Gonorrhea Cases in Six LHDs Selected for the GC PS* Project in 2007

These 6 Project Site Counties Accounted for 26% of Reported GC Cases in 2007 in Illinois Excluding Chicago. * PS = Partner Services

targeted gc counseling and sex partner services all outcomes 2 february december 2009
Targeted GC Counseling and Sex Partner Services All Outcomes – 2: February – December 2009

CP = Critical Period (60 Days Prior to Positive GC Test

Cx = Counseled, Rx = Treatment

targeted gc counseling and sex partner services outcomes by sex february december 2009
Targeted GC Counseling and Sex Partner Services Outcomes By Sex: February – December 2009

Rpt= Reported, Cx = Counseled, SP = Sex Partners, Tx/Rx = Test/Treatment, Init = Initiated

CP = Critical Period (60 Days Prior to Positive GC Test)

targeted gc counseling and sex partner services outcomes by race ethnicity february december 2009
Targeted GC Counseling and Sex Partner Services Outcomes By Race/Ethnicity: February – December 2009

Rpt= Reported, Cx = Counseled, SP = Sex Partners, Tx/Rx = Test/Treatment, Init = Initiated

CP = Critical Period (60 Days Prior to Positive GC Test)

targeted gc counseling and sex partner services outcomes by age group february december 2009
Targeted GC Counseling and Sex Partner Services Outcomes By Age Group: February – December 2009

Rpt= Reported, Cx = Counseled, SP = Sex Partners, Tx/Rx = Test/Treatment, Init = Initiated

CP = Critical Period (60 Days Prior to Positive GC Test)

targeted gc counseling and sex partner services outcomes by cx setting february december 2009
Targeted GC Counseling and Sex Partner Services Outcomes By Cx Setting: February – December 2009

Rpt= Reported, Cx = Counseled, SP = Sex Partners, Tx/Rx = Test/Treatment, Init = Initiated

CP = Critical Period (60 Days Prior to Positive GC Test)

illinois conclusions and implications
IllinoisConclusions and Implications
  • Number of Critical Period Sex Partners per Case was very Consistent Across Data (~1.4 per case)
  • Counseling Males May Be More Productive Than Females
  • Counseling at Time of Rx is almost 2x as Productive as Counseling in Field or by Telephone; and was 2.7 times less costly to Identify Infected Newly Treated Sex Partners
key terms for nys
Key Terms for NYS

Core - Census tract with 50% of morbidity

Adjacent - Census tract with 30% of morbidity

Peripheral - Remaining Census tracts with 20% of morbidity

new york state s approach to gonorrhea partner services
For transmission purposes not all gonorrhea cases are equal, therefore:

Intensely interview core area cases

Target gonorrhea screening to facilities and providers that serve the core population

New York State’s Approach to Gonorrhea Partner Services
reported gonorrhea cases and core epi interventions monroe county 2002 2007
Reported Gonorrhea Cases and Core Epi Interventions, Monroe County: 2002-2007

Data Source: New York State Department of Health, Bureau of STD Control

update on gc action plans
Update on GC Action Plans

Washington State

“Gonorrhea morbidity is likely quite sensitive to changes in the proportion of cases interviewed and provided partner management. The proportion of cases provided partner management by public health staff in King County decreased from 43% in the first half of 2009 to 39% for cases diagnosed year-to-date in 2010 due to budget restrictions. In contrast, in Pierce County, an urban jurisdiction directly south of King County, the proportion of cases interviewed increased from 55 to 69% in the same time period and gonorrhea morbidity decreased by 27%. These observations underscore the potential importance of maintaining sufficient capacity for disease intervention in the control and prevention of gonorrhea. ”

Oregon

“During the first 6 months of 2010 compared to the same time period in 2009 reported GC cases decreased slightly or remained steady in all counties… Every reported GC case is contacted by the health department and interviewed if they can be located. Many of the increased cases are related to case finding.

The Oregon STD Program has prioritized the following groups for enhanced gonorrhea intervention: MSM, African Americans, and males and females in the 15 – 24 year age group.”

update on gc action plans1
Update on GC Action Plans

Connecticut

“In May 2010, a GC partner services (PS) initiative began in the cities of

Hartford and New Haven. The targeted areas of these cities were based on reported cases in specific high morbidity zip codes. These two towns were selected because many of the cases reported in the state are from these towns and DIS worksites are based in these areas, giving them easy and timely access to provide PS. Anyone reported to the Sexually Transmitted Disease (STD) Control Program within three weeks of diagnosis and <25 years of age is immediately assigned to a DIS for a PS interview. The DIS will work intensely to locate these individuals for five days to [identify] exposed partners. This effort focuses on GC health disparities among African Americans. ”

slide93

Health Promotion

Division of Adolescent and School Health

National Center for Chronic Disease Prevention and Health Promotion

slide94
Division of Adolescent and School HealthPercentage of secondary schools that tried to increase student knowledge on HIV prevention in a required course

53% - 86%

87% - 89%

90% - 93%

94% - 97%

No Data

School Health Profiles, 2010 see http://www.cdc.gov/healthyyouth/profiles/slides/index.htm

slide95
Division of Adolescent and School HealthPercentage of secondary schools that tried to increase student knowledge on STD prevention in a required course

50% - 85%

86% - 88%

89% - 91%

92% - 97%

No Data

School Health Profiles, 2010 see http://www.cdc.gov/healthyyouth/profiles/slides/index.htm

slide96
Division of Adolescent and School HealthPercentage of secondary schools that taught 11 key HIV, STD, and pregnancy prevention topics in a required course during grades 6, 7, or 8

13% - 39%

40% - 42%

43% - 53%

54% - 66%

No Data

School Health Profiles, 2010 see http://www.cdc.gov/healthyyouth/profiles/slides/index.htm

slide97
Division of Adolescent and School HealthPercentage of secondary schools that taught 4 key topics related to condom use in a required course during grades 9, 10, 11, or 12

9% - 31%

32% - 44%

45% - 66%

67% - 88%

No Data

School Health Profiles, 2010 see http://www.cdc.gov/healthyyouth/profiles/slides/index.htm

key strategies what s the right mix for your area
Key Strategies:What’s the right mix for YOUR AREA?

Surveillance

Screening

Treatment

Partner Services

Primary Prevention/risk reduction

Community Engagement

Key Health Care Providers

gc prevention continuum
GC Prevention Continuum

Comprehensive

Sex Ed

Work with

Key Medical

Providers

Targeted

Screening

Promote

Screening

School/Jail

Screening

Media

Campaigns

PS Tools

Follow-up on

individual cases

Community

Level

interventions

Partner

Services

For all

GC

Targeted

Partner

Services

High

Morbidity

Low

Morbidity

gonorrhea prevention and control lessons
Gonorrhea Prevention and Control Lessons

Assess surveillance, testing data…

Target screening based on local epi:

PUBLIC – IPP/FP, corrections, CHCs, HIVP, school clinics

PRIVATE – promote screening by key private providers in HMAs (ERs, MCOs), policy (CT HEDIS)

Assess & ensure access to care/treatment

Partner with providers and communities

gonorrhea prevention and control lessons1
Gonorrhea Prevention and Control Lessons

Primary Prevention: Health Promotion/Risk Reduction/Condoms/Comprehensive sex ed – especially in core areas

Partner Services

Reaching partners is very important due to high positivity (…but low contact index)

What proportion of case to interview? (~ more than 25% of cases)

Time management? (minimize effort & max. impact, quick OIs, 7 – 10d follow-up)

Less intense, more effective than PS for other STDs

Offer PS tools and training to providers

Need ongoing evaluation and improvement

slide103
MSM

Limited Screening

Enhance & promote routine non-genital NAATs screening for MSM

Need comprehensive services

In HIV prevention and care; gay-friendly providers

Real concerns about potential spread of resistant GC

Efforts must be connected to HIV prevention and care

drug resistant gc
Drug Resistant GC

Surveillance and detection

Case definition; elevated suspicion

Assess and enhance Culture capacity labs

Enhance surveillance to rapidly detect resistant GC

Treatment

Management of patients and partners

Enhance current GC prevention efforts

slide105

Thank you!

Questions?

Division of STD Prevention

slide107

Thanks to:

State Epidemiologists and Program Directors

Michael Bender

DSTDP Program Consultants

Steven Shapiro

Catherine Satterwhite

Heather Bradley

Bob Kirkcaldy

see additional materials from the GC Regional meetings at the

resources section of the ‘GC Control’ group at www.STDPreventionOnLine.org

National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

Division of STD Prevention