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Sexually Transmitted Diseases What Me Worry ?

Sexually Transmitted Diseases What Me Worry ?. STD Trends and Prevention Strategies A State Perspective August 8, 2007 Springfield, Illinois. Illinois Department of Public Health Office of Health Protection, Division of Infectious Diseases, STD Section. Why You Should Care About STDs.

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Sexually Transmitted Diseases What Me Worry ?

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  1. Sexually Transmitted DiseasesWhat Me Worry ? STD Trends and Prevention Strategies A State Perspective August 8, 2007 Springfield, Illinois Illinois Department of Public Health Office of Health Protection, Division of Infectious Diseases, STD Section

  2. Why You Should Care About STDs • Very Common in US • Often Asymptomatic • STDs Facilitate Increased HIV Transmission • Cause Significant Medical & Psychological Complications • Infertility • Cancer • Adverse Pregnancy Outcomes • Newborn Illness and Death • Some are Incurable • High Health Care Cost - $16.6 Billion per year in US • Teens-Young Adults, Women & Economically Disadvantaged Are Disproportionately Affected • Social Stigma & Mixed Messages Hamper Prevention Source: Tracking the Hidden Epidemics, 2000; CDC

  3. Estimated Annual New Cases of STDs in USTotal Incidence 15 Million 20,000 5 million 102,000 5.5 million 1 million 70,000 650,000 3 million Source: Tracking the Hidden Epidemics 2000, CDC

  4. Estimated Prevalence of Leading STDs HIV(560,000) HepatitisB(750,000) Chlamydia (3 million) HPV (20 million) Herpes (45 million) Kaiser Family Foundation and American Social Health Association. 1998.

  5. STDs are Sexist • Transmission efficiency greater male to female than the reverse • More women asymptomatic or with atypical, nonspecific Sx; delayed care • Diagnosis more difficult in women • Complications more frequent in women, often severe or permanent

  6. High Rates In Teenagers • Sex at Early Age • 25% of Females Had Sex by 15 Yrs • 80% of Females Had Sex by 19 Yrs • Drug and Alcohol Usage • Average Antibiotic Compliance Rate 54% • Biologic Factors • Lack of Cervical Mucus Protection • Denial, Risk Taking and Multiple Partners • STD Education: Abstinence-Only, Biology vs. Behaviors • Environmental - Media Messages, Clubs, etc. Source: Journal of Adolescent Health 1991; 12; 91

  7. STD/HIV Interactions • Enhanced HIV transmission • Genital ulcer disease: HSV, chancroid, syphilis • Inflammatory STDs: gonorrhea, chlamydia, trich • Other: ? bacterial vaginosis, ? candidiasis, ? HPV • Adverse effects of STD on HIV progression • HSV (?) • Adverse effects of HIV on natural Hx or Rx of STD • HSV – Chancroid • HPV – Neurosyphilis • Molluscum contagiosum – PID

  8. Chlamydia – Why Should We Care? • High Prevalence and Incidence in Adolescents and Young Adults • PID • Infertility • Ectopic Pregnancy • Newborn Infection • Facilitates HIV Transmission

  9. Illinois Reported Chlamydia Cases by Year, 1990-2006 No. Cases

  10. Reported Chlamydia Cases By Provider TypeIllinois 2006

  11. Illinois Chlamydia Cases By Gender, 1990 - 2006 Cases

  12. Chlamydia Case Rates by Race & Ethnicity*Illinois 1990 - 2006 *1990-1999 Case Rates (oer 100,000) based on 1990 U.S. Census,2000 –2001 – 2004 Case Rates based on 2000 U.S. Census. Racial categories include persons of any or unknown ethnicity: Hispanic ethnicity includes persons of any race

  13. Reported Chlamydia Cases by Age Group*Illinois, 2006 *Where age is known (n=53,563)

  14. Reported Chlamydia Cases by Selected Counties and Age Groups, Illinois 2006

  15. Reported Chlamydia Cases by Selected Counties and Age Groups, Illinois 2006

  16. Winnebago Jo Daviess Stephenson Boone McHenry Lake Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee Kendall Cook Will Rock Island Henry Bureau Grundy La Salle Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Woodford Iroquois Peoria Henderson McLean Ford Tazewell McDonough Fulton Hancock Mason >=400 Vermilion De Witt Champaign Schuyler Logan Menard Piatt Cass Adams Brown Macon Sangamon Morgan Douglas Edgar Scott Pike Moultrie Christian Coles Shelby Greene Calhoun Clark Cumberland Macoupin Montgomery 20 - 99 Jersey Effingham Crawford Jasper Fayette Bond Madison Lawrence Clay Richland Marion Clinton St. Clair Wabash Wayne Edwards Washington Jefferson Monroe Perry Hamilton White Randolph Franklin Jackson Saline Gallatin Williamson Pope Hardin Union Johnson Pulaski Massac Alexander 2006 Illinois Chlamydia Rates 200 - 399 100 - 199 Rate per 100,000 Population

  17. Jo Daviess Stephenson Winnebago Boone McHenry Lake Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee Kendall Cook Will Rock Island Henry Bureau La Salle Grundy Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Woodford Iroquois Peoria Henderson McLean Ford Tazewell McDonough Fulton Hancock Mason Vermilion De Witt Champaign Schuyler Logan Piatt Menard Cass Adams Brown Macon Sangamon Douglas Morgan Edgar Scott Pike Moultrie Christian Coles Shelby Greene Clark Cumberland Macoupin Montgomery Calhoun Jersey Effingham Crawford Jasper Fayette Bond Madison Clay Richland Lawrence Marion Clinton Wabash St. Clair Wayne Edwards Washington Monroe Jefferson Perry Hamilton White Randolph 10% Change in Chlamydia Cases 2005 and 2006 Franklin Jackson Saline Gallatin Williamson >=10% Increase Pope Hardin (32) Union Johnson >=10% Decrease (34) Pulaski Massac Alexander <10% or No Change (37) Change in Reported Chlamydia Cases for Illinois Counties January – December 2005 and 2006

  18. Gonorrhea – Why Should We Care? • PID • Infertility • Ectopic Pregnancy • Newborn infection • Facilitates HIV transmission • Antibiotic Resistance • Incidence in Adolescents and Young Adults

  19. Illinois Reported Gonorrhea Cases by Year, 1990-2006 No. Cases

  20. Reported Gonorrhea Cases By Provider TypeIllinois 2006

  21. Illinois Gonorrhea Cases By Gender, 1990 - 2006 Cases

  22. Gonorrhea Case Rates By Race & Ethnicity*Illinois 1990 -2006 *Racial categories do not include persons of Hispanic ethnicity: Hispanic ethnicity includes persons of any race

  23. Illinois Reported STD Case RatesDisparity Between Racial/Ethnic Groups, 2005 *Primary and Secondary

  24. Jo Daviess Winnebago Stephenson Boone McHenry Lake Carroll Ogle Kane DeKalb Chicago DuPage Whiteside Lee Cook Kendall Will Rock Island Henry Bureau La Salle Grundy Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Woodford Iroquois Peoria Henderson McLean Ford Tazewell McDonough Fulton Hancock Mason Vermilion De Witt Champaign Schuyler Logan Menard Piatt Cass Adams Brown Macon Sangamon Douglas Morgan Edgar Scott Pike Moultrie Christian Coles Shelby Greene Clark Calhoun Cumberland Macoupin Montgomery Jersey Effingham Jasper Crawford Fayette Bond Madison Clay Lawrence Richland Marion Clinton Wabash St. Clair Wayne Edwards Washington Jefferson Monroe Perry Hamilton White Randolph Franklin Jackson Saline Gallatin Williamson Pope Hardin Union Johnson Pulaski Massac Alexander 2006 Illinois Gonorrhea Rates >300 > 100 - 300 >0 - 100 0 Rate per 100,000 Population

  25. Jo Daviess Winnebago Stephenson Boone McHenry Lake Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee Kendall Cook Will Rock Island Henry Bureau Grundy La Salle Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Woodford Iroquois Peoria Henderson McLean Ford Tazewell McDonough Fulton Hancock Mason Vermilion De Witt Champaign Schuyler Logan Piatt Menard Cass Adams Brown Macon Sangamon Douglas Morgan Edgar Scott Pike Moultrie Christian Coles Shelby Greene Clark Calhoun Cumberland Macoupin Montgomery Jersey Effingham Jasper Crawford Fayette Bond Madison Clay Richland Lawrence Marion Clinton Wabash St. Clair Wayne Edwards Washington Monroe Jefferson 10% Change in Gonorrhea Cases 2005 and 2006 Perry Hamilton Randolph White Franklin Jackson Saline Gallatin Williamson >=10% Increase (31) Hardin Pope Union Johnson >=10% Decrease (46) Alexander Pulaski Massac <10% or No Change (26) Change in Reported Gonorrhea Cases for Illinois Counties January – December 2005 and 2006

  26. Syphilis – Why Should We Care? • Congenital infection • Facilitates HIV transmission • Late complications • High rate of syphilis-HIV co-infection among MSM and increasing neurological involvement

  27. Illinois Reported Early Syphilis By Year, 1990 - 2006 No. Cases Source: IDPH STD Section

  28. Reported Early Syphilis Cases by Provider TypeIllinois 2006

  29. Illinois Reported Early Syphilis Cases By Gender, 1990 – 2006 Cases

  30. Illinois Reported Primary & Secondary Syphilis Cases By Age Group, 2006

  31. Illinois Reported Primary & Secondary Syphilis CasesBy Gender and Sexual Orientation, 2000-2006 *heterosexual or sexual orientation not stated

  32. Illinois Reported Primary & Secondary Syphilis Case RatesBy Race/Ethnicity, 1990 - 2006

  33. Jo Daviess Winnebago Stephenson McHenry Lake Boone Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee Cook Kendall Will Rock Island Henry Bureau Grundy La Salle Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Woodford Peoria Iroquois Henderson McLean Ford McDonough Tazewell Fulton Hancock Mason Vermilion De Witt Champaign Schuyler Logan Piatt Menard Adams Brown Cass Macon Morgan Douglas Sangamon Edgar Scott Pike Moultrie Christian Coles Shelby Greene Clark Macoupin Calhoun Cumberland Montgomery Jersey Effingham Crawford Jasper Fayette Bond Madison Clay Richland Lawrence Marion Clinton Wabash St. Clair Wayne Edwards Washington Monroe Jefferson Perry Hamilton White Randolph Franklin Jackson Saline Gallatin Williamson Hardin Pope Union Johnson Pulaski Massac Alexander 2006 Illinois Primary and Secondary Syphilis Rates >10 > 4 - 10 >0 - 4 0 Rate per 100,000 population

  34. Jo Daviess Winnebago Stephenson Boone McHenry Lake Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee Kendall Cook Will Rock Island Henry Bureau Grundy La Salle Putnam Mercer Kankakee Stark Marshall Knox Livingston Warren Peoria Woodford Iroquois Henderson McLean Ford McDonough Tazewell Fulton Hancock Mason Vermilion De Witt Champaign Schuyler Logan Piatt Menard Cass Adams Brown Macon Sangamon Douglas Morgan Edgar Scott Pike Moultrie Christian Coles Shelby Greene Clark Calhoun Cumberland Macoupin Montgomery Jersey Effingham Jasper Crawford Fayette Bond Madison Clay Richland Lawrence Marion Clinton Wabash St. Clair Wayne Edwards Washington Monroe Jefferson Perry Hamilton White Randolph Franklin Early Syphilis 2005 and 2006 Jackson Saline Gallatin Williamson Hardin Pope Union Johnson Alexander No Cases or No Change Pulaski Massac (65) Decrease (17) 2006 Illinois Reported Early Syphilis Cases And Change in Reported Cases Compared to 2005 by County January - December Increase (21)

  35. Illinois Reported Primary and Secondary Syphilis CasesMale:Female Ratio, 1992-2006 Cases 1.00:1.00

  36. Illinois Primary & Secondary SyphilisBy Gender and Sexual Orientation, 2000-2006 *heterosexual or sexual orientation not stated

  37. Illinois Primary and Secondary Syphilis Among MSMPercent of Reported Cases By Race*/Ethnicity, 2002 - 2006 Percent of Cases Racial categories are non-Hispanic

  38. HIV Status By Gender and Sexual Orientation Illinois Primary & Secondary Syphilis, 2006

  39. Illinois Primary & Secondary Syphilis Among MSM by Year and HIV Status, 2000 - 2006

  40. QuestionsFor Local Health Departments • What activities and resources currently provided by the IDPH STD program are helpful and should continue? • What activities and resources are needed that are not currently provided by the IDPH STD Program?

  41. Significant STD Challenges • Degradation of Public Health Infrastructure • Affordable, Accessible and High Quality Public and Private Diagnostic and Treatment Services • Schizophrenic Public Messages and Attitudes About Sexuality and STD Prevention • Absence of Social and Political Will for Long Term, Sustainable and Effective Prevention Education in Schools and Other Settings Serving Persons at Increased Risk • Stigma, Discrimination and Marginalization • Difficulty in Engaging Communities and Fostering Shared Responsibility for Prevention

  42. Significant Opportunities • Renewed Attention for STD Prevention • IDHS MCH Program Making STI Reduction and Prevention a Priority • Targeted LHD Initiatives Developed Using CDC STD Program Planning Evaluation Process • Interest From External Partners • Overall High Quality LHD and IDPH Core Program Services • Reporting and Surveillance • Screening • Accessibility of STD Medications • Counseling and Sex Partner Referral • Technical Assistance and Training

  43. IDPH STD Program For Questions and AssistanceContact Us At217-782-274firstname.lastname@Illinois.gov John Creviston Becky Rinozzi Marilyn Harris Ed Renier Steve Holmes Alice Studzinski Diana McGrath Richard Zimmerman Charlie Rabins Valerie Young

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