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Gonorrhea in San Francisco

Gonorrhea in San Francisco. Kyle T Bernstein Chief, Epidemiology, Research and Surveillance STD Prevention and Control Services San Francisco Department of Public Health Gonorrhea Control in Region XI: Optimizing Strategies to Reduce Morbidity Phoenix, AZ January 14, 2010.

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Gonorrhea in San Francisco

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  1. Gonorrhea in San Francisco Kyle T Bernstein Chief, Epidemiology, Research and Surveillance STD Prevention and Control Services San Francisco Department of Public Health Gonorrhea Control in Region XI: Optimizing Strategies to Reduce Morbidity Phoenix, AZ January 14, 2010

  2. GC Diagnoses, San Francisco City Clinic 2008

  3. Non-STD Clinic GC, SSuN

  4. Non-STD Clinic GC, SSuN

  5. Approach Screen, Treat, Treat, Screen • Screening for MSM and adolescents • Quick and appropriate treatment of index patient • Quick and appropriate treatment of partners • Rescreening in 3-6 months

  6. Screening for MSM and Adolescents • SFSTD supports dual GC/CT screening at STD clinic, jails, Magnet, sex worker clinic, and primary care clinics • Annual urogenital screening for females • <26 years old • Pregnant • IUD insertion • Rectal and pharyngeal screening for MSM/transmen/transwomen every 3-6 months • Diagnostic testing supported for patients with symptoms or who are contacts to GC • Sexual Health Promotion Team targets MSM and adolescents geographically to promote screening

  7. Quick and Appropriate Treatment of Index • Surveillance staff verify treatment of reported GC cases • Cefpodoxime 400mg + azithromycin 1 gram PO x 1 • Mosaic penA PCR for GC • Review of current treatment protocols • Transition to Ceftriaxone

  8. Exposed Re - infection Crude RR 95% CI All Patients PDPT 921 123 (13.4%) 0.89 0.72 - 1.10 No PDPT 1194 180 (15.1%) 1.0 -- MSM PDPT 724 114 (15.75%) 0.89 0.72 - 1.11 No PDPT 959 169 (17.62%) 1.0 -- MSW PDPT 144 6 (4.17%) 0.71 0.26 - 1.93 No PDPT 152 9 (5.92%) 1.0 -- Females PDPT 52 3 (5.77%) 2.39 0.41 - 13.85 No PDPT 83 2 (2.41%) 1.0 -- Quick and Appropriate Treatment of Partners • Patient-delivered partner therapy (PDPT) • Available to all patients tested at STD-supported clinical sites • Also available through InSpot • Evaluation of PDPT at STD clinic

  9. Rescreening in 3-6 months • All patients with GC encouraged to re-screen • Reminder Phone Call Pilot • Pre-pilot 29.6% of women rescreened • Pilot 56.5% of women rescreened • Two sided exact test p=0.085 • No difference for CT

  10. Acknowledgments • Julia Marcus • Robert Kohn • Sally Stephens • Ameera Snell • Monica Lee • Andrew Reynolds • Susan Philip

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