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Sexually Transmitted Disease (STD) Surveillance Report, 2005

Sexually Transmitted Disease (STD) Surveillance Report, 2005. Minnesota Department of Health STD Surveillance System. Introduction. This slide set describes new cases of chlamydia, gonorrhea, and syphilis in Minnesota by person, place, and time.

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Sexually Transmitted Disease (STD) Surveillance Report, 2005

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  1. Sexually Transmitted Disease (STD) Surveillance Report, 2005 Minnesota Department of Health STD Surveillance System

  2. Introduction • This slide set describes new cases of chlamydia, gonorrhea, and syphilis in Minnesota by person, place, and time. • The slides display data from cases diagnosed through 2005 and reported to the Minnesota Department of Health (MDH) STD Surveillance System. • Data analyses exclude federal and private prisoners. STDs in Minnesota: Annual Review

  3. Introduction • STD Surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population. • STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions. STDs in Minnesota: Annual Review

  4. Interpreting STD Surveillance Data • Factors that impact the completeness and accuracy of the data include: • Level of STD screening and individual test-seeking behavior • Sensitivity of diagnostic tests • Compliance with case reporting • Timeliness of case reporting • Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the factors described above. • For example, in 2002 MDH added an active component to the previously passive STD Surveillance System. As a result, compliance with reporting improved and the number of chlamydia and gonorrhea cases reported to MDH increased by at least 7% and 5%, respectively, between 2001 and 2002 as an artifact of reporting. STDs in Minnesota: Annual Review

  5. National Context STDs in Minnesota: Annual Review

  6. United States: State-Specific Chlamydia Rates, 2004 STDs in Minnesota: Annual Review SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.

  7. United States: State-Specific Gonorrhea Rates, 2004 STDs in Minnesota: Annual Review SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.

  8. United States: State-Specific P&S Syphilis Rates, 2004 STDs in Minnesota: Annual Review SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.

  9. Overview of STDs in Minnesota STDs in Minnesota: Annual Review

  10. STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 1995-2005† * P&S = Primary and Secondary.

  11. STDs in Minnesota:Number of Cases Reported in 2005 • Total of 15,875 STD cases reported to MDH in 2005: • 12,187 Chlamydia cases • 3,481 Gonorrhea cases • 207 Syphilis cases (all stages)

  12. CHLAMYDIA STDs in Minnesota: Annual Review

  13. 2005 Minnesota Chlamydia Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Cook Red Lake Polk Lake Clearwater St. Louis Itasca Norman Mahnomen Hubbard Becker Cass Clay Wadena Aitkin Carlton Rate per 100,000 persons Wilkin Otter Tail Crow Wing 0 - 75 Pine Todd Morrison 76 - 150 Grant Douglas Mille Lacs Kanabec Traverse 151 - 300 Benton Pope Stevens Stearns Isanti Big Stone > 300 Sherburne Chisago City of Minneapolis 717 City of St. Paul 598 Suburban# 184 Greater Minnesota 158 (509 cases missing residence information) Swift Anoka Wright Kandiyohi Meeker Washington Chippewa Ramsey Hennepin Lac Qui Parle McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Lyon Redwood Goodhue Nicollet Rice Le Sueur Wabasha Brown # 7-county metro area, excluding the cities of Minneapolis and St. Paul Murray Dodge Pipestone Cottonwood Blue Earth Steele Olmsted Waseca Winona Watonwan Rock Nobles Jackson Martin Faribault Fillmore Houston Freeborn Mower

  14. Chlamydia Infections in Minnesotaby Residence at Diagnosis, 2005 Total Number = 12,187 (509 missing residence information) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  15. Chlamydia Rates by GenderMinnesota, 1995-2005

  16. Chlamydia Rates by AgeMinnesota, 1995-2005

  17. Chlamydia Rates by Race/Ethnicity Minnesota, 1995-2005 * Persons of Hispanic ethnicity can be of any race.

  18. Chlamydia Rates by Race/Ethnicity Excluding BlacksMinnesota, 1995-2005 * Persons of Hispanic ethnicity can be of any race.

  19. GONORRHEA STDs in Minnesota: Annual Review

  20. 2005 Minnesota Gonorrhea Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Cook Red Lake Polk Lake Clearwater St. Louis Itasca Norman Mahnomen Hubbard Becker Cass Clay Crow Wing Wadena Aitkin Carlton Rate per 100,000 persons Wilkin Otter Tail 0 - 10 Pine 11 - 29 Todd Morrison Grant Douglas Kanabec 30 - 100 Mille Lacs Traverse Benton > 100 Stevens Pope Stearns Isanti Big Stone Chisago Sherburne City of Minneapolis 333 City of St. Paul 238 Suburban# 46 Greater Minnesota 22 (132 missing residence information) Swift Anoka Kandiyohi Wright Meeker Washington Chippewa Ramsey Lac qui Parle Hennepin McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Lyon Redwood Goodhue Nicollet Rice Le Sueur Wabasha Brown # 7-county metro area, excluding the cities of Minneapolis and St. Paul Murray Blue Earth Cottonwood Steele Dodge Olmsted Pipestone Winona Watonwan Waseca Rock Nobles Jackson Martin Faribault Fillmore Houston Freeborn Mower

  21. Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2005 Total Number = 3,481 (132 missing residence information) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  22. Gonorrhea Rates by GenderMinnesota, 1995-2005

  23. Gonorrhea Rates by AgeMinnesota, 1995-2005

  24. Gonorrhea Rates by Race/Ethnicity Minnesota, 1995-2005 * Persons of Hispanic ethnicity can be of any race.

  25. Gonorrhea Rates by Race/Ethnicity Excluding BlacksMinnesota, 1995-2005 * Persons of Hispanic ethnicity can be of any race.

  26. PRIMARY & SECONDARY SYPHILIS STDs in Minnesota: Annual Review

  27. 2005 Minnesota P&S Syphilis Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Cook Red Lake Polk Lake Clearwater St. Louis Itasca Norman Mahnomen Hubbard Becker Cass Clay Crow Wing Wadena Aitkin Carlton Wilkin Otter Tail Rate per 100,000 persons Pine Todd Morrison Grant Douglas 0 – 0.2 Mille Lacs Kanabec Traverse 0.21 – 1.0 Benton Stevens Pope Stearns Isanti Big Stone > 1.0 Chisago Sherburne Swift Anoka City of Minneapolis 11.0 City of St. Paul 2.8 Suburban# 0.9 Greater Minnesota 0.1 Kandiyohi Wright Meeker Chippewa Washington Hennepin Lac qui Parle Ramsey McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Lyon Redwood Goodhue Le Sueur # 7-county metro area, excluding the cities of Minneapolis and St. Paul Nicollet Rice Wabasha Brown Pipestone Murray Cottonwood Steele Dodge Olmsted Winona Blue Earth Waseca Watonwan Rock Nobles Jackson Martin Faribault Fillmore Houston Freeborn Mower

  28. Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2005 Total Number = 70 Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  29. Primary &Secondary Syphilis Rates by GenderMinnesota, 1995-2005

  30. Primary & Secondary Syphilis Rates by AgeMinnesota, 1995-2005

  31. Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 1995-2005 * Persons of Hispanic ethnicity can be of any race.

  32. Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 2000-2005 * Persons of Hispanic ethnicity can be of any race.

  33. ADOLESCENTS & YOUNG ADULTS 15-19 year olds 20-24 year olds STDs in Minnesota: Annual Review

  34. Chlamydia Disproportionately Impacts Adolescents & Young Adults Chlamydia Cases in 2005 (n = 12,187) MN Population in 2000 (n = 4,919,479)

  35. Gonorrhea Disproportionately Impacts Adolescents & Young Adults Gonorrhea Cases in 2005 (n = 2,957) MN Population in 2000 (n = 4,919,479)

  36. Characteristics of Adolescents & Young Adults Diagnosed With Chlamydia or Gonorrhea in 2005(n=9,787)

  37. Characteristics of Adolescents & Young Adults Diagnosed With Chlamydia Or Gonorrhea In 2005 (Continued) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  38. Chlamydia Rates for Adolescents & Young Adultsby Gender in Minnesota, 1995-2005

  39. Chlamydia Cases Among Adolescents and Young Adults† by Gender and Race, 2005 Males (n = 1,902) Females (n = 6,619) †Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.

  40. Gonorrhea Rates for Adolescents & Young Adultsby Gender in Minnesota, 1995-2005

  41. Gonorrhea Cases Among Adolescents and Young Adults† by Gender and Race, 2005 Males (n = 597) Females (n = 1,231) †Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.

  42. EMERGING TRENDS: • Drug Resistant Gonorrhea • Syphilis among MSM • Continuing Increase of the Chlamydia Rate STDs in Minnesota: Annual Review

  43. Increasing Prevalence of Drug-Resistant Gonorrhea in Minnesota STDs in Minnesota: Annual Review

  44. Background Information • CDC-recommended antibiotic treatments for gonorrhea: • Ceftriaxone • Single dose therapy, administered by injection • Relatively expensive • Cefixime • Single dose therapy, administered orally • Production discontinued in 2002; No longer available • Ciprofloxacin, Ofloxacin, Levofloxacin (Quinolones) • Single dose therapy, administered orally • Spread of quinolone-resistant N. gonorrhoeae (QRNG) threatens the efficacy of fluoroquinolones as the frontline treatment for gonorrhea STDs in Minnesota: Annual Review

  45. Prevalence of Quinolone-Resistant N. Gonorrhoeae (QRNG) 1990s QRNG prevalent in Asia, >40% in some countries Hawaii discontinues use of fluoroquinolones following increase in QRNG prevalence from 1.4% in 1997 to 9.5% in 1999 2000 2001 California discontinues use of fluoroquinolones after reaching QRNG prevalence of 5% in 2001 2002 CDC recommends non-quinolone therapy for infections acquired in HI, CA, and other areas with high QRNG prevalence 2003 Increases in QRNG reported in other U.S. states (e.g., MI, MA) 2004 Prevalence of QRNG in MN five times higher than in 2002 2005 Prevalence of QRNG in MN continues to increase STDs in Minnesota: Annual Review

  46. Prevalence of QRNG in Minnesota,1999 - 2005

  47. Prevalence of QRNG by Mode of Transmission in Minnesota, 2002 - 2005 † † For 2002 and 2003 the isolates tested came only from The Gonococcal Isolate Surveillance Project (GISP). GISP is a sentinel surveillance system established by the CDC to monitor antimicrobial resistance in Gonorrhea among males. The Red Door Clinic in Minneapolis is one of the participating clinics. For 2004 and 2005 the numbers include isolates from Room 111 in St. Paul and include both males and females.

  48. Characteristics of 2005 QRNG cases(n = 25) • All cases were male. • 72% of the cases were White • 32% of cases (8) were 25 or younger and a majority of cases (52%) were among men 30 years of age or younger. (Mean age – 33, Median age – 29) • 24 of 25 cases (96%) were among gay/bisexual males • Twelve percent of cases among gay/bisexual males were also HIV+ • A majority of cases reported having multiple sex partners in the previous 60 days

  49. What’s Being Done in Minnesota? • MDH continues to test gonorrhea isolates from Room 111 and Red Door Clinic for Quinolone resistance • In 2005 and 2006, through a project funded by APHL and CDC, MDH conducted surveillance for QRNG among women tested at Red Door Clinic and Room 111. • Healthcare providers are encouraged to obtain travel histories of patients and to be alert for treatment failures. Gonorrhea infections acquired in areas with high QRNG prevalence and among MSM should receive non-quinolone therapy • Clinicians and laboratories are asked to report suspected treatment failures and resistant gonococcal isolates to MDH • MDH Partner Services Program follows up on cases and sex partners STDs in Minnesota: Annual Review

  50. Syphilis among Gay/Bisexual Men in Minnesota STDs in Minnesota: Annual Review

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