Laboratory Surveillance of Sexually Transmitted Disease

1. Laboratory Surveillance of Sexually Transmitted Disease LA County Dept. of Health Services Sexually Transmitted Disease Program Laboratory Surveillance Unit Chandra Higgins, MPH chiggins@ladhs.org

2. Reportable STDs in LA County • Reporting requirements • Dual reporting system • Forms

3. Laboratory Syphilis Chlamydia Gonorrhea Health Provider Syphilis Chlamydia Gonorrhea Chancroid PID (Pelvic Inflammatory Disease) NGU (Non-Gonococcal Urethritis) Legal STD Reporting Requirements in California

4. Laboratory All positives Report within one working day of identification Health Provider Known or suspect Report syphilis within one working day of identification. All others within 7 calendar days. Reporting Responsibilities

5. Laboratory Patient name & limited demographics Provider name, address, phone Specimen accession, dates, test type & results Health Provider Patient name & full demographics Diagnosis, date of diagnosis & onset Name, address, & phone of reporter Reporting Responsibilities

6. Medical Provider’s STD Reporting Form (p.1)

7. Medical Provider’s STD Reporting Form (p.1, continued)

8. Medical Provider’s STD Reporting Form (p.2)

9. Medical Provider’s STD Reporting Form (p.2, continued)

10. Reports to LA County STD Program Chlamydia,Gonorrhea, and Syphilis 2004 Both ESy 51% CT 70% GC 66% Laboratory Only ESy 49% CT 27% GC 29% Provider Only ESy 0.3% CT 3.5% GC 4.8%

11. Reporting Issues • Improved enforcement of reporting laws • State investigations; non-compliance can result in loss of lab license • Identification of non-reporters is difficult • Dual reporting requirement facilitates identification • Annual laboratory survey identifies laboratories with deficient reporting practices

12. Reporting Issues(continued) • Heaviest burden on laboratories • Often sole reporting source • Rely on providers for patient information • Referring laboratories withhold patient / provider information from testing facilities • Increased interstate testing has accompanied growth of managed care & core laboratories • Reporting requirements vary by state

13. Annual Laboratory Survey • Monitor compliance with reporting guidelines • Monitor trends in test utilization & laboratory practice • Provide information on STD testing trends and recommendations • Inform laboratories about STD Program function

14. 2004 STD Testing Laboratories N=163

15. Test Volume by Lab-Type 2004 Syphilis, Chlamydia, Gonorrhea

16. L.A. County STD Testing 1995 – 2004

17. Syphilis Testing, 2004 N=1,629,500

18. Growth In Amplified Tests Chlamydia, 1995 - 2004

19. Amplified Methods 2003 & 2004 Chlamydia Tests 2003 2004

20. Growth in Amplified Testing Gonorrhea, 1995 - 2004

21. L.A. County STD Testing All 2004 Testing