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Highlights from the Sexually Transmitted Disease (STD) Surveillance Report, 2012

Highlights from the Sexually Transmitted Disease (STD) Surveillance Report, 2012. Minnesota Department of Health STD Surveillance System. www.health.state.mn.us/std. Announcements. STDs in Minnesota Rate per 100,000 by Year of Diagnosis, 2002-2012. * P&S = Primary and Secondary. CHLAMYDIA.

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Highlights from the Sexually Transmitted Disease (STD) Surveillance Report, 2012

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  1. Highlights from theSexually Transmitted Disease (STD) Surveillance Report, 2012 Minnesota Department of Health STD Surveillance System www.health.state.mn.us/std

  2. Announcements

  3. STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 2002-2012 * P&S = Primary and Secondary

  4. CHLAMYDIA STDs in Minnesota: Annual Review

  5. Chlamydia in MinnesotaRate per 100,000 by Year of Diagnosis, 2002-2012 340 per 100,000 202 per 100,000

  6. Chlamydia Infections by Residence at Diagnosis Minnesota, 2012 Total Number of Cases = 18,048 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.

  7. Age-Specific Chlamydia Rates by Gender Minnesota, 2012

  8. Chlamydia Rates by Race/Ethnicity Minnesota, 2002-2012 2012 rates compared with Whites: Black = 11x higher American Indian = 5x higher Asian/PI = 2x higher Hispanic = 3x higher * Persons of Hispanic ethnicity can be of any race.

  9. Chlamydia Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

  10. GONORRHEA STDs in Minnesota: Annual Review

  11. Gonorrhea in MinnesotaRate per 100,000 by Year of Diagnosis, 2002-2012

  12. Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2012 Total Number of Cases= 3,082 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.

  13. Age-Specific Gonorrhea Rates by GenderMinnesota, 2012

  14. Gonorrhea Rates by Race/Ethnicity Minnesota, 2002-2012 2012 rates compared with Whites: Black = 26x higher American Indian = 8x higher Asian/PI = 0x higher Hispanic = 2x higher * Persons of Hispanic ethnicity can be of any race.

  15. Gonorrhea Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

  16. SYPHILIS STDs in Minnesota: Annual Review

  17. Syphilis Rates by Stage of Diagnosis Minnesota, 2002-2012 * P&S = Primary and Secondary

  18. Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2012 Total Number of Cases = 118 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.

  19. Age-Specific Primary & Secondary Syphilis Rates by Gender, Minnesota, 2012

  20. Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

  21. Topics in the spotlight: • Chlamydia and Gonorrhea among Adolescents and Young Adults (15-24 years of age) • Early Syphilis Among Men Who Have Sex With Men • in Minnesota STDs in Minnesota: Annual Review

  22. CHLAMYDIA AND GONORRHEA AMONGADOLESCENTS & YOUNG ADULTS (15-19 year olds) (20-24 year olds) STDs in Minnesota: Annual Review

  23. Chlamydia Disproportionately Impacts Youth Chlamydia Cases in 2012 (n = 18,048) MN Population in 2010 (n = 5,303,925)

  24. Gonorrhea Disproportionately Impacts Youth Gonorrhea Cases in 2012 (n = 3,082) MN Population in 2010 (n = 5,303,925)

  25. Early Syphilis Among • Men Who Have Sex With Men • in Minnesota STDs in Minnesota: Annual Review

  26. Early Syphilis† Cases Among MSM by Age Minnesota, 2012 (n=158) Mean Age = 38 years Range: 15 to 74 years MSM=Men who have sex with men † Early Syphilis includes primary, secondary, and early latent stages of syphilis.

  27. Early Syphilis† (ES) Cases Co-infected with HIV, 2006-2012 MSM=Men who have sex with men † Early Syphilis includes primary, secondary, and early latent stages of syphilis.

  28. SURVEILLANCE SUMMARY

  29. Future Updates to STD Reporting New case report form to accommodate changes in gonorrhea treatment guidelines Case report form will be able to be filled out on a computer and printed to be mailed or faxed in Link will be put up on MDH website to indicate interest in future online “provider portal” for direct online reporting Letters will be sent in late May/early June to providers to introduce new case report form, provide link to sign up for future “provider portal” online reporting, and highlight new gonorrhea treatment guidelines

  30. INCREASING PREVALENCE OF DRUG- RESISTANT GC Candy Hadsall, RN STD Nurse Specialist MDH

  31. Resistance is Increasing • Beginning to see resistance to Suprax – • High number of treatment failures in Canada. • Gonococcal Isolate Surveillance Project (GISP) has identified cases, including few in MN • Steepest increase in western US, especially in MSM; started in 2009 • One study = 11.9% of patients + on retest 2-4 weeks after treatment with Suprax • Concern: cephalosporins are last effective antibiotic; no new drugs in production

  32. 2012 Rev Recommended Tx of Uncomplicated GC (Cervix, urethra, rectum) Ceftriaxone 250 mg IM, single dose PLUS Azithromycin 1 g orally, single dose or doxycycline 100 mg. orally bid x 7 days Note: Fluoroquinolones discontinued in 2007

  33. 2012 Alternative Tx for Uncomplicated GC • If no ceftriaxone, Cefixime 400 mg po, single dose PLUS Azithromycin 1 gm orally, single dose (or doxy) MUST DO Test of cure in 1 week via culture if possible

  34. Test of Cure for GC • TOC recommended when: • One week following re-treatment if used alternative treatment and not Rocephin • Treatment failure is suspected • Patients have persistent symptoms • Culture recommended unless not available • Poses problems since culture use declined • If unavailable, can use NAATS (GC clears from body within 5 days if responsive to treatment med)

  35. Pharyngeal Gonorrhea • Infection in mouth and throat sometimes occurs. More difficult to eradicate • CDC treatment recommendation: • Ceftriaxone (Rocephin) 250 mg. IM single dose PLUS Azithromycin 1 g orally, single dose (or doxy) • Not recommended even prior to 2012: • Cefixime 400 mg po

  36. What About EPT? • Treatment recommendation for partners of individuals who test positive for gonorrhea and refuse to come into clinic: • Cefixime (Suprax) 400 mg orally, single dose PLUS - Azithromycin 1 gm. orally, single dose • No change in treatment guidelines

  37. Different Focus When Addressing Gonorrhea in Minnesota • Since large majority of cases are in Twin Cities and suburbs, important to: • Pay attention to geography – of clinic, of clients • Do detailed sexual histories, risk assessments; identify and discuss social/sexual networks • Treat prophylactically when indicated. Treat positives quickly and appropriately. (CDC Guidelines) • Get partners into clinic for treatment • When not possible, provide EPT for all partners • Report untreated cases to MDH right away

  38. What Should Clinicians Do in 2013? • Be alert to treatment failures in patients who received Suprax as alternative treatment AND • In patients who return with symptoms after treatment when partner(s) are treated with EPT • Do not stop using Suprax in designated situations, especially if patient/partner would not otherwise get treated • Update treatment protocols; decide on clinic’s ability to collect cultures; see if lab does cultures

  39. GOAL: Treat as many people as possible as long as we still have an effective treatment, including partners through EPT

  40. Recommendations for GC(and CT)Re-Screening after Treatment In patients who are positive and have uncomplicated cases, and do not return with symptoms, no changes Re-screen all patients who were positive 3 - 4 months after treatment, or whenever seek care within 12 months if did not return at 3 months

  41. Repeat Infections Repeat CT and GC infection rates at rescreening 3-4 months later are high, 10-30%, usually because partners not treated Risk of serious reproductive health sequelae increases with every subsequent infection Upper tract infection (PID) more common with re-infection than initial infection Repeat CT: 2x odds of ectopic pregnancy; 4x odds of pelvic inflammatory disease (PID)1 1 - Hillis et al 1997

  42. What Else Can Clinicians Do? • Ask patients about sex of partners and include treatment/EPT • Put as much information as possible on case report forms • Call MDH if suspect treatment failure • Be able to explain disease investigation when necessary. • Make a connection with a Disease Investigator at MDH – 651-201-5414.

  43. Candy Hadsallcandy.hadsall@state.mn.us651-201-4015

  44. Chlamydia Screening: Provider Toolkit Tools to increase chlamydia screening rates in your practice Anisa Esse, Senior Regulatory Quality Analyst Medica

  45. Project Background • Health Plans required by DHS Contract to impalement a statewide Performance Improvement Project annually that lasts for 3 years. (PIP)– 3 year project • Health Plans work collaboratively together on projects. • This performance improvement project (PIP) is a Collaborative effort among four Minnesota health plans: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, and UCare with project support provided by Stratis Health.

  46. Project Background • Purpose: The goal of this PIP is to increase the rate of Chlamydia screening in women • Barriers discovered: providers lack of knowledge about CT, belief systems, confidence in skills re: talking to youth/parents

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