LOCAL EPIDEMIOLOGY AND THE ROLE OF THE HEALTH DEPARTMENT
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1 LOCAL EPIDEMIOLOGY AND THE ROLE OF THE HEALTH DEPARTMENT M. Winston Tilghman, M.D. HIV, STD, and Hepatitis Branch Public Health Services LEARNING OBJECTIVE UPON COMPLETION OF THIS TRAINING, PARTICIPANTS WILL BE ABLE TO: Describe local STD epidemiology and the role of the public health department in STD control activities 1
2 STD SURVEILLANCE Dual reporting requirement Laboratory Provider Reportable STDs: Within 24 hours: Syphilis Within 7 days: Gonorrhea Chlamydia, including LGV Chancroid HIV & STD REPORTING 3,695 x 2 = 7,39 2
3 STD SURVEILLANCE SYPHILIS 3
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7 Number of Cases STD Update for Clinicians: San Diego Case Count by Stage of Syphilis San Diego County, Total cases = 1, Primary Syphilis Secondary Syphilis Early Latent Late Latent Stage of Syphilis 7
8 Number of Cases Number of Cases Female and Congenital Syphilis Cases San Diego County, Female Syphilis Congenital Syphilis Primary Syphilis Secondary Syphlis Early Latent Syphilis Confirmed Cases Stillbirths Female Syphilis Congenital Syphilis Note: For public health purposes, congenital syphilis is defined as an infant born to a mother with untreated or inadequately treated syphilis at the time of delivery. Only cases of confirmed neonatal or infant infection are reported here. Primary & Secondary Syphilis Cases by Year San Diego County, Men who have sex with men Other Year Note: The white-shaded numbers within the blue bars represent the number of cases in men who have sex with men per year. The numbers above the columns represents the total number of primary and secondary syphilis cases per year. 8
9 Number of Cases Rate Per 1, Population Rate per 1, Population Primary & Secondary Syphilis Cases and Rates by Year San Diego County, Cases Rate per 1, population Year Primary & Secondary Syphilis Rates by Gender and Year San Diego County, Females Males * Year * Between 214 and 215 the female primary and secondary syphilis rate decreased by 22% and the number of cases decreased by 21%. 9
10 Number of Cases Rate per 1, Population Primary & Secondary Syphilis Cases by Gender and Age San Diego County, Female Male < Age Group Primary & Secondary Syphilis Rates by Gender and Age San Diego County, Female Male < Age Group 1
11 Rate per 1, Population Number of Cases Primary & Secondary Syphilis Cases by Gender and Race/Ethnicity San Diego County, 215 Female Male Native American/ Alaskan Native 45 Asian/Pacific Islander Black Hispanic White Other/Mixed Race Race/Ethnicity 8 12 Note: Excludes 15 cases missing race/ethnicity information. Primary & Secondary Syphilis Rates by Gender and Race/Ethnicity San Diego County, Female Male Native American/ Alaskan Native Asian/Pacific Islander Black Hispanic White Other/Mixed Race Race/Ethnicity Note: Rates exclude 15 cases missing race/ethnicity information. 11
12 Percent Percent of Interviewed MSM Cases MSM* Primary & Secondary Syphilis Cases Co-Infected with HIV by Year San Diego County, % Year *MSM: Men Who Have Sex With Men. Meeting Venues Among Interviewed MSM* Primary & Secondary Syphilis Cases San Diego County, Internet Bathhouses/Sex Clubs Parties Bars/Clubs 55 55% % % 4% Year Note: Reported use of venues is not mutually exclusive. *MSM: Men Who Have Sex With Men. 12
13 Number of Interviewed Cases Reporting Use of Site Percent of Interviewed MSM Cases Reported Use of Internet-Based Services** Among Primary & Secondary MSM* Syphilis Cases San Diego County, Note: Reported use of sites is not mutually exclusive. *MSM: Men who have sex with men. ** Included websites have been used by at least 2 MSM cases per year in 213 or 214. Reported Substance Use of Interviewed MSM* Primary & Secondary Syphilis Cases by Year San Diego County, Methamphetamine Cocaine Alkyl Nitrites (Poppers) Impotence Drugs MDMA (Ecstasy) % 1 5 9% 6% 5% 5% Year Note: Reported substances are not mutually exclusive. *MSM: Men Who Have Sex With Men. 13
14 Primary & Secondary Syphilis Cases by Reporting Facility Type San Diego County, 215 Planned Parenthood 4% Military 2% HIV Care/EIP Facility Other 12% 2% County STD Clinics 39% Student Health 2% Community Health Clinics 13% Correctional Facilities <1% Hospital/Emergency Room/Urgent Care 3% Private MD/HMO 24% 14
15 WHAT IS DRIVING THE CURRENT SYPHILIS EPIDEMIC? SOME POSSIBILITIES INCLUDE: Advances in HIV prevention and treatment Methamphetamine and other substance use Internet sites/hook-up apps Lack of effective biomedical prevention Low funding for STD control Stigma Poverty, access to quality healthcare GONORRHEA 15
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17 Number of Cases Rate per 1, Population Rate per 1, Population Gonorrhea Cases and Rates by Year San Diego County, Cases Rate per 1, population Year Gonorrhea Rates by Gender and Year San Diego County, Females Males Year 17
18 Number of Male Cases Number of cases Rectal or Pharyngeal Gonorrhea Infections in Males San Diego County, Year Gonorrhea Cases by Gender and Age San Diego County, 215 Female Male < Age Group Note: Excludes 5 cases missing gender information and 16 cases missing age information. 18
19 Number of Cases Rate per 1, Population Gonorrhea Rates by Gender and Age San Diego County, Female Male < Age Group Note: Rates exclude 21 cases missing gender or age information. Gonorrhea Cases by Gender and Race/Ethnicity San Diego County, Female Male Native American/ Alaskan Native Asian/Pacific Islander Black Hispanic White Other/Mixed Race Race/Ethnicity Note: 44.7% of cases are missing race/ethnicity data and are not included in counts above
20 Rate per 1, Population Gonorrhea Rates by Gender and Race/Ethnicity San Diego County, Female Male Native American/ Alaskan Native Asian/Pacific Islander Black Hispanic White Other/Mixed Race Race/Ethnicity Note: 44.7% of cases are missing race/ethnicity data and are not included in rates above. Gonorrhea Cases by Reporting Facility Type San Diego County, 215 Other 8% County STD Clinics 22% Planned Parenthood 22% Private MD/HMO 23% Military 7% Student Health 1% Community Health Clinics 9% Correctional Facilities 2% Hospital/Emergency Room/Urgent Care 6% 2
21 CHLAMYDIA 21
22 Number of Cases Rate per 1, Population STD Update for Clinicians: San Diego Chlamydia Cases and Rates by Year San Diego County, Cases Rate per 1, Population Year 22
23 Number of Cases Rate per 1, Population STD Update for Clinicians: San Diego Chlamydia Rates by Gender and Year San Diego County, Females Males Year Rectal or Pharyngeal Chlamydia Infections in Males San Diego County, Year 23
24 Rate per 1, Population Number of Cases Chlamydia Cases by Gender and Age San Diego County, Female 4789 Male < Age Group Note: Excludes 34 cases missing gender information and 8 cases missing age information. Chlamydia Rates by Gender and Age San Diego County, Female Male < Age Group Note: Rates exclude 114 cases missing gender or age information 24
25 Chlamydia Cases by Reporting Facility Type San Diego County, 215 Planned Parenthood 35% Other 3% County STD Clinics 6% Private MD/HMO 24% Hospital/Emergency Room/Urgent Care 6% Military 12% Student Health 1% Community Health Clinics 12% Correctional Facilities 1% 25
26 PUBLIC HEALTH RESPONSE CASE INVESTIGATIONS/PARTNER SERVICES 26
27 LOW- TO NO-COST STD CLINICAL SERVICES GC/CT HOME TESTING PROGRAM 27
28 GONOCOCCAL ISOLATE SURVEILLANCE PROJECT (GISP) Sentinel Sites and Regional Laboratories, 211 CHLAMYDIA SCREENING PROJECT (CLASP) Chlamydia and gonorrhea screening in juvenile detention facility Typical female CT positivity rate of 1-15% Typical female GC positivity rate of 1-3% Treatment provided to those who are released prior to diagnosis 28
29 EDUCATION AND TRAINING DATA AND STATISTICS 29
30 OTHER SERVICES STD Clinical Consultation Pager: (877) Syphilis Histories (619) THANK YOU! ACKNOWLEDGEMENTS Heidi Aiem Tara Beeston Lawrence Wang California Department of Public Health STD Control Branch STD Clinic and Field Services Staff 3
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