STD UPDATE Patrick Loose, Chief HIV, STD & Hepatitis Branch February 15, 2018
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1 Patrick Loose, Chief HIV, STD & Hepatitis Branch February 15, 2018
2 MISSION Improve health outcomes in communities disproportionately impacted by HIV and STDs
3 Collect, study and publish data Diagnose and investigate priority diseases Educate residents about sexual health Work in partnership with communities Provide policy recommendations Connect people to care and treatment services Provide or purchase services Develop workforce capacity & competency Ensure quality Support continued research
4 STD PRIORITIES Prevent congenital syphilis cases Investigate and intervene in infectious syphilis cases Investigate and intervene in syphilis and gonorrhea cases that can lead to HIV transmission Monitor GC resistance PrEP Build capacity of youth-serving organizations to support sexual health
5 STDs Reported Among San Diego County Residents, Chlamydia Gonorrhea Primary & Secondary Syphilis Chlamydia and Gonorrhea Cases Primary and Secondary Syphilis Cases Year Note: Scale for syphilis is on the right.
6 GONORRHEA CALIFORNIA INCIDENCE RATES, Rev. 6/2017
7 PRIMARY & SECONDARY SYPHILIS, CA & UNITED STATES INCIDENCE RATES, Rev. 6/2017
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10 PRIMARY & SECONDARY SYPHILIS, Number of Cases Men who have sex with men 2016 case count = rate = Year Other 490
11 HIV CO-INFECTION AMONG MSM CASES Percent % Year *MSM: Men Who Have Sex With Men.
12 Rates of Primary and Secondary Syphilis among Men who have sex with Men (MSM), men who have sex with women only (MSW), and women. United States, Cases per 100,000 Stonewall riot: June, 1969 First report of AIDS: June, 1981 MSM HAART July 1996 MSW Women Estimated using modified Heffelfinger M:F rate ratio of , assuming no MSM had syphilis in 1994, and estimating 3.9% of men are MSM Peterman et al. Expert Rev Anti Infect Ther. 2015
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14 #7 #22 #7
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18 STD PREVENTION Chlamydia Screening Project STD Community Intervention Project Don t Think, Know
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20 GONORRHEA SURVEILLANCE California Gonorrhea Surveillance System Gonococcal Isolate Surveillance Project
21 Gonococcal Isolate Surveillance Project (GISP), Percent of Neisseria Gonorrhoeae Isolates with CDC "Alert" Values for Selected Cephalosporins in California GISP STD Clinic Sites, 1992 April Cefixime Ceftriaxone Percent of Isolates '92 '93 '94 '95 '96 '97 '98 ' '01 '02 '03 '04 '05 '06 '07 '08 ' '11 '12 '13 ' '16 Year * Cefixime susceptibility was not run in * * Note: Alert values are set by CDC as markers to look at possible decreased susceptibility. Cefixime alerts have MICs 0.25 μg/ml. Ceftriaxone alerts have MICs μg/ml data are provisional as of 6/20/2016. STD Clinic Sites: Long Beach (ended participation in 2007), Los Angeles (added in 2003), Orange, San Diego, San Francisco Rev. 06/2016 STD Control Branch
22 Gonococcal Isolate Surveillance Project (GISP), Percent of Neisseria Gonorrhoeae Isolates with CDC "Alert" Values for Azithromycin in California GISP STD Clinic Sites, 1992 April Percent of Isolates '92 '93 '94 '95 '96 '97 '98 ' '01 '02 '03 '04 '05 '06 '07 '08 ' '11 '12 '13 ' '16 Year Note: Alert values are set by CDC as markers to look at possible decreased susceptibility. Azithromycin alerts have MICs 2.0 μg/ml. No data before data are provisional as of 6/20/2016. STD Clinic Sites: Long Beach (ended participation in 2007), Los Angeles (added in 2003), Orange, San Diego, San Francisco Rev. 06/2016 STD Control Branch
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25 STD CLINICAL SERVICES Rosecrans STD Clinic Central Regional Public Health Center North Coastal Regional Public Health Center South Regional Public Health Center
26 STD & HIV FIELD SERVICES Syphilis Investigation HIV Results Disclosure HIV/STD Integration (Rectal GC) Partner Services (HIV, Syphilis, some GC) Surveillance- Based HIV Partner Services Data to Care
27 OPPORTUNITIES AND FUTURE DIRECTIONS Increase epidemiology workforce to collect and analyze data Integrate HIV and STD epidemiology and surveillance Expand workforce Invest in workforce competency development Develop medical systems capacity to prevent congenital syphilis Advocate for increased funding and resources for STDs Advocate for building capacity of medical systems and youthserving organizations to address sexual health Advocate for research
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