INTRODUCTION AND TABLE OF CONTENTS... Page 1

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1 1 California Gonorrhea Surveillance System (CGSS) Quarterly Summary Data Tables for Cases Diagnosed January 1 - December 31, 2009 and Graphs of Trends from for Selected Risk Factors and Subpopulations In response to changing trends in gonorrhea rates, the State of California Sexually Transmitted Disease Control Branch initiated the California Gonorrhea Surveillance System (CGSS), in order to collect risk factor and clinical data on cases beyond what is routinely available through case morbidity reports. This data collection is based on a 10 random sample of the State s reported gonorrhea (GC) cases, with roughly half of the State s local health jurisdictions choosing to over-sample and interview all of their cases. Data collection includes provider-reported clinical variables (symptom status, treatment, etc.) and case-reported variables (detailed demographics, behavioral risk factors). Most analyses are presented with stratification by region and sexual orientation. In tables where both N and n are provided, N represents the number of cases who answered each question, while n represents the number of respondents who answered affirmatively. To account for the sampling scheme and for variable response rates by LHJ, data are weighted prior to analysis. In Tables 1 through 15, weighted count data are rounded to integers. INTRODUCTION AND TABLE OF CONTENTS... Page 1 SEXUAL ORIENTATION Table 1 Weighted and Unweighted Case Counts, by Region and Gender of Sex Partners... Page 2 Definitions of regions... Page 2 NUMBER OF SEX PARTNERS Table 2 Number of Sexual Partners (Categorical) in the 12 Months Prior to GC Infection... Page 3 TREATMENT DATA Table 3 Drug Class Received at Initial Treatment... Page 4 RECREATIONAL DRUG USE Table 4 Meth Use in the 12 Months Prior to Infection... Page 5 Table 5 Sex Partner Meth Use in the 12 Months Prior to Infection... Page 6 Table 6 Popper Use in the 12 Months Prior to Infection... Page 6 VENUES USED TO MEET NEW OR ANONYMOUS SEX PARTNERS Table 7 Internet... Page 7 Table 8 Bathhouses/Spas/Sex Clubs... Page 7 Table 9 Private Parties... Page 7 INCARCERATION Table 10 Case Incarcerated in the 12 Months Prior to Infection... Page 8 Table 11 Sex Partner Incarcerated in the 12 Months Prior to Case s Infection... Page 8 CLINICAL FACTORS Table 12 Symptomatic Infection... Page 9 Table 13 Previous GC Infection in the 12 Months Prior to Infection... Page 9 Table 14 Percent Who Know Their HIV Status... Page 10 Table 15 HIV Status (Percent HIV Positive)... Page 10

2 2 Weighted and Unweighted Totals by Region and Gender of Sex Partners REGION n n n Weighted Weighted 2 N 2 Unweighted N 2 Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL Regions are defined as follows: Northern California Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Placer, Plumas, Sacramento, San Joaquin, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Yolo, Yuba Bay Area (excluding San Francisco) Alameda, Berkeley, Contra Costa, Marin, Napa, San Mateo, Santa Clara, Solano, Sonoma San Francisco County Central California Fresno, Inyo, Kings, Madera, Mariposa, Merced, Mono, Monterey, San Benito, Santa Cruz, Stanislaus, Tulare, Tuolumne Southern California (excluding Los Angeles) Imperial, Kern, Long Beach, Orange, Pasadena, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura Los Angeles County 2 N includes individuals with unknown gender of sex partners; Unknowns excluded from percent calculations and further analyses

3 3 TABLE 2 - NUMBER OF SEXUAL PARTNERS (CATEGORICAL) IN THE 12 MONTHS PRIOR TO GONORRHEA INFECTION Region # Partners 2 n n n Total Northern CA 1 Partner Partners Partners Partners Partners Bay Area 1 1 Partner Partners Partners Partners Partners San Francisco 1 Partner Partners Partners Partners Partners Central CA 1 Partner Partners Partners Partners Partners Southern CA 1 1 Partner Partners Partners Partners Partners Los Angeles 1 Partner Partners Partners Partners Partners # Partners n n n Total State Totals 1 Partner Partners Partners Partners Partners Excludes individuals who reported no sexual partners in the 12 months prior to their infection

4 4 TABLE 3 - DRUG CLASS RECEIVED AT INITIAL TREATMENT Region Drug Class n n n Total Northern CA Recommended Tx Fluoroquinolone alone Other non-recommended Tx Bay Area 1 Recommended Tx Fluoroquinolone alone Other non-recommended Tx San Francisco Recommended Tx Other non-recommended Tx Central CA Recommended Tx Fluoroquinolone alone Other non-recommended Tx Southern CA 1 Recommended Tx Fluoroquinolone alone Other non-recommended Tx Los Angeles Recommended Tx Fluoroquinolone alone Other non-recommended Tx Drug Class n n n Total State Totals Recommended Tx Fluoroquinolone alone Other non-recommended Tx FIGURE 1 PROPORTION OF CASES STATEWIDE THAT RECEIVED A NON-RECOMMENDED GONORRHEA TREATMENT OR NO TREATMENT, BY SETTING OF DIAGNOSIS, 1/1/09 12/31/09 Treated w ith Fluoroquinolone Alone Other non-recommended Tx Untreated Private physician/hmo STD clinic Other Community/Public Health clinic Planned Parenthood/Fam planning Correctional facility Hospital outpatient Emergency Room Urgent care TOTAL

5 5 Risk Factors by Region and Gender of Sex Partners - DRUG USE TABLE 4 - METH USE IN 12 MONTHS PRIOR TO INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL FIGURE 2 - METH USE IN THE 12 MONTHS PRECEDING INFECTION, BY SEXUAL ORIENTATION, CGSS DATA MSM Male Heterosexual Female (All) Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q Data not available or numbers too small to interpret

6 6 Risk Factors by Region and Gender of Sex Partners - DRUG USE TABLE 5 - SEX PARTNER METH USE IN 12 MONTHS PRIOR TO INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL FIGURE 3 - SEX PARTNER METH USE IN THE 12 MONTHS PRECEDING INFECTION, BY SEXUAL ORIENTATION, CGSS DATA MSM Male Heterosexual Female (All) Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 TABLE 6 - POPPER (AMYL NITRATE) USE IN 12 MONTHS PRIOR TO INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL Data not available or numbers too small to interpret

7 7 Risk Factors by Region and Gender of Sex Partners - VENUES TO MEET NEW OR ANONYMOUS SEX PARTNERS TABLE 7 - INTERNET 4 REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL TABLE 8 - BATHS/SPAS/SEX CLUBS 4 REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL TABLE 9 - PRIVATE PARTIES 4 REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL Data not available 4 Calculations for venues are restricted to individuals reporting new or anonymous sex partners

8 8 Risk Factors by Region and Gender of Sex Partners - INCARCERATION TABLE 10 - CASE INCARCERATED IN 12 MONTHS PRIOR TO INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL FIGURE 4: ANY INCARCERATION IN THE 12 MONTHS PRECEDING INFECTION AMONG CASES AND THEIR SEX PARTNERS, CGSS Data Incarcerated Sex Partner Incarcerated MSM Heterosexual Males Females TABLE 11 - SEX PARTNER INCARCERATED IN 12 MONTHS PRIOR TO CASE S INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL Data not available or numbers too small to interpret

9 9 Risk Factors by Region and Gender of Sex Partners - CLINICAL TABLE 12 - SYMPTOMATIC INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL FIGURE 5 - SPECIMEN SOURCE AMONG MSM, BY SYMPTOM STATUS AND SETTING TYPE, STD Clinic Setting non-std Clinic Setting Multiple sites Throat Anus/Rectum Urethra/Penis Urine 20 0 Symptomatic Asymptomatic Symptomatic Aymptomatic TABLE 13 - PREVIOUS GONORRHEA INFECTION IN 12 MONTHS PRIOR TO INFECTION REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL

10 10 Risk Factors by Region and Gender of Sex Partners - CLINICAL TABLE 14 - PERCENT WHO KNOW THEIR HIV STATUS REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL TABLE 15 - HIV STATUS (PERCENT HIV POSITIVE) 5 REGION N n N n N n Northern CA Bay Area San Francisco Central CA Southern CA Los Angeles TOTAL Among those with known HIV status