This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Sexually Transmitted Disease (STD) Surveillance Report, 2017 STD Surveillance System http://www.health.state.mn.us/divs/idepc/dtopics/stds/stats/index.html 1
Introduction 1/2 Under Minnesota law, physicians and laboratories must report all laboratoryconfirmed cases of chlamydia, gonorrhea, syphilis, and chancroid to the Minnesota Department of Health (MDH) within one working day. MDH does not maintain statistics for other, non-reportable STDs (ex: herpes, HPV/genital warts). This slide set describes trends in reportable STDs in Minnesota by person, place, and time. Analyses exclude cases reported from federal and private prisons. 2
Introduction 2/2 STD surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population. STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions. 3
Interpreting STD Surveillance Data 1/2 Factors that impact the completeness and accuracy of STD data include: Level of STD screening by healthcare providers Individual test-seeking behavior Sensitivity of diagnostic tests Compliance with case reporting Completeness of case reporting Timeliness of case reporting Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the above factors 4
Interpreting STD Surveillance Data 2/2 The surveillance system only includes cases with a positive laboratory test. Cases diagnosed solely on symptoms are not counted. Since 2012 we have included cases that had only a lab report and no corresponding case report form. This has increased the number of unknowns in some variables. In 2016, in order to be consistent with CDC, we categorized all White, Hispanic and Black, Hispanic cases as Hispanic. That means the race categories now reflect only White, Non-Hispanic and Black, Non-Hispanic cases Surveillance data represent cases of infection, not individuals. A person with multiple infections in a given year will be counted more than once. Caution is warranted when interpreting changes in STD numbers that can seem disproportionately large when the number of cases is small. 5
National Context 6
Chlamydia Rates of Reported Cases by State United States and Outlying Areas, 2016 NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 494.2 cases per 100,000 population. 7
Gonorrhea Rates of Reported Cases by State United States and Outlying Areas, 2016 NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 144.4 cases per 100,000 population. 8
Primary & Secondary Syphilis Rates of Reported Cases by State United States and Outlying Areas, 2016 NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 8.7 cases per 100,000 population. 9
Overview of STDs in Minnesota 10
STDs in Minnesota Rate per 100,000 by Year of Diagnosis, 2007-2017 Chlamydia Gonorrhea P&S* Syphilis Rate of Chlamydia and Gonorrhea 500 450 400 350 300 250 200 150 100 50 0 * P&S = Primary and Secondary 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 10 9 8 7 6 5 4 3 2 1 0 Rate of P&S Syphilis 11
STDs in Minnesota Number of Cases Reported in 2017 Total of 30,981 STD cases reported to MDH in 2017: 23,528 Chlamydia cases 6,519 Gonorrhea cases 934 Syphilis cases (all stages) 0 Chancroid cases 12
Chlamydia 13
2017 Minnesota Chlamydia Rates by County 14
Chlamydia Infections by Residence at Diagnosis Minnesota, 2017 Total Number of Cases = 23,528 Unknown 2% Minneapolis 21% Greater MN 31% St. Paul 12% Suburban 34% 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. 15
Chlamydia Rates by Gender Minnesota, 2007-2017 Males Females Overall Rate per 100,000 persons 371 259 145 390 388 275 272 158 154 416 292 167 443 319 193 470 340 206 484 353 220 504 375 244 528 400 271 560 428 293 574 444 311 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 16
Chlamydia Rates by Age, Minnesota, 2007-2017 15-19 20-24 25-29 30-39 Rate per 100,000 persons 1539 1507 1423 1162 1220 1059 649 669 639 2336 2391 2424 2244 2142 2015 1907 1651 1316 1385 1458 1394 1402 1403 1061 1102 932 843 698 719 771 1617 1608 213 217 216 230 242 273 291 348 402 441 480 1181 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 17
Age-Specific Chlamydia Rates by Gender Minnesota, 2017 4000 3500 3000 Rate per 100,000 persons 2500 2000 1500 1000 500 0 10-14 15-19 20-24 25-29 30-39 40-44 45-49 50+ Age in Years Males Female 18
Chlamydia Rates by Race/Ethnicity Minnesota, 2007-2017 (1/2) 2017 rates compared with Whites: Black, Non-Hispanic = 9.7x higher American Indian = 5x higher Asian/PI = 2x higher Hispanic* = 3x higher 2020 Rate per 100,000 persons 1825 1727 1631 1611 1619 1661 1587 1527 1524 1517 1083 943 830 730 706 744 780 703 653 649 649 590 424 458 507 522 383 405 434 440 376 379 265 293 263 284 313 284 289 312 334 342 391 125 130 127 143 162 151 158 178 188 193 209 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 * Persons of Hispanic ethnicity can be of any race Year White, Non-Hispanic Black, Non-Hispanic American Indian Asian/PI Hispanic 19
Chlamydia Rates by Race/Ethnicity Minnesota, 2007-2017 (2/2) White, Non_Hispanic American Indian Asian/PI Hispanic* 1083 943 Rate per 100,000 persons 830 780 730 744 706 703 653 649 649 590 507 522 458 424 434 440 383 405 376 379 391 293 313 265 263 284 284 289 312 334 342 125 130 127 143 162 151 158 178 188 193 209 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 20
Gonorrhea 21
2017 Minnesota Gonorrhea Rates by County 22
Gonorrhea Infections in Minnesota by Residence at Diagnosis, 2017 Greater MN 21% Unknown 1% Minneapolis 33% Suburban 29% St. Paul 16% 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. 23
Gonorrhea Rates by Gender Minnesota, 2007-2017 Males Females Overall 136 123 109 110 Rate per 100,000 persons 74 67 59 63 58 53 48 47 48 44 40 41 43 38 34 63 58 53 73 76 70 86 92 77 77 67 63 96 83 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 24
Gonorrhea Rates by Age Minnesota, 2007-2017 15-19 20-24 25-29 30-39 491 416 Rate per 100,000 persons 297 228 186 83 275 214 146 69 216 217 227 165 169 159 117 95 105 50 38 45 290 213 142 65 360 362 352 267 218 238 177 174 123 103 86 302 244 149 363 317 217 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 25
Age-Specific Gonorrhea Rates by Gender Minnesota, 2017 600 500 459 500 478 Rate per 100,000 persons 400 300 200 181 409 314 276 155 100 0 105 81 48 32 16 17 2 4 10-14 15-19 20-24 25-29 30-39 40-44 45-49 50+ Age in Years Males Females 26
Gonorrhea Rates by Race/Ethnicity Minnesota, 2007-2017 (1/2) White, Non-Hispanic Black, Non-Hispanic American Indian Asian/PI Hispanic* Rate per 100,000 persons 690 591 2017 rates compared with Whites: Black, Non-Hispanic = 20x higher American Indian = 13x higher Asian/PI = 2x higher Hispanic* = 3x higher 406 376 410 488 611 543 518 657 321 875 563 217 218 132 152 165 135 102 98 70 94 67 90 22 19 15 15 16 19 23 31 33 37 44 16 24 47 13 13 15 27 32 39 44 63 34 30 37 35 53 75 81 103 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year * Persons of Hispanic ethnicity can be of any race 27
Gonorrhea Rates by Race/Ethnicity Minnesota, 2007-2017 (2/2) White American Indian Asian/PI Hispanic* 563 Rate per 100,000 persons 321 217 218 152 165 132 135 102 98 94 103 90 67 70 75 81 63 47 53 22 19 15 15 16 19 23 31 33 37 44 16 24 34 13 13 15 27 32 39 44 30 37 35 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year * Persons of Hispanic ethnicity can be of any race. 28
Syphilis 29
Syphilis Rates by Stage of Diagnosis Minnesota, 2007-2017 All Stages P&S* Early Latent 17.6 16.1 Rate per 100,000 persons 5 3.6 4.1 2.2 1.1 0.9 1.3 0.9 6.6 6.9 2.8 2.3 2.6 1.4 6.3 2.2 1.8 10.1 3.6 2.6 11.9 12.3 4.8 4.6 3 3.5 5.8 5.9 5.5 4.7 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 * P&S = Primary and Secondary Year 30
2017 Minnesota Primary & Secondary Syphilis Rates by County 31
Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2017 Total Number of Cases = 292 Greater MN 22% Unknown 0% Minneapolis 38% Suburban 31% St. Paul 9% 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. 32
Primary & Secondary Syphilis Rates by Gender Minnesota, 2007-2017 Rate per 100,000 persons Females Overall Males 10.1 9.6 8.9 7.9 6.8 5.8 5.4 5.5 5.1 4.8 4.6 4.3 4.2 3.6 2.7 2.8 2.6 2.2 2.2 2.2 1.5 1.4 1.4 1.1 1.3 0.8 0 0.2 0.3 0 0.2 0.3 0.4 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 12 10 8 6 4 2 0 33
Primary & Secondary Syphilis Rates by Age Minnesota, 2007-2017 15-19 20-24 25-29 30-39 40-49 18.5 16.9 Rate per 100,000 persons 14.9 14.6 13.4 13.4 13.8 13.1 11.3 11.3 9.6 9.3 9.4 9.5 7.3 7.5 6.7 7 7 7 6.4 5.5 5.9 4.9 4.8 5.1 5.4 5.8 4.5 4.9 4.1 4 3.4 3.8 4.2 3.8 3.3 3 2.5 2.7 2.7 2 2.3 2.4 1.4 1.6 0.5 0.8 0.5 0.8 1.1 0.5 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 34
Age-Specific Primary & Secondary Syphilis Rates by Gender Minnesota, 2017 35 30 Males Females Rate per 100,000 persons 25 20 15 10 5 0 15-19 20-24 25-29 30-39 40-44 45-49 50+ Age in Years 35
Primary & Secondary Syphilis Cases by Race Minnesota, 2017 Asian/PI 5% Total Number of Cases = 292 Unknown 2% Hispanic 10% American Indian 11% White, Non-Hispanic 53% Black, Non-Hispanic 19% *Includes persons reported with more than one race 36
Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 2007-2017 Rate per 100,000 persons 50 45 40 35 30 25 20 15 10 5 0 White, Non-Hispanic Black, Non-Hispanic American Indian Asian/PI Hispanic 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year * Persons of Hispanic ethnicity can be of any race. 37
Chlamydia and Gonorrhea among Adolescents & Young Adults 38
Chlamydia Disproportionately Impacts Youth 25-34 yrs 13% MN Population in 2010 (n = 5,303,925) 35+ yrs 53% Chlamydia Cases in 2017 (n = 23,528) 25-29 yrs 19% 30-44 yrs 16% 15-24 yrs 14% <15 yrs 20% 15-24 yrs 62% <15 yrs 0% 45+ yrs 3% 39
Gonorrhea Disproportionately Impacts Youth 25-34 yrs 13% MN Population in 2010 (n = 5,303,925) 35+ yrs 53% Gonorrhea Cases in 2017 25-29 yrs 21% (n = 6,519) 30-44 yrs 26% 45+ yrs 8% 15-24 yrs 14% <15 yrs 20% 15-24 yrs 45% <15 yrs 0% 40
Characteristics of Adolescents & Young Adults Diagnosed With Chlamydia or Gonorrhea in 2017 Cases % of Total Male 5,231 29% Female 12,199 70% Transgender 12 White, Non-Hispanic 6,600 38% Black, Non-Hispanic 5,029 29% Am Indian 555 3% Asian/PI 545 3% Hispanic Other/Unknown 1,152 3,564 TOTAL 17,445 6% 20% Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 41
Characteristics of Adolescents & Young Adults Diagnosed With Chlamydia or Gonorrhea in 2017 Cases % of Total Minneapolis 3,509 20% St. Paul 2,161 12% Suburban MN 5,807 33% Greater MN 5,619 32% Unknown 349 2% TOTAL 17,445 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. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds 42
Chlamydia Rates Among Adolescents & Young Adults by Gender in Minnesota, 2007-2017 Rate per 100,000 persons 1955 544 2103 2124 2334 620 629 661 Males Females 2646 2690 2745 2780 2506 812 845 871 924 980 2970 2976 1063 1079 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Rate= Cases per 100,000 persons based on 2010 U.S. Census counts. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 43
Chlamydia Cases Among Adolescents and Young Adults by Gender and Race, Minnesota, 2017 Males (n = 3,986) Females (n = 10,540) White 35% Black 32% White 43% Black 23% Amer Indian 3% Unknown 21% Hispanic 7% Amer Indian 2% Asian/PI 3% Unknown 21% Hispanic 7% Asian / PI 3% Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 44
Chlamydia Rate Among Adolescents and Young Adults by Race, Minnesota, 2017 Males Females 478 1589 1499 511 1753 1105 RATE PER 100,000 PERSONS 5036 9926 6103 3599 WHITE, NON-HISPANIC BLACK, NON-HISPANIC AMERICAN INDIAN ASIAN/PI HISPANIC Rate= Cases per 100,000 persons based on 2010 U.S. Census counts. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 45
Gonorrhea Rates Among Adolescents & Young Adults by Gender in Minnesota, 2007-2017 468 Rate per 100,000 335 320 172 171 249 263 258 134 125 129 337 167 401 228 329 283 250 240 371 287 337 2001 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Males Females Rate=Cases per 100,000 persons based on 2010 U.S. Census counts. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 46
Gonorrhea Cases Among Adolescents and Young Adults by Gender and Race, 2017 Males (n = 1,245) Females (n = 1,659) White, Non- Hispanic 23% Black, Non- Hispanic 50% Black, Non- Hispanic 45% Unknown 15% Hispanic 6% Other 1% Asian/PI 2% Amer Indian 3% White, Non- Hispanic 23% Unknown 16% Hispanic 5% Other 2% Amer Indian 6% Asian / PI 3% Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 47
Gonorrhea Rate Among Adolescents and Young Adults by Race, Minnesota, 2017 Males Females 99 134 148 229 322 387 582 RATE PER 100,000 PERSONS 2434 3128 2028 WHITE, NON-HISPANIC BLACK, NON-HISPANIC AMERICAN INDIAN ASIAN/PI HISPANIC Rate= Cases per 100,000 persons based on 2010 U.S. Census counts. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 48
Summary of Chlamydia and Gonorrhea Among Adolescents and Young Adults, Minnesota, 2017 Adolescents and young adults accounted for 62% of chlamydia and 45% of gonorrhea cases diagnosed in Minnesota. 70% of chlamydia or gonorrhea cases diagnosed among adolescents and young adults were females. 19% of chlamydia and gonorrhea cases diagnosed among adolescents and young adults are missing race/ethnicity 33% of gonorrhea or chlamydia cases were in the Cities of Minneapolis and Saint Paul. Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. 49
Topic of Interest: Early Syphilis Among Men Who Have Sex With Men in Minnesota 50
Number of Early Syphilis Cases by Gender Minnesota, 2007-2017 All Male MSM Women Number of Cases 511 468 426 374 341 359 298 283 247 261 209 218 222 185 196 158 158 138 111 103 106 96 88 87 91 2 5 9 15 13 18 30 41 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year MSM=Men who have sex with men. Figure does not include cases diagnosed in transgender persons (1 each in 2005, 2007, 2009, 4 in 2013, 1 in 2014, 2 in 2015, 3 in 2017). Early Syphilis includes primary, secondary, and early latent stages of syphilis. 51
Early Syphilis Cases by Stage at Diagnosis Minnesota, 2007-2017 Number of Cases 163 114 117 55 71 38 47 45 21 46 41 30 221 259 214 120 98 88 96 72 51 51 66 52 332 139 117 76 416 159 156 101 431 557 251 605 313 185 164 132 142 155 137 114 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Primary Secondary Early Latent Total Early Syphilis includes primary, secondary, and early latent stages of syphilis. 52
Early Syphilis by Gender and Sexual Behavior Minnesota 2007-2017 MSM=Men who have sex with men Year Early Syphilis Cases Male Cases (%) MSM Cases (% of males) 2007 114 111 (97) 103 (93) 2008 163 158 (97) 140 (89) 2009 117 106 (91) 96 (91) 2010 221 207 (94) 185 (89) 2011 260 246 (95) 218 (89) 2012 214 196 (92) 158 (81) 2013 332 298 (90) 261 (88) 2014 416 374 (90) 283 (76) 2015 431 341 (79) 222 (65) 2016 557 468 (84) 359 (77) 2017 605 511 (84) 426 (83) Early Syphilis includes primary, secondary, and early latent stages of syphilis. 53
Early Syphilis Cases Among MSM by Age Minnesota, 2017 (n=426) Mean Age = 35 years Range: 15 to 65 years NUMBER OF CASES 68 89 67 46 47 39 37 10 23 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ AGE IN YEARS MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis. 54
Early Syphilis (ES) Cases Co-infected with HIV 2007-2017 All ES Cases MSM ES Cases 59% 57% 57% 56% 54% Percent HIV Positive 45% 41% 45% 40% 46% 49% 49% 47% 46% 38% 50% 37% 44% 46% 30% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis. 32% 33% 55
Characteristics of Early Syphilis Cases Among MSM, Minnesota, 2016 Gay and bisexual men account for 77% of cases among men. 62% of cases among MSM are White, but a disproportionate number of cases (17%) are African American. 44% of cases are also infected with HIV. MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis. 56
Topic of Interest: Syphilis Among Females and Congenital Syphilis in Minnesota 57
Female Early Syphilis Cases NUMBER OF FEMALE EARLY SYPHILIS CASES 109 83 88 87 91 Number of Cases 74 52 41 30 22 22 17 18 13 10 12 14 14 13 7 9 6 8 9 5 2 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year 58
Early Syphilis Infections in Women in Minnesota by Residence at Diagnosis, 2017 Total Number of Cases = 91 Unknown 0% Minneapolis 19% Greater MN 47% St. Paul 8% Suburban 26% 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. 59
Early Syphilis Cases in Females by Race Minnesota, 2017 Asian/PI 3% Total Number of Cases = 91 Hispanic 6% Unknown 4% White, Non-Hispanic 29% American Indian 35% Black, Non-Hispanic 23% *Includes persons reported with more than one race 60
What s Being Done in Minnesota? The MDH Partner Services Program continues to follow up on early syphilis cases and their sex partners and all pregnant syphilis cases. All HIV/Syphilis co-infected cases are assigned to Partner Services for follow-up. Physicians are encouraged to screen men who have sex with men at least annually and to ask about sex partners. All pregnant females should be screened for syphilis at first prenatal visit, 28 weeks gestation (at minimum 28-36 weeks), and at delivery. 61
Summary of STD Trends in Minnesota From 2007-2017, the chlamydia rate increased by 71%. The rate of gonorrhea increased by 84%. Rates of reported syphilis increased in 2017 compared to 2016 by 10%. Minnesota has seen a resurgence of syphilis over the past decade, with men who have sex with men and those co-infected with HIV being especially impacted. However, the number of females is near the record high for the last decade. Persons of color continue to be disproportionately affected by STDs. STD rates are highest in the cities of Minneapolis and Saint Paul. However, chlamydia and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for 62% of the reported cases in 2017. Between 2016 and 2017, early syphilis cases increased by 9%. Men who have sex with men comprised 83% of all male cases in 2017; cases among women are continuing to rise. 62
Future Updates to STD Reporting and Current Follow-Up New case report form to accommodate changes in treatment guidelines, requesting HIV testing status, and PrEP (Pre- Exposure Prophylaxis) usage. Case report form is be able to be filled out on a computer and printed to be mailed or faxed in All cases co-infected with HIV (diagnosed in the last year)/gonorrhea, HIV/Syphilis, and Early Syphilis will be continue to be assigned to MDH Partner Services for follow-up All Gonorrhea cases continue to have the potential for being contacted by MDH for additional follow-up 63