City and County of Denver Sexually Transmitted Infections Surveillance Report 2005

City and County of Denver Sexually Transmitted Infections Surveillance Report 2005 Denver Public Health Department Sexually Transmitted Disease Control Program November 2006

This report was prepared by: Cornelis A. Rietmeijer, MD, PhD Douglas B. Richardson Christie J. Mettenbrink BS, MSPH, MT (ASCP) With statistical support from: L. Dean McEwen, MBA Denver Public Health Department STI Control Program 605 Bannock Street Denver, CO 80204 Tel. (303) 436-7200 Fax. (303) 436-7211 Email: krietmei@dhha.org 2

Contents Introduction 4 HIV/AIDS 5 Gonorrhea 6 Chlamydia 6 Syphilis 6 Trends in the Denver Metro Health Clinic 7 STI trends among men who have sex with men 8 Reproductive Health for Young Adults 8 Comment 9 Technical Notes 11 References 12 Figures 13 Tables 19 3

Introduction This is the third annual report of reportable sexually transmitted infections (STI) in the City and County of Denver. Since the Denver Metro Health Clinic (DMHC) at Denver Public Health reports more than 50% of all reportable STI in the City and County of Denver, operational changes at this clinic may have considerable impact on STI morbidity reporting in the Denver jurisdiction, impeding the interpretation of trend data. As has been mentioned in previous reports, the institution of a clinic co-pay in December 2002 resulted in a considerable drop in reported STI in 2003 1, with a modest rebound reported in 2004 due to a number of activities to counteract the negative impact of the copay system. Foremost among these activities was the offering of a no-cost, screeningonly Express Visit for lower-risk clinic clients. Even though the co-pay was largely rescinded in January 2005, the number of visits to the clinic in 2005 stagnated at a level approximately 25% lower than the number of visits in the year prior to the institution of the co-pay. This stagnation is likely compounded by another change in clinic operations: the transition to a fully electronic medical record in March 2005 that resulted in a temporary slowdown in clinic flow. To offset this negative effect, the clinic expanded the Express Visit option, which currently accounts for 25% of all clinic visits. As we have managed and are managing these changes at DMHC, we expect that morbidity reporting will be less affected by operational factors in the clinic and will once again better reflect trends in STI morbidity among the citizens of the City and County of Denver. 4

HIV/AIDS In 2005, 265 cases of HIV infection were newly reported for the City and County of Denver, compared to 258 cases in 2004. Of cases in 2005, 74 (27.9%) had an AIDS defining condition at the time of HIV diagnosis or had progressed to AIDS within the year. In addition, 152 persons diagnosed with HIV infection prior to 2004 had progressed to AIDS during the year. Thus of 226 persons diagnosed with AIDS in 2004, 32.7% were first diagnosed with HIV infection during the same year. An unduplicated cumulative total of 11,150 persons have been diagnosed with HIV or AIDS in the City and County since 1982. Figure 1 shows trend data since 1985. After peaking in 1987 at 1,077 cases, a gradual decrease occurred until 1998 when 278 cases were reported. Since then incidence has stabilized. Reported AIDS cases peaked with 563 cases in 1993, declined to 207 cases in 2001 and have since stabilized. Figure 2 shows trends in the relative proportions of diagnosed HIV and AIDS cases. For this analysis, cases were unduplicated within the year, i.e., persons diagnosed with AIDS within the same year as they were diagnosed with HIV were counted as AIDS cases for that year and not as HIV cases. The proportion of AIDS cases increased from 12.8% of all cases in 1985 to 61.8% in 1994 and started to decline again to 53.0% in 2003 and 54.2% in 2005. Trends in demographic and risk factors appear in Figures 3-6. Denominators for these analyses comprise all cases of HIV and/or AIDS by first year of report. Women comprised 2.5% of cases in 1985, gradually increasing to 14.7% in 2001 but then decreasing to 12.0% in 2005 (Figure 3). among non-whites increased from 17.6% in 1985 to 50.0% in 2001 and then decreased to 43.4% in 2005. In 2005, 15.6% of new cases were diagnosed among blacks and 26.4% among Hispanics (Figure 4). Men who have sex with men (MSM) continue to be the single most important risk group for HIV infection in the Denver area. In 1985, 92.5% of all cases were reported for MSM or MSM who also injected drugs. Over time, this proportion decreased to 66.9% in 2000 and the again increased to 74.0% in 2005. Injection drug users comprised 8.7% of cases in 2005, which has been a steady decrease since 1996 when 14.2% of cases were diagnosed in this risk group. Heterosexual contact as an only risk factor was reported for 10.2% of cases in 2005, which has been relatively stable since 1996. (Figure 5). Since the beginning of the epidemic, there has been a gradual increase in age at first diagnosis of HIV/AIDS. In 1985, only 27.8% were 35 years or older; in 2005 50.6% of cases fell into that age category (Figure 6). The median age at diagnosis increased form 30 in 1985 to 35 in 2005 (Figure 7). 5

As of December 31, 2005, a total of 7,065 persons were alive with HIV/AIDS in the City and County of Denver; of these, 3,115 (44.1%) had an AIDS diagnosis. Gonorrhea During the year, 1,331 cases of gonorrhea were reported in the City and County of Denver, a decrease of 44 cases (3.2%) compared with the previous year (Figure 8). However, while cases decreased from 617 to 535 among women (a decrease of 82 or 13.2%), cases increased among males from 758 to 796 (an increase of 38 cases or 5.0%). In the past 5 years, reported gonorrhea cases increased from 1,566 cases in 2001 to 1,738 cases in 2002, declined to 1,292 cases in 2003, and then increased to 1,375 in 2004 (Table 1). The overall case rate fell from 247 cases per 100,000 in 2004 to 239 cases per 100,000 in 2005 (Table 1). As in previous years, case rates in 2005 were higher among males, younger age groups, and African American populations. Among males the case rate (per 100,000) was 281 compared to 195 among females (Table 2). Case rates were highest among 20-24 year-old males (878; Table 3a) and 15-19 year-old females (1,219; Table 3b). Rates among blacks (1,012) were 4.3 times higher than among Hispanics (235) and 9.2 times higher than among whites (110). Rates were highest among 25-29 year-old black men (5,985; Table 5e) and 20-24 year-old black women (4,306; Table 5f). Chlamydia In 2005, 4,221 cases of chlamydia infection were reported for the City and County of Denver. Compared to the previous year, this represents an increase of 6.2% (248 cases). This follows the 8% increase in 2004 that in turn followed a substantial (16%) decrease noted in 2003 when compared to 2002 (Figure 9). The chlamydia case rate (per 100,000) in 2005 increased to 758 from 713 in 2004. The case rate continued to be considerably higher among women (1038) than among men (486; Table 2), but the increases from 2004 were similar for both sexes (6.2% and 6.8% respectively). Age/gender groups with highest rates included 15-19 year-old females (7,211), 20-24 year-old females (5,780; Table 3b), and 20-24 year-old males (2,295; Table 3a). As before, case rates were higher among blacks (2,170) than among Hispanics (1,225), and whites (209; Table 4). Highest chlamydia rates were reported for 20-24 year-old black women (13,795) followed by 15-19 year-old black women (12,547), 25-29 year-old black women (6,381; Table 5f), 15-19 year-old Hispanic women (9,474) and 20-24 year-old Hispanic women (8,494; Table 5i). Syphilis In 2005, a total of 28 cases of primary and secondary syphilis were reported, down from 41 cases in 2004, a 31.7% decrease. In addition, there were 11 cases of early latent syphilis for the year, compared to 13 in the previous year. Recent trends in cases and case rates for primary and secondary syphilis are illustrated in Figure 10. Case rates (per 6

100,000) were considerably higher among men (9.5) compared to women (0.4), representing a male-to-female ratio of 23.8. Rates were highest in the 35-39 year-old male age group (29.8; Table 3a). In 2005, rates were higher among whites (5.7) and blacks (5.4) compared to Hispanics (4.7; Table 4). Of the 39 cases of early (primary, secondary, and early latent) syphilis reported for the City and County in 2005 (for whom race/ethnicity was known), 64.1% were among whites, 28.2% among Hispanics, and 7.6% among blacks, compared to respectively 56.4%, 30.9%, and 10.9% in 2004. Trends in the Denver Metro Health Clinic In March, 2005, the Denver Metro Health Clinic (DMHC) switched to an electronic medical record system that necessitated a complete overhaul of the clinic s computer system and associated databases. This also allowed the clinic its first major revision and update of its clinical charting system in almost 20 years. As a result, a number of clinic metrics changed and cannot be easily compared with previous years, specifically those related to number of clinic visits and services delivered. In addition, to offset the negative impact of the clinic co-pay system in 2003, the clinic started to offer a no-cost express visit option that only included chlamydia and gonorrhea urine NAAT testing, and later expanded to include rapid HIV testing as well as RPR screening for syphilis. While the clinic co-pay was largely rescinded in 2005, the express visit option was continued, in part to relieve the impact of the introduction of the electronic medical record on clinic flow. During 2005, the clinic had 18,398 unduplicated patient visits, including 12,966 comprehensive STD evaluations and 2,555 express visits. The total of these two services (15,521) is comparable and roughly equal to the number of clinic visits in 2004 (15,333). In addition, 1,380 clients accessed the independent HIV counseling and testing site in the clinic, 2,261 accessed family planning services and 208 made visits to the DMHC teen clinic. Outreach activities included STD and HIV testing of 669 inmates at the Denver County Jail and of 1,124 patrons of the three Denver bathhouses. For the year, a total of 1,808 cases of chlamydia were diagnosed at DMHC compared to 1,773 in 2004, an increase of 1.9%. This increase was due to a higher number of cases among men (+3.4%), while the number of cases among women decreased slightly (- 0.9%). The number of diagnosed cases of gonorrhea decreased from 837 in 2004 to 798 in 2005 (-4.6%). This decline was specifically due to a decrease among women (-22.0%), while cases among men remained unchanged. The number of cases of primary and secondary syphilis decreased from 25 in 2004 to 18 in 2005, a decrease of 28% (Table 7). Five-year trends in patient volume and diagnosed cases of chlamydia and gonorrhea are presented in Figure 11. Overall case rates (i.e., number of cases/number of visits) were 11.9% and 5.1% for chlamydia and gonorrhea respectively. While cases have increased over the past two year, they have not reached the level of 2002. 7

STI Trends among Men Who Have Sex with Men In 2005 there were 944 visits to DMHC by men who reported a male sex partner in the previous year, comprising 6.2% of all clinic visits. This is down 14.9% from 1,110 visits in 2002, but up 27.2% from 746 visits in 2003 and 9.9% form 944 visits in 2004. Gonorrhea was diagnosed at 144 visits (15.8%) in 2005, compared to 92 visits (13.2%) in 2003 and 86 visits (10.7%) in 2004. Overall, gonorrhea among MSM accounted for 24.1% of all male cases in the clinic in 2005, compared to 14.3% in 2004. Chlamydia was diagnosed at 73 visits (8.2%) in 2005, compared to 52 visits (7.0%) in 2003, and 59 visits (7.4%) in 2004. Primary and secondary syphilis were diagnosed at 13 visits (1.4%) in 2005, compared to 6 visits (0.8%) in 2003, and 13 visits (1.5%) in 2004. In 2005, among 113 MSM with HIV infection (self-reported or by test at the day of visit), 27% (n=31) had gonorrhea, 8% (n=9) had chlamydia and 7% (n=8) had primary or secondary syphilis, compared to respectively 11%, 7%, and 0.7% among un-infected MSM. Of all gonorrhea, chlamydia and primary and secondary syphilis infections diagnosed among MSM in 2005, respectively 22%, 12%, and, 62% were among HIV-infected MSM. Reproductive Health for Young Adults (ReHYA) With the introduction of nucleic acid amplification testing (NAAT) for gonorrhea and chlamydia in the mid-1990s, Denver Public Health was among the first public health departments in the country to use this non-invasive, urine-based technique to screen for these pathogens among asymptomatic, high-risk individuals in non-clinical settings, including juvenile detention centers, school-based clinics, community-based organizations, and street outreach. In 2005, 2,787 urine samples were tested through the ReHYA program, up 31% from the previous year. Of these samples, 384 (13.8%) tested positive for chlamydia and 67 (2.4%) for gonorrhea. Five-year testing and positivity trends are shown in Figure 12. Data on testing volume and positivity rate by venue are summarized in Table 9a. The largest positivity rates were seen among women in juvenile detention centers (chlamydia 20.5%; gonorrhea 8.1%, Table 9c), followed by males in school-based clinics (chlamydia 14.8%, gonorrhea 3.4%, Table 9b). 8

Comment MSM continue to account for a disproportionate number of STIs, particularly HIV, gonorrhea, and syphilis. While the proportion of first-diagnosed HIV/AIDS accounted for by MSM and MSM who also inject drugs had decreased to an all-time low of 66.9% in 2000, this proportion has since steadily increased to 74.0% in 2005. At the same time, the number of MSM who make visits to DMHC also continues to increase as is the proportion of MSM diagnosed with gonorrhea at the clinic. While the absolute numbers of new HIV/AIDS cases among MSM has remained relatively stable since 2000, the non- HIV STI trends are worrisome and should prompt a renewed prevention effort among this vulnerable population. In this context, enhancements in the DPH HIV testing programs that include a more routine offering of HIV testing at DMHC, the use of rapid tests to increase the likelihood that infected individuals will learn their positive results, and an extensive linkage to care and prevention program for those infected, are steps in the right direction. Since more than 50% of chlamydia and gonorrhea cases in the City and County of Denver are reported from one of the Denver Public Health STI programs (including clinic and outreach programs), variations in the operations of these programs may have significant impact on STI morbidity reporting. For example, as we have reported on previously, the institution of a co-pay system at DMHC resulted in dramatic decreases of reported chlamydia and gonorrhea cases in 2003 and, even though the co-pay was largely rescinded in 2005, our 2005 report shows that we have yet to fully recover from that impact. The introduction of a new electronic medical record system at DMHC in March of 2005 compounded the problem as the transition into the new system was accompanied by a slowing of patient flow for a number of months and an associated decrease in the number of patients that could be given a full exam during the day. This negative effect was largely offset by the expansion of the express visit which had been introduced in 2004 as a no-cost, screening-only option to compensate for the fall in patient volume due to the co-pay. While the numbers of reported chlamydia and gonorrhea cases are once again approaching normal levels, there remains a serious concern that clinic-based programs will continue to seriously underestimate the real morbidity in the community. Over 80% of chlamydial infections in women and over 50% of infections among males are asymptomatic and, while gonococcal infections are more likely to be symptomatic among males, many such infections, especially among women, are asymptomatic as well. Since clinics rely for a large part on patients who self-refer because they have symptoms, large numbers of cases will remain undetected, thus fuelling endemic levels of these infections that appear to have been stable for many years. Clearly, innovative, sustainable programs focusing on high-risk, asymptomatic individuals are necessary to make a substantial impact on the spread of chlamydia and gonorrhea in the community. The ReHYA program, in existence for over 10 years, has attempted to do this by offering non-invasive, urine-based screening in venues with concentrations of high-risk individuals. As shown in this report, chlamydia positivity 9

rates in a number of these venues exceed the overall positivity rate at DMHC which is all the more concerning as the clinic population is self-selected for symptoms whereas the venue-based population is not. Our data stress the importance of conducting outreach testing in these and other high-risk venues and offer a strong rationale to expand these programs. 10

Technical Notes Data for reportable STIs, including HIV/AIDS, syphilis, gonorrhea, and chlamydia are sent electronically from the Colorado Department of Public Health and Environment (CDPHE) to the Denver Public Health Department (DPH) on a monthly basis. HIV/AIDS cases are downloaded from the CDC HIV/AIDS Reporting System (HARS), while other STIs are downloaded from the STD Management System (SMS). Both HARS and SMS are CDC-supported databases maintained at CDPHE. Downloads include reportable cases with a City and County of Denver domicile or cases that have been diagnosed at Denver Health (including the Denver Metro Health Clinic and HIV Counseling and Testing Site) but have a domicile outside the City and County of Denver. Individual persons may be included more than once if they have multiple diagnoses, or if they have the same diagnosis at different times. However, persons with manifestations of a single STI at multiple anatomical sites (e.g., simultaneous urethral and pharyngeal gonorrhea) on the same date are counted as a single case. HIV-infected patients who move into the Denver jurisdiction in a given year are included in the HARS database by the year that they were first diagnosed with HIV and/or AIDS. By contrast, patients who move out of the jurisdiction will stay in the database. Therefore, year-to-year statistics will show slight upward variations even for the earlier years of the HIV epidemic. Case reporting for notifiable STI is incomplete and completeness of reporting may vary from year to year. Moreover, many case reports have missing data. Most importantly, information on race/ethnicity is often missing. For the City and County of Denver in 2005, race/ethnicity data were not available for 25.7% of gonorrhea case reports, 39.3% of chlamydia reports, and 12.1% of syphilis reports. We used the method used by the Centers for Disease Control and Prevention to prorate cases according to the distribution of cases for which these variables were specified. 2 Rates of infection were calculated using population estimates for the years 2001-2005 from the U.S. Census Bureau. 3 11

References 1. Rietmeijer CA, Alfonsi GA, Douglas JM, Lloyd LV, Richardson DB, Judson FN. Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infections after the introduction of a copayment in a sexually transmitted infection clinic. Sex Transm Dis. Apr 2005;32(4):243-246. 2. CDC. Sexually Transmitted Disease Surveillance, 2003.Atlanta, GA: U.S. Department of Health and Human Services, September 2004. 3. U.S. Census Bureau. http://www.census.gov/popest/counties/asrh/cc-est2004- alldata.html. Accessed October 26, 2005. 12

Figure 1 1200 HIV and AIDS By Year of first Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 1000 800 600 400 HIV AIDS 200 0 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Figure 2 HIV (no AIDS in same year ) and AIDS By Year of Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% AIDS HIV 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 13

Figure 3 HIV/AIDS by Gender Year of First HIV Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 100% 80% 60% 40% Female Male 20% 0% 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Figure 4 HIV/AIDS by Race/Ethnicity Year of First HIV Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 100% 80% 60% 40% 20% Other Native Hispanic Black White 0% 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 14

Figure 5 HIV/AIDS by Mode of Exposure Year of First HIV Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 100% 80% 60% 40% 20% OTHER HETERO IDU MSM/IDU MSM 0% 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Figure 6 HIV/AIDS by Age Year of First HIV Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 100% 80% 60% 40% >59 55-59 50-54 45-49 40-44 35-39 20% 0% 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 30-34 25-29 20-24 15-19 <15 15

Figure 7 Median Age at HIV/AIDS Diagnosis Year of First HIV Report HIV/AIDS Surveillance City and County of Denver, 1985-2005 39 37 35 33 31 29 27 25 Age 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Figure 8 Gonorrhea Reported and Case Rate per 100,000 City and County of Denver 2000-2005 Rate / 100,000 2000 350 1800 1600 1400 300 250 1200 1000 800 200 150 Rate 600 400 200 100 50 0 2001 2002 2003 2004 2005 0 16

Figure 9 4600 Chlamydia Reported and Case Rate per 100,000 City and County of Denver 2000-2004 Rate / 100,000 800 4400 4200 780 760 740 4000 3800 720 700 680 Rate 3600 660 3400 640 620 3200 2001 2002 2003 2004 2005 600 Figure 10 Primary and Secondary Syphilis Reported and Case Rates per 100,000 City and County of Denver 2000-2005 Rate / 100,000 50 9 45 40 35 30 25 20 15 10 5 8 7 6 5 4 3 2 1 Rate 0 2000 2002 2003 2004 2005 0 17

Figure 11 Gonorrhea and Chlamydia Diagnoses Denver Metro Health Clinic 2000-2005 2500 2000 1500 1000 500 2001 2002 2003 2004 2005 0 Gonorrhea Chlamydia Figure 12 Reproductive Health for Young Adults Numbers of Tests Chlamydia (CT) and Gonorrhea (GC) Positivity Rates 3500 % Positive 16 3000 14 2500 2000 1500 1000 12 10 8 6 4 Tests CT GC 500 2 0 2001 2002 2003 2004 2005 0 18

TABLE 1. Reportable STD cases and rates, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A ll A ll A ll 1566 1738 1292 1375 1331 278.9 311.7 232.4 246.9 239.0 Chlamydia 4164 4359 3678 3973 4221 741.6 781.7 661.5 713.5 758.0 Syphilis, all 60 99 91 89 66 10.7 17.8 16.4 16.0 11.9 Syphilis, P&S 15 45 32 43 28 2.7 8.1 5.8 7.7 5.0 Syphilis, Early 18 59 45 56 39 3.2 10.6 8.1 10.1 7.0 TABLE 2. Reportable STD cases and rates by gender, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A ll Male A ll 864 1018 682 758 796 304.0 360.1 241.6 267.8 281.2 Female 702 720 610 617 535 253.2 261.9 222.8 225.4 195.4 Chlamydia Male 1187 1320 1077 1289 1376 417.6 466.9 381.5 455.4 486.1 Female 2972 3038 2597 2678 2842 1071.9 1104.9 948.7 978.2 1038.1 Syphilis, all Male 40 84 75 71 60 14.1 29.7 26.6 25.1 21.2 Female 20 15 16 18 6 7.2 5.5 5.8 6.6 2.2 Syphilis, P&S Male 13 45 31 38 27 4.6 15.9 11.0 13.4 9.5 Female 2 0 1 5 1 0.7 0.0 0.4 1.8 0.4 Syphilis, Early Male 16 58 42 48 38 5.6 20.5 14.9 17.0 13.4 Female 2 1 3 8 1 0.7 0.4 1.1 2.9 0.4 19

TABLE 3a. Estimated reportable STD cases and rates, males by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A ll Male 10-14 years 6 1 2 3 2 36.3 6.1 12.0 17.8 12.2 15-19 years 105 97 77 82 95 657.1 640.1 522.9 559.5 637.7 20-24 years 180 219 149 169 166 809.6 1080.6 787.0 948.6 878.0 25-29 years 186 201 130 133 155 596.6 687.9 479.7 532.6 638.3 30-34 years 140 172 108 124 117 453.4 539.7 334.5 383.0 376.1 35-39 years 90 137 102 98 100 361.7 546.1 398.0 372.8 372.3 40-44 years 51 97 61 66 53 235.3 446.4 282.4 298.1 240.8 45-54 years 90 77 40 51 75 242.7 208.2 108.5 138.9 204.7 55+ years 16 16 11 18 30 36.0 35.3 23.8 38.2 62.2 Chlamydia 10-14 years 8 5 2 3 7 48.4 30.3 12.0 17.8 42.7 15-19 years 267 240 169 201 227 1670.9 1583.7 1147.6 1371.5 1523.8 20-24 years 389 444 360 440 434 1749.7 2190.8 1901.5 2469.8 2295.4 25-29 years 232 269 246 286 295 744.2 920.6 907.7 1145.3 1214.8 30-34 years 119 170 126 158 182 385.4 533.4 390.3 488.1 585.1 35-39 years 94 95 79 92 99 377.8 378.7 308.2 350.0 368.6 40-44 years 32 51 47 49 49 147.6 234.7 217.6 221.3 222.7 45-54 years 37 36 36 37 56 99.8 97.3 97.6 100.8 152.9 55+ years 5 7 9 18 24 11.3 15.5 19.5 38.2 49.8 Syphilis, all 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 0 1 2 0.0 0.0 0.0 6.8 13.4 20-24 years 4 3 4 7 7 18.0 14.8 21.1 39.3 37.0 25-29 years 6 10 11 4 6 19.2 34.2 40.6 16.0 24.7 30-34 years 7 17 11 10 9 22.7 53.3 34.1 30.9 28.9 35-39 years 6 21 15 14 14 24.1 83.7 58.5 53.3 52.1 40-44 years 6 15 15 12 13 27.7 69.0 69.5 54.2 59.1 45-54 years 7 14 14 7 5 18.9 37.9 38.0 19.1 13.6 55+ years 4 4 1 7 4 9.0 8.8 2.2 14.9 8.3 Syphilis, P&S 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 0 1 1 0.0 0.0 0.0 6.8 6.7 20-24 years 0 1 3 5 3 0.0 4.9 15.8 28.1 15.9 25-29 years 3 5 3 2 1 9.6 17.1 11.1 8.0 4.1 30-34 years 2 10 4 6 5 6.5 31.4 12.4 18.5 16.1 35-39 years 2 14 5 7 8 8.0 55.8 19.5 26.6 29.8 40-44 years 3 7 8 6 5 13.8 32.2 37.0 27.1 22.7 45-54 years 3 7 5 3 1 8.1 18.9 13.6 8.2 2.7 55+ years 0 1 1 2 3 0.0 2.2 2.2 4.2 6.2 Syphilis, Early 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 0 1 1 0.0 0.0 0.0 6.8 6.7 20-24 years 1 3 3 6 6 4.5 14.8 15.8 33.7 31.7 25-29 years 5 6 6 2 2 16.0 20.5 22.1 8.0 8.2 30-34 years 2 12 6 9 6 6.5 37.7 18.6 27.8 19.3 35-39 years 2 18 7 11 10 8.0 71.8 27.3 41.8 37.2 40-44 years 3 10 14 7 7 13.8 46.0 64.8 31.6 31.8 45-54 years 3 8 5 3 3 8.1 21.6 13.6 8.2 8.2 55+ years 0 1 1 3 3 0.0 2.2 2.2 6.4 6.2 20

TABLE 3b. Estimated reportable STD cases and rates, females by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A ll Female 10-14 years 16 23 9 14 12 102.8 148.0 56.6 87.4 76.9 15-19 years 232 229 192 173 170 1573.0 1632.1 1410.8 1273.2 1218.6 20-24 years 219 215 198 166 177 1096.8 1218.1 1242.5 1103.7 1076.9 25-29 years 102 120 90 122 74 369.6 457.4 365.9 541.1 336.2 30-34 years 60 59 62 52 45 232.5 219.0 225.6 188.5 171.1 35-39 years 43 39 29 38 26 205.2 189.1 139.4 176.4 119.4 40-44 years 18 25 20 24 16 90.9 127.3 103.7 124.7 84.8 45-54 years 8 9 10 15 13 22.0 25.1 28.0 42.5 37.5 55+ years 2 0 0 3 2 3.4 0.0 0.0 4.9 3.2 Chlamydia 10-14 years 67 76 44 51 51 430.5 489.2 276.8 318.4 327.0 15-19 years 1063 1055 858 873 1006 7207.3 7519.1 6304.7 6424.8 7211.5 20-24 years 1067 1084 924 912 950 5343.8 6141.6 5798.2 6063.8 5780.0 25-29 years 456 455 427 455 433 1652.5 1734.3 1735.9 2018.2 1967.3 30-34 years 188 202 202 218 201 728.5 749.7 734.9 790.2 764.4 35-39 years 82 89 75 81 91 391.3 431.6 360.5 376.1 417.9 40-44 years 28 35 36 40 37 141.4 178.3 186.7 207.8 196.1 45-54 years 10 28 19 24 32 27.5 77.9 53.2 68.0 92.3 55+ years 5 6 3 16 28 8.4 10.0 5.0 26.0 44.8 Syphilis, all 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 1 1 2 2 1 6.8 7.1 14.7 14.7 7.2 20-24 years 3 2 1 0 1 15.0 11.3 6.3 0.0 6.1 25-29 years 3 1 5 4 2 10.9 3.8 20.3 17.7 9.1 30-34 years 5 3 2 2 1 19.4 11.1 7.3 7.2 3.8 35-39 years 3 2 2 3 0 14.3 9.7 9.6 13.9 0.0 40-44 years 0 2 1 2 1 0.0 10.2 5.2 10.4 5.3 45-54 years 5 1 1 2 0 13.7 2.8 2.8 5.7 0.0 55+ years 0 3 1 2 0 0.0 5.0 1.7 3.3 0.0 Syphilis, P&S 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 20-24 years 1 0 0 0 1 5.0 0.0 0.0 0.0 6.1 25-29 years 1 0 0 0 0 3.6 0.0 0.0 0.0 0.0 30-34 years 0 0 0 1 0 0.0 0.0 0.0 3.6 0.0 35-39 years 0 0 1 2 0 0.0 0.0 4.8 9.3 0.0 40-44 years 0 0 0 1 0 0.0 0.0 0.0 5.2 0.0 45-54 years 0 0 0 1 0 0.0 0.0 0.0 2.8 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Syphilis, Early 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 1 0 0 0.0 0.0 7.3 0.0 0.0 20-24 years 1 0 0 0 1 5.0 0.0 0.0 0.0 6.1 25-29 years 1 0 1 1 0 3.6 0.0 4.1 4.4 0.0 30-34 years 0 1 0 2 0 0.0 3.7 0.0 7.2 0.0 35-39 years 0 0 1 2 0 0.0 0.0 4.8 9.3 0.0 40-44 years 0 0 0 2 0 0.0 0.0 0.0 10.4 0.0 45-54 years 0 0 0 1 0 0.0 0.0 0.0 2.8 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 21

TABLE 4. Estimated reportable STD cases and rates by race, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A sian/pi A ll A ll 9 18 16 10 8 53.5 108.7 93.5 57.5 48.1 Black 820 792 637 681 559 1370.9 1353.3 1107.5 1201.5 1011.8 Hispanic 433 473 348 342 447 240.8 258.7 186.8 180.4 234.5 Native A mer 7 10 5 10 8 174.8 252.9 133.1 271.1 226.5 White 296 444 285 331 308 101.7 155.4 101.3 118.5 109.7 Chlamydia A sian/pi 42 56 61 49 36 249.7 338.3 356.6 282.0 216.5 Black 1601 1407 1095 1196 1199 2676.7 2404.2 1903.9 2110.1 2170.3 Hispanic 1757 2049 1802 2053 2336 977.0 1120.5 967.4 1082.7 1225.6 Native A mer 8 17 10 29 48 199.8 429.9 266.2 786.1 1359.0 White 749 806 694 644 588 257.3 282.1 246.7 230.6 209.4 Syphilis, all A sian/pi 1 2 1 2 0 5.9 12.1 5.8 11.5 0.0 Black 8 11 17 13 8 13.4 18.8 29.6 22.9 14.5 Hispanic 32 33 28 30 22 17.8 18.0 15.0 15.8 11.5 Native A mer 0 1 0 0 0 0.0 25.3 0.0 0.0 0.0 White 14 50 42 42 36 4.8 17.5 14.9 15.0 12.8 Syphilis, P&S A sian/pi 0 1 0 1 0 0.0 6.0 0.0 5.8 0.0 Black 0 0 6 4 3 0.0 0.0 10.4 7.1 5.4 Hispanic 4 9 4 14 9 2.2 4.9 2.1 7.4 4.7 Native A mer 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 White 11 35 21 24 16 3.8 12.2 7.5 8.6 5.7 Syphilis, Early A sian/pi 0 1 0 1 0 0.0 6.0 0.0 5.8 0.0 Black 0 1 9 6 3 0.0 1.7 15.6 10.6 5.4 Hispanic 7 16 11 17 11 3.9 8.7 5.9 9.0 5.8 Native A mer 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 White 11 41 25 31 25 3.8 14.3 8.9 11.1 8.9 22

TABLE 5a. Estimated reportable STD cases and rates, Asians & Pacific Islanders, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A sian/pi A ll 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 1 4 4 1 0 118.5 536.2 547.9 141.2 0.0 20-24 years 4 4 3 3 7 269.7 304.9 249.0 261.8 527.5 25-29 years 1 6 5 1 0 36.6 236.0 202.3 43.8 0.0 30-34 years 2 4 3 4 0 91.6 169.0 114.7 142.5 0.0 35-39 years 0 0 1 0 1 0.0 0.0 66.4 0.0 57.1 40-44 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 45-54 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 14 11 10 7 8 1658.8 1474.5 1369.9 988.7 1181.7 20-24 years 8 12 20 22 11 539.4 914.6 1659.8 1919.7 828.9 25-29 years 8 12 14 4 8 293.0 472.1 566.6 175.1 393.3 30-34 years 9 9 10 11 3 412.1 380.2 382.4 391.9 110.7 35-39 years 2 2 4 4 3 159.4 148.1 265.8 248.1 171.3 40-44 years 0 3 2 0 0 0.0 336.3 216.9 0.0 0.0 45-54 years 2 2 0 2 2 121.0 122.8 0.0 123.5 124.1 55+ years 0 3 0 0 0 0.0 121.8 0.0 0.0 0.0 23

TABLE 5b. Estimated reportable STD cases and rates, Asian & Pacific Islander males, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A sian/pi Male 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 3 0 0 0 0.0 817.4 0.0 0.0 0.0 20-24 years 1 1 0 1 5 142.9 157.2 0.0 181.8 786.2 25-29 years 0 2 1 1 0 0.0 160.6 83.9 94.0 0.0 30-34 years 1 4 3 4 0 84.0 307.7 212.0 259.7 0.0 35-39 years 0 0 1 0 0 0.0 0.0 120.8 0.0 0.0 40-44 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 45-54 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 4 4 0 3 1 975.6 1089.9 0.0 810.8 298.5 20-24 years 1 4 7 3 1 142.9 628.9 1202.7 545.5 157.2 25-29 years 0 7 1 0 3 0.0 562.2 83.9 0.0 338.6 30-34 years 3 3 4 3 0 251.9 230.8 282.7 194.8 0.0 35-39 years 0 0 1 1 1 0.0 0.0 120.8 115.5 101.2 40-44 years 0 0 1 0 0 0.0 0.0 223.2 0.0 0.0 45-54 years 1 1 0 0 0 138.5 138.5 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 24

TABLE 5c. Estimated reportable STD cases and rates, Asian & Pacific Islander females, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea A sian/pi Female 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 1 1 4 1 0 230.4 263.9 1129.9 295.9 0.0 20-24 years 3 3 3 2 2 383.1 443.8 481.5 335.6 289.4 25-29 years 1 4 5 0 0 75.1 308.4 390.9 0.0 0.0 30-34 years 1 0 0 0 0 100.7 0.0 0.0 0.0 0.0 35-39 years 0 0 0 0 2 0.0 0.0 0.0 0.0 262.1 40-44 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 45-54 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 8 5 12 4 7 1843.3 1319.3 3389.8 1183.4 2046.8 20-24 years 8 9 13 21 11 1021.7 1331.4 2086.7 3523.5 1591.9 25-29 years 12 2 15 4 5 901.6 154.2 1172.8 327.9 435.5 30-34 years 7 7 6 8 4 704.9 656.0 500.0 631.4 340.4 35-39 years 2 2 3 2 2 340.7 328.4 443.1 268.1 262.1 40-44 years 0 4 0 0 0 0.0 862.1 0.0 0.0 0.0 45-54 years 0 0 0 2 2 0.0 0.0 0.0 223.2 221.7 55+ years 0 6 0 0 0 0.0 440.2 0.0 0.0 0.0 25

TABLE 5d. Estimated reportable STD cases and rates, Blacks, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Black A ll 10-14 years 17 14 6 8 4 331.6 280.6 121.3 166.9 89.6 15-19 years 213 167 132 139 132 4793.0 3811.0 3064.1 3269.8 3038.7 20-24 years 207 198 172 161 145 5948.3 5844.2 4982.6 4440.2 4044.6 25-29 years 143 148 115 139 85 3778.1 4231.0 3570.3 4675.4 3383.8 30-34 years 87 106 84 83 63 1928.6 2431.2 2032.4 2121.7 1703.2 35-39 years 63 60 60 52 51 1258.2 1279.9 1333.3 1221.8 1273.7 40-44 years 37 53 46 52 30 722.9 1052.0 953.2 1115.4 675.1 45-54 years 51 45 21 37 32 610.6 532.1 247.9 436.7 378.1 55+ years 4 3 1 8 16 36.1 26.8 8.8 69.1 134.9 Chlamydia 10-14 years 29 21 14 13 16 565.6 420.8 283.1 271.2 358.3 15-19 years 514 438 282 305 334 11566.2 9995.4 6546.0 7174.8 7688.8 20-24 years 533 448 361 385 389 15316.1 13223.1 10457.7 10617.8 10850.8 25-29 years 269 245 209 252 181 7107.0 7004.0 6488.7 8476.3 7205.4 30-34 years 118 137 106 113 122 2615.8 3142.2 2564.7 2888.5 3298.2 35-39 years 76 65 57 62 72 1517.9 1386.5 1266.7 1456.8 1798.2 40-44 years 27 30 34 40 46 527.5 595.5 704.5 858.0 1035.1 45-54 years 23 21 19 24 26 275.4 248.3 224.3 283.3 307.2 55+ years 4 3 2 2 12 36.1 26.8 17.6 17.3 101.2 26

TABLE 5e. Estimated reportable STD cases and rates, Black males, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Black Male 10-14 years 5 1 2 3 0 187.5 38.7 79.2 122.4 0.0 15-19 years 58 49 43 49 48 2560.7 2194.4 1949.2 2243.6 2150.5 20-24 years 81 97 65 85 69 4900.2 5995.1 3810.1 4775.3 3940.6 25-29 years 96 95 72 74 65 5225.9 5712.6 4845.2 5493.7 5985.3 30-34 years 69 79 54 59 41 3006.5 3628.8 2644.5 3066.5 2223.4 35-39 years 37 48 48 40 42 1436.3 1984.3 2076.1 1859.6 2062.9 40-44 years 31 51 38 37 19 1196.4 1986.8 1540.3 1548.1 840.3 45-54 years 50 43 18 30 27 1193.6 1015.8 426.7 707.7 629.7 55+ years 4 3 1 8 15 84.1 62.3 20.2 157.9 289.8 Chlamydia 10-14 years 4 0 0 0 1 150.0 0.0 0.0 0.0 44.2 15-19 years 93 82 48 78 80 4106.0 3672.2 2175.9 3571.4 3584.2 20-24 years 132 123 95 128 133 7985.5 7602.0 5568.6 7191.0 7595.7 25-29 years 94 92 72 106 82 5117.0 5532.2 4845.2 7869.3 7550.6 30-34 years 51 60 40 59 60 2222.2 2756.1 1958.9 3066.5 3253.8 35-39 years 44 45 31 36 47 1708.1 1860.3 1340.8 1673.6 2308.4 40-44 years 15 21 22 21 23 578.9 818.1 891.8 878.7 1017.2 45-54 years 19 13 14 18 15 453.6 307.1 331.9 424.6 349.8 55+ years 3 2 2 1 7 63.1 41.5 40.4 19.7 135.2 27

TABLE 5f. Estimated reportable STD cases and rates, Black females, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Black Female 10-14 years 12 12 4 6 4 487.6 498.8 165.2 256.2 181.4 15-19 years 156 118 89 95 88 7159.2 5490.9 4234.1 4596.0 4166.7 20-24 years 128 102 108 77 79 7006.0 5762.7 6185.6 4171.2 4307.5 25-29 years 47 53 42 65 18 2412.7 2888.3 2420.7 3997.5 1262.3 30-34 years 17 26 30 21 22 767.1 1191.0 1434.7 1056.3 1186.0 35-39 years 26 12 10 11 7 1069.5 528.9 457.0 522.6 355.7 40-44 years 7 3 9 14 10 277.0 121.4 381.5 616.2 458.1 45-54 years 0 3 3 6 4 0.0 71.0 70.5 141.7 95.8 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 24 20 13 15 17 975.2 831.3 537.0 640.5 771.0 15-19 years 430 357 232 237 265 19733.8 16612.4 11037.1 11465.9 12547.3 20-24 years 412 331 273 254 253 22550.6 18700.6 15635.7 13759.5 13795.0 25-29 years 171 151 139 133 91 8778.2 8228.9 8011.5 8179.6 6381.5 30-34 years 59 79 66 43 54 2662.5 3618.9 3156.4 2163.0 2911.1 35-39 years 29 12 24 17 17 1192.9 528.9 1096.9 807.6 863.8 40-44 years 11 6 8 15 20 435.3 242.8 339.1 660.2 916.2 45-54 years 0 4 2 0 9 0.0 94.7 47.0 0.0 215.5 55+ years 0 0 0 0 4 0.0 0.0 0.0 0.0 59.8 28

TABLE 5g. Estimated reportable STD cases and rates, Hispanics, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Hispanic A ll 10-14 years 5 8 4 8 7 33.3 51.6 24.8 48.7 43.0 15-19 years 102 97 92 73 93 720.3 720.0 699.7 553.1 697.0 20-24 years 113 142 109 101 129 618.1 805.6 637.4 611.0 823.6 25-29 years 98 89 59 65 90 504.6 458.7 308.9 346.3 484.0 30-34 years 57 53 31 46 50 343.7 306.7 173.8 251.0 270.2 35-39 years 28 45 28 23 35 203.9 322.3 195.3 156.5 231.6 40-44 years 12 29 12 12 12 109.2 255.7 102.6 99.2 98.2 45-54 years 8 6 9 10 23 50.6 36.9 54.4 59.4 133.2 55+ years 10 4 3 4 8 58.1 22.5 16.3 21.1 40.4 Chlamydia 10-14 years 39 54 24 37 53 259.6 348.3 149.1 225.1 325.9 15-19 years 625 658 562 544 689 4413.8 4884.2 4274.1 4121.8 5163.8 20-24 years 627 749 679 814 793 3429.6 4249.4 3970.3 4924.1 5063.2 25-29 years 274 345 313 329 455 1410.7 1778.0 1638.7 1752.8 2446.9 30-34 years 109 147 140 195 211 657.2 850.6 784.8 1064.2 1140.2 35-39 years 63 65 48 75 79 458.7 465.6 334.8 510.2 522.7 40-44 years 19 29 30 29 26 172.9 255.7 256.6 239.7 212.9 45-54 years 10 11 20 22 20 63.2 67.6 120.9 130.8 115.8 55+ years 2 0 5 4 7 11.6 0.0 27.2 21.1 35.4 29

TABLE 5h. Estimated reportable STD cases and rates, Hispanic males, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Hispanic Male 10-14 years 1 0 0 0 0 13.1 0.0 0.0 0.0 0.0 15-19 years 40 35 27 17 34 525.3 484.8 387.7 244.9 486.5 20-24 years 65 79 54 53 69 615.7 771.7 536.8 547.1 747.2 25-29 years 55 54 36 32 55 497.4 485.9 326.2 291.5 500.5 30-34 years 33 38 14 26 29 354.2 390.7 138.9 249.3 274.2 35-39 years 21 33 17 14 25 277.1 421.3 210.3 168.3 290.0 40-44 years 6 18 4 8 8 101.7 295.0 63.0 121.0 119.3 45-54 years 8 6 5 6 18 98.8 71.5 58.5 68.4 197.6 55+ years 8 4 3 3 8 100.4 48.6 35.1 33.9 86.4 Chlamydia 10-14 years 4 5 2 1 5 52.2 63.7 24.6 12.0 60.3 15-19 years 149 128 101 102 125 1956.7 1772.9 1450.1 1469.3 1788.5 20-24 years 186 241 196 261 250 1761.9 2354.2 1948.5 2694.1 2707.4 25-29 years 84 120 120 113 156 759.7 1079.7 1087.4 1029.5 1419.7 30-34 years 39 60 52 67 82 418.6 616.8 516.0 642.5 775.4 35-39 years 31 22 19 25 34 409.0 280.9 235.0 300.6 394.4 40-44 years 11 14 9 13 9 186.5 229.5 141.7 196.7 134.2 45-54 years 7 4 10 6 8 86.4 47.7 117.0 68.4 87.8 55+ years 0 0 3 3 3 0.0 0.0 35.1 33.9 32.4 30

TABLE 5i. Estimated reportable STD cases and rates, Hispanic females, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea Hispanic Female 10-14 years 4 8 4 9 7 54.3 104.5 50.2 111.2 87.8 15-19 years 61 61 64 60 62 932.0 975.7 1034.9 959.1 975.8 20-24 years 46 62 54 48 62 595.5 839.1 766.7 701.4 964.5 25-29 years 43 36 23 33 35 514.0 434.3 285.2 423.4 460.1 30-34 years 24 16 19 20 21 330.1 211.8 244.8 253.3 264.8 35-39 years 7 12 12 9 9 113.7 195.8 191.9 141.0 138.6 40-44 years 6 11 7 5 4 117.8 210.0 131.1 91.1 72.6 45-54 years 0 0 4 3 4 0.0 0.0 50.0 37.3 49.0 55+ years 2 0 0 2 0 21.6 0.0 0.0 19.7 0.0 Chlamydia 10-14 years 35 50 22 41 52 475.1 653.4 276.0 506.7 652.3 15-19 years 457 525 449 481 602 6982.4 8397.3 7260.7 7688.6 9474.3 20-24 years 420 491 477 552 546 5436.9 6645.0 6772.7 8066.6 8494.1 25-29 years 198 233 188 212 296 2366.7 2810.6 2331.1 2720.0 3891.2 30-34 years 76 94 89 126 124 1045.4 1244.4 1146.6 1595.7 1563.5 35-39 years 33 53 36 49 43 536.1 864.9 575.7 767.8 662.0 40-44 years 6 17 28 15 17 117.8 324.5 524.4 273.4 308.6 45-54 years 5 12 14 17 11 64.7 152.3 175.1 211.3 134.8 55+ years 3 0 3 2 4 32.4 0.0 30.5 19.7 38.0 31

TABLE 5j. Estimated reportable STD cases and rates, Whites, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea White A ll 10-14 years 0 3 1 0 0 0.0 31.5 10.5 0.0 0.0 15-19 years 20 56 39 25 35 197.7 592.7 431.8 278.8 375.0 20-24 years 74 90 62 70 59 417.8 622.9 514.6 665.2 431.6 25-29 years 45 76 40 64 58 143.1 264.7 155.6 286.1 262.9 30-34 years 52 67 52 57 51 161.9 200.2 153.7 169.9 163.1 35-39 years 42 71 42 55 32 168.7 286.5 167.0 209.4 119.5 40-44 years 16 36 23 29 28 67.8 155.0 101.6 127.1 124.5 45-54 years 39 34 18 23 35 84.5 75.4 40.5 52.7 82.2 55+ years 4 9 7 7 8 11.7 12.5 9.6 9.5 10.7 Chlamydia 10-14 years 7 6 8 2 2 71.0 63.0 83.6 20.8 21.5 15-19 years 176 178 171 139 110 1739.5 1883.8 1893.5 1550.1 1178.5 20-24 years 284 301 217 208 216 1603.3 2083.3 1801.1 1976.6 1580.1 25-29 years 133 117 134 117 107 422.9 407.5 521.3 523.0 485.0 30-34 years 71 77 72 71 61 221.0 230.1 212.9 211.6 195.1 35-39 years 36 52 41 47 33 144.6 209.8 163.1 178.9 123.2 40-44 years 14 23 18 27 21 59.3 99.0 79.5 118.3 93.4 45-54 years 13 32 16 26 31 28.2 70.9 36.0 59.5 72.8 55+ years 4 8 5 5 7 11.7 11.1 6.9 6.8 9.4 32

TABLE 5k. Estimated reportable STD cases and rate, White males, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea White Male 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 6 10 7 8 10 117.5 210.2 152.1 175.0 211.4 20-24 years 33 43 30 36 29 377.8 594.7 494.5 679.4 427.0 25-29 years 35 50 20 37 41 216.3 343.7 156.1 335.0 379.1 30-34 years 36 50 37 43 43 207.0 278.4 205.2 242.0 261.2 35-39 years 32 57 35 36 27 235.6 418.5 251.7 249.4 183.7 40-44 years 13 26 19 22 26 105.4 212.9 159.2 179.9 213.5 45-54 years 32 28 17 18 31 137.0 122.1 75.0 80.8 141.9 55+ years 4 9 7 5 6 13.4 29.5 22.7 16.0 18.9 Chlamydia 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 21 26 19 21 19 411.4 546.4 413.0 459.4 401.7 20-24 years 69 74 62 53 62 790.0 1023.5 1021.9 1000.2 912.8 25-29 years 53 49 52 53 54 327.5 336.8 405.9 479.8 499.4 30-34 years 26 45 29 34 38 149.5 250.6 160.8 191.3 230.8 35-39 years 18 29 24 31 19 132.5 212.9 172.6 214.8 129.3 40-44 years 6 15 14 18 15 48.7 122.8 117.3 147.2 123.2 45-54 years 10 18 12 15 23 42.8 78.5 52.9 67.3 105.3 55+ years 2 5 5 4 4 6.7 16.4 16.2 12.8 12.6 33

TABLE 5l. Estimated reportable STD cases and rates, White females, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea White Female 10-14 years 0 3 1 0 0 0.0 66.6 22.2 0.0 0.0 15-19 years 14 46 33 18 27 279.3 980.6 744.9 409.5 586.4 20-24 years 41 48 32 35 31 456.6 665.0 535.0 670.0 450.7 25-29 years 9 25 21 26 16 59.0 176.5 162.9 229.6 142.2 30-34 years 16 17 13 12 6 108.6 109.6 82.3 76.0 40.5 35-39 years 10 15 6 18 4 88.4 134.4 53.4 152.0 33.1 40-44 years 3 10 4 6 1 26.6 90.8 37.4 56.7 9.7 45-54 years 8 6 1 5 3 35.1 27.1 4.6 23.4 14.5 55+ years 0 0 0 2 1 0.0 0.0 0.0 4.7 2.3 Chlamydia 10-14 years 8 6 8 2 2 168.7 133.3 177.5 43.8 45.2 15-19 years 168 158 163 131 98 3351.3 3368.2 3679.5 2980.0 2128.6 20-24 years 223 237 154 163 157 2483.6 3283.5 2574.8 3120.2 2282.6 25-29 years 69 63 79 56 46 452.0 444.7 612.6 494.5 408.9 30-34 years 46 22 40 32 17 312.3 141.9 253.3 202.7 114.9 35-39 years 18 22 12 9 11 159.1 197.1 106.8 76.0 91.0 40-44 years 9 6 0 4 4 79.8 54.5 0.0 37.8 38.8 45-54 years 5 12 2 6 4 21.9 54.1 9.2 28.1 19.3 55+ years 3 0 0 0 2 70.8 0.0 0.0 0.0 4.7 34

TABLE 5m. Estimated reportable STD cases and rate, Native Americans, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea NatA m A ll 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 3 1 1 3 0.0 1102.9 387.6 392.2 1195.2 20-24 years 1 0 1 0 3 316.5 0.0 403.2 0.0 1315.8 25-29 years 1 2 1 6 0 251.9 566.6 335.6 2230.5 0.0 30-34 years 1 1 0 1 0 241.5 229.4 0.0 253.8 0.0 35-39 years 0 0 0 0 3 0.0 0.0 0.0 0.0 1041.7 40-44 years 4 4 0 0 0 1166.2 1162.8 0.0 0.0 0.0 45-54 years 0 0 1 1 0 0.0 0.0 171.2 174.2 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 2 0 0.0 0.0 0.0 749.1 0.0 15-19 years 0 4 0 4 20 0.0 1470.6 0.0 1568.6 7968.1 20-24 years 2 7 4 11 17 632.9 2405.5 1612.9 4761.9 7456.1 25-29 years 4 2 2 5 7 1007.6 566.6 671.1 1858.7 2573.5 30-34 years 0 2 0 4 5 0.0 458.7 0.0 1015.2 1562.5 35-39 years 0 0 4 0 0 0.0 0.0 1242.2 0.0 0.0 40-44 years 2 2 0 2 0 583.1 581.4 0.0 678.0 0.0 45-54 years 0 0 0 2 0 0.0 0.0 0.0 348.4 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 35

TABLE 5n. Estimated reportable STD cases and rates, Native American males, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea NatA m Male 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 20-24 years 0 0 0 0 1 0.0 0.0 0.0 0.0 1136.4 25-29 years 0 0 1 1 0 0.0 0.0 709.2 751.9 0.0 30-34 years 0 1 0 0 0 0.0 434.8 0.0 0.0 0.0 35-39 years 0 0 0 0 3 0.0 0.0 0.0 0.0 2097.9 40-44 years 1 3 0 0 0 578.0 1818.2 0.0 0.0 0.0 45-54 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 1 0 0.0 0.0 0.0 724.6 0.0 15-19 years 0 0 0 0 1 0.0 0.0 0.0 0.0 680.3 20-24 years 0 1 0 1 3 0.0 694.4 0.0 862.1 3409.1 25-29 years 0 0 0 3 1 0.0 0.0 0.0 2255.6 751.9 30-34 years 0 1 0 1 1 0.0 434.8 0.0 507.6 520.8 35-39 years 0 0 3 0 0 0.0 0.0 1851.9 0.0 0.0 40-44 years 0 1 0 1 0 0.0 606.1 0.0 689.7 0.0 45-54 years 0 0 0 1 0 0.0 0.0 0.0 352.1 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 36

TABLE 5o. Estimated reportable STD cases and rates, Native American females, by age, Denver, 2001-2005 Rate per 100,000 population Diagnosis Race Gender A ge 2001 2002 2003 2004 2005 2001 2002 2003 2004 2005 Gonorrhea NatA m Female 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 3 1 2 3 0.0 2343.8 847.5 1785.7 2884.6 20-24 years 1 0 1 0 1 621.1 0.0 833.3 0.0 714.3 25-29 years 1 3 0 5 0 523.6 1775.1 0.0 3676.5 0.0 30-34 years 1 0 0 2 0 510.2 0.0 0.0 1015.2 0.0 35-39 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 40-44 years 2 1 0 0 0 1176.5 558.7 0.0 0.0 0.0 45-54 years 0 0 1 2 0 0.0 0.0 337.8 689.7 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 Chlamydia 10-14 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 15-19 years 0 5 0 4 20 0.0 3906.3 0.0 3571.4 19230.8 20-24 years 3 6 5 11 15 1863.4 4081.6 4166.7 9565.2 10714.3 25-29 years 6 2 2 2 6 3141.4 1183.4 1273.9 1470.6 4316.5 30-34 years 0 0 0 2 4 0.0 0.0 0.0 1015.2 3125.0 35-39 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 40-44 years 2 0 0 0 0 1176.5 0.0 0.0 0.0 0.0 45-54 years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 55+ years 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 37

TABLE 6. Number and percentage of patient visits by gender, age, race/ethnicity and county of residence, Denver Metro Health Clinic, 2001-2005 No. % No. % No. % No. % No. % Total 17,292 100.0 19,738 100.0 14,409 100.0 15,333 100.0 15121 100.0 Gender Male 11,207 64.8 12,425 62.9 9,391 65.2 9,603 62.6 9,267 61.3 Female 6,085 35.2 7,313 37.1 5,018 34.8 5,911 38.6 5,854 38.7 Age (yrs.) 0-14 72 0.4 71 0.4 46 0.3 68 0.4 21 0.1 15-19 2,521 14.6 3,103 15.7 1,800 12.5 2,363 15.4 1,780 11.8 20-24 4,832 27.9 5,587 28.3 4,093 28.4 4,378 28.6 4,216 27.9 25-29 3,314 19.2 3,819 19.3 3,027 21.0 3,168 20.7 3,403 22.5 30-39 3,766 21.8 4,286 21.7 3,266 22.7 3,231 21.1 3,348 22.1 40-49 2,054 11.9 2,131 10.8 1,554 10.8 1,625 10.6 1,565 10.3!50 733 4.2 741 3.8 623 4.3 681 4.4 788 5.2 Race/ethnicity White, non-hispanic 6,480 37.5 7,834 39.7 5,933 41.2 6,347 41.4 5,269 34.8 Black 4,273 24.7 4,625 23.4 3,213 22.3 3,487 22.7 3,338 22.1 Hispanic 5,923 34.3 6,474 32.8 4,682 32.5 5,132 33.5 5,309 35.1 Other, non-hispanic 598 3.5 805 4.1 581 4.0 543 3.5 1,205 8.0 County Denver 12,183 70.5 13,275 67.3 9,521 66.1 10,119 66.0 10,648 70.4 Jefferson 1,062 6.1 1,292 6.5 570 4.0 678 4.4 592 3.9 Tricounty* 3,444 19.9 4,208 21.3 3,432 23.8 3,821 24.9 3,267 21.6 Other 592 3.4 965 4.9 861 6.0 715 4.7 538 3.6 Comprehensive + Express visits (see text, page 7). *Includes Adams, Arapahoe and Douglas counties. 2001 2002 2003 2004 2005 38

TABLE 7. Number and percentage of gonorrhea and chlamydia case by gender, Denver Metro Health Clinic, 2001-2005 Gonorrhea No. % No. % No. % No. % No. % Total 807 100.0 1,202 100.0 724 100.0 837 100.0 779 100.0 Male 563 69.8 918 76.4 542 75 601 71.8 597 76.6 Female 244 30.2 284 23.6 182 25.1 236 28.2 182 23.4 Chlamydia 2001 2002 2003 2004 Total 1,684 100.0 1,996 100.0 1,469 100.0 1,773 100.0 1,808 100.0 Male 1,097 65.1 1,279 64.1 1,017 69.2 1,182 66.7 1,222 67.6 Female 587 34.9 717 35.9 452 30.8 591 33.3 586 32.4 2005

TABLE 8. Number and percentage* of gonorrhea, chlamydia, syphilis, and HIV cases among MSM Visiting the Denver Metro Health Clinic, 2001-2005 2001 2002 2003 2004 No. % No. % No. % No. % No. % Visits 637 100.0 1,110 100.0 746 100.0 859 100.0 944 100.0 Gonorrhea 79 13.2 198 18.8 92 13.2 86 10.7 144 15.8 CT 36 7.6 74 6.2 52 7.0 59 7.4 73 8.2 Syphilis All 5 0.8 27 2.4 18 2.4 27 3.1 23 2.4 Primary 1 0.2 7 0.6 4 0.5 6 0.7 4 0.4 Secondary 3 0.5 7 0.6 2 0.3 7 0.8 9 1.0 Early Latent 0 0.0 5 0.5 2 0.3 2 0.2 1 0.1 Unknow n/late Latent 1 0.2 9 0.8 10 1.3 11 1.3 9 1.0 HIV All 79 12.4 108 9.7 84 11.3 84 9.8 113 12.0 HIV by history 47 7.4 81 7.3 60 8.0 62 7.2 83 8.8 HIV by test 32 8.2 28 4.0 26 5.1 26 5.1 30 4.3 *Percentages for gonorrhea, chlamydia and HIV by test are of number tested. Percentages for syphilis, HIV All and HIV by test are of visits. 2005 40