Patrick Loose, Chief HIV, STD & Hepatitis Branch February 15, 2018
MISSION Improve health outcomes in communities disproportionately impacted by HIV and STDs
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
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
STDs Reported Among San Diego County Residents, 1997 2016 Chlamydia Gonorrhea Primary & Secondary Syphilis 20000 600 18000 Chlamydia and Gonorrhea Cases 16000 14000 12000 10000 8000 6000 4000 2000 500 400 300 200 100 Primary and Secondary Syphilis Cases 0 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year Note: Scale for syphilis is on the right.
GONORRHEA CALIFORNIA INCIDENCE RATES, 1913 2016 Rev. 6/2017
PRIMARY & SECONDARY SYPHILIS, CA & UNITED STATES INCIDENCE RATES, 1941 2016 Rev. 6/2017
PRIMARY & SECONDARY SYPHILIS, 1988 2015 Number of Cases 500 450 400 350 300 250 200 150 100 50 0 424 310 323 284 112 106 98 52 Men who have sex with men 2016 case count = 523 2016 rate = 16 35 23 23 25 27 27 47 25 33 12 20 10 16 5 11 5 1 10 13 14 26 94 111 144 201 290 269 227 253 236 282 288 282 428 38 109 137 193 234 346 346 289 277 263 369 333 347 1988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015 Year Other 490
HIV CO-INFECTION AMONG MSM CASES 100 90 80 70 Percent 60 50 40 48% 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year *MSM: Men Who Have Sex With Men.
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, 1963-2013 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 1.1236, 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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STD PREVENTION Chlamydia Screening Project STD Community Intervention Project Don t Think, Know
GONORRHEA SURVEILLANCE California Gonorrhea Surveillance System Gonococcal Isolate Surveillance Project
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 2016 6 Cefixime Ceftriaxone Percent of Isolates 4 2 0 '92 '93 '94 '95 '96 '97 '98 '99 2000 '01 '02 '03 '04 '05 '06 '07 '08 '09 2010 '11 '12 '13 '14 2015 '16 Year * Cefixime susceptibility was not run in 2007-2008. * * 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 0.125 μg/ml. 2015-2016 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
Gonococcal Isolate Surveillance Project (GISP), Percent of Neisseria Gonorrhoeae Isolates with CDC "Alert" Values for Azithromycin in California GISP STD Clinic Sites, 1992 April 2016 6 Percent of Isolates 4 2 0 '92 '93 '94 '95 '96 '97 '98 '99 2000 '01 '02 '03 '04 '05 '06 '07 '08 '09 2010 '11 '12 '13 '14 2015 '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 1992. 2015-2016 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
STD CLINICAL SERVICES Rosecrans STD Clinic Central Regional Public Health Center North Coastal Regional Public Health Center South Regional Public Health Center
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
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