Epidemiology of Neisseria gonorrhoeae Sexually Transmitted Disease Program

Epidemiology of Neisseria gonorrhoeae Sexually Transmitted Disease Program Los Angeles County Department of Health Services

Overview Facts about Gonorrhea National Trends – – – Counts Rates Health People 2010 Los Angeles County – – Counts Rates Key Points to Ponder Data Limitations

Facts about Gonorrhea Second most common bacterial STD Incubation period is 2 -7 days; GC divides every 20 -30 minutes Males: purulent (pus) discharge Females: cervicitis (mostly asymptomatic) Causes PID, infertility, ectopic pregnancy, and conjunctivitis Increase transmission and susceptibility to HIV 2 -5 fold

National Trends

Reported Sexually Transmitted Diseases United States, 2004 Source: CDC Sexually Transmitted Disease Report, 2004

Healthy People 2010 Health objectives for the Nation Based on initiatives – 1979 Surgeon General’s Report, Health People – Healthy People 2000: National Health Promotion and Disease Prevention Objectives Measurement of health outcomes over time 467 HP 2010 objectives tracked by 196 data sources – Includes 23 major data sources (e. g. , NHIS)

HP 2010 Goal: Gonorrhea (25 -2) Reduce gonorrhea to 19 cases per 100, 000 population Progress monitored by information gathered from State and local Health Department STD Programs

Gonorrhea — Rates: United States, 1970– 2003 and the Healthy People 2010 target National GC Control Program 475. 0 Reasons for decline in gonorrhea rates: 1. Increased screening 2. Increase use of sensitive diagnostic tests 3. Improved reporting and case finding Note: The Healthy People 2010 (HP 2010) objective for gonorrhea is 19. 0 cases per 100, 000 population. 113. 5 (2004)

Gonorrhea Rates by Gender: United States, 1981– 2003 W: 116. 5 M: 110. 0 (2004)

Gonorrhea by Age and Gender United States, 2004

Gonorrhea Rates by state: United States and outlying areas, 2004 Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 112. 1 per 100, 000 population. The Healthy People 2010 target is 19. 0 cases per 100, 000 population.

Gonorrhea Rates by race and ethnicity: United States, 1981– 2004 Note: The Healthy People 2010 target for gonorrhea is 19. 0 cases per 100, 000 population.

Local Trends

Reported Sexually Transmitted Diseases Los Angeles County, 2004 Source: LAC DHS STD/ACD Programs 2004

Gonorrhea Rates* Los Angeles County, 1993 -2004 Introduction of nucleic amplification tests Healthy People 2010 Objective *Per 100, 000 population

Reported Gonorrhea Rates, by Gender* Los Angeles County, 1993 -2003 231. 0 Introduction of nucleic amplification tests 113. 2 134. 1 92. 2 Healthy People 2010 Objective *Per 100, 000 population

Gonorrhea Rates* by Age and Gender Los Angeles County, 2004 *Per 100, 000 LA County population

Gonorrhea Rates* by Gender and Race/Ethnicity Los Angeles, 2004 *Per 100, 000 LA County population

Key Points to Ponder Second most common bacterial STD GC rates declined because of: – Increased screening – Increased use of sensitive tests – Improved reporting/case finding GC rates leveled off because of true increases in Gc among some groups (e. g. , MSM) Rates are high among young females, adult males, and African Americans

Data Limitations Incomplete case reporting – Reporting delays – Missing information Reporting bias – Stigmatized condition – Public vs. Private

Additional Resources Centers for Disease Control and Prevention (CDC) www. cdc. gov/std/stats/ www. healthypeople. gov/ Los Angeles County STD Program www. ladhs. org/stdfacts. htm

STD Rates = Number of new events in specific period n X 10 Average population* during specific period Essential for comparing dx in different populations: Pop A: 1, 000/10, 000 = 100 cases per 1000 population Pop B: 1, 000/1, 000 = 1 case per 1000 population *Assumes average population and “population at risk” are comparable.