Gonorrhea in New York City Epidemiology Disease Control

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Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges Presented by: Julia

Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges Presented by: Julia A. Schillinger, MD, MSc CAPT USPHS Bureau of STD Control New York City Department of Health and Mental Hygiene jschilli@health. nyc. gov

Gonorrhea rates, by sex New York City, 1995 -2009* 2004: NYC STD clinic QRNG

Gonorrhea rates, by sex New York City, 1995 -2009* 2004: NYC STD clinic QRNG prevalence exceeds 5% April 2007: April 2004: NYC DOHMH QRNG health alert CDC alert: Discontinue FQ use September 2006: NYC joins GISP Data based on cases reported to the NYC DOHMH; * Annualized based on half-year 2009 data January 2008: NYC makes AST for GC reportable

*excludes persons for whom sex or age were not reported

*excludes persons for whom sex or age were not reported

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, by age

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, by age

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, by age

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, by age

GC reported to the NYC DOHMH (n=10, 483); case rates by race/ethnicity and sex,

GC reported to the NYC DOHMH (n=10, 483); case rates by race/ethnicity and sex, 2008 2, 186 Other = 187 Unknown race/eth = 5, 011 1, 665 13 5 560 378 347 58 44 28

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, by race

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, by race

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, by race

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, by race

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, ages 15 -19,

Male GC reported to the NYC DOHMH, 2000 -2008, case rates, ages 15 -19, by race

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, ages 15 -19,

Female GC reported to the NYC DOHMH, 2000 -2008, case rates, ages 15 -19, by race

Case rate (per 100, 000 population) of Neisseria gonorrhea reported to the New York

Case rate (per 100, 000 population) of Neisseria gonorrhea reported to the New York City DOHMH, with percent reported from Bureau of STD clinics, 2000 -2008, by sex

New York City United Hospital Fund (UHF) Neighborhoods

New York City United Hospital Fund (UHF) Neighborhoods

Percent fluoroquinolone resistance among gonorrhea isolates detected among BSTDC clinic patients, 2001 -2008

Percent fluoroquinolone resistance among gonorrhea isolates detected among BSTDC clinic patients, 2001 -2008

NYC Bureau of STD Control Current GC Activities I • GC (& CT) screening

NYC Bureau of STD Control Current GC Activities I • GC (& CT) screening in NYC high schools • Partner notification – GC cases dx’d in NYC school screening program – HIV-GC coinfected at select NYC facilities – In. SPOT • EZ Pass/VIP Program for core transmitters – HIV-GC co-infected, or 2 GC/12 mos eligible

NYC Bureau of STD Control Current GC Activities II • Sentinel surveillance for antimicrobial

NYC Bureau of STD Control Current GC Activities II • Sentinel surveillance for antimicrobial resistance – Culture at Fort Greene clinic – Gonococcal Isolate Surveillance Project (GISP) • Routine surveillance for antimicrobial resistance • Sentinel surveillance network – Extract behavioral and clinical information on GC cases diagnosed in BSTDC clinics – Interview sample of non-BSTDC dx’d cases (SSu. N project)

Challenges in GC control • Large number of infections – Universal interventions unsustainable –

Challenges in GC control • Large number of infections – Universal interventions unsustainable – Focused interventions staff-intensive • Syphilis & HIV interview and PN consume staff resources • NAATs commonly used test – Provide no information on resistance – Not approved for anorectal specimens • Antibiotic resistance – Opted not to pursue EPT legislation for GC