Epidemiology of Neisseria gonorrhoeae Sexually Transmitted Disease Program Los Angeles County...

Epidemiology of Neisseria gonorrhoeae

Sexually Transmitted

Disease ProgramLos Angeles

CountyDepartment of

Health Services

Facts about GonorrheaFacts about GonorrheaNational TrendsNational Trends– CountsCounts– RatesRates– Health People 2010Health People 2010

Los Angeles County Los Angeles County – CountsCounts– RatesRates

Key Points to PonderKey Points to PonderData LimitationsData Limitations

OverviewOverview

Facts about GonorrheaFacts about Gonorrhea

Second most common bacterial STDSecond most common bacterial STDIncubation period is 2-7 days; GC divides Incubation period is 2-7 days; GC divides every 20-30 minutesevery 20-30 minutesMales: purulent (pus) dischargeMales: purulent (pus) dischargeFemales: cervicitis (mostly asymptomatic) Females: cervicitis (mostly asymptomatic) Causes PID, infertility, ectopic pregnancy, Causes PID, infertility, ectopic pregnancy, and conjunctivitisand conjunctivitisIncrease transmission and susceptibility to Increase transmission and susceptibility to HIV 2-5 foldHIV 2-5 fold

National TrendsNational Trends

Reported Sexually Transmitted Diseases Reported Sexually Transmitted Diseases United States, 2004United States, 2004

Source: CDC Sexually Transmitted Disease Report, 2004

Chlamydia929,462

70%

Gonorrhea330,132

25%

AIDS43,514

3%

P&S 7,9801%

Early Latent7,7681%

Congenital Syphilis

353<1%

Healthy People 2010Healthy People 2010

Health objectives for the NationHealth objectives for the Nation

Based on initiatives Based on initiatives – 1979 Surgeon General’s Report, 1979 Surgeon General’s Report, Health PeopleHealth People– Healthy People 2000: National Health Promotion and Healthy People 2000: National Health Promotion and

Disease Prevention ObjectivesDisease Prevention Objectives

Measurement of health outcomes over timeMeasurement of health outcomes over time

467 HP2010 objectives tracked by 196 data 467 HP2010 objectives tracked by 196 data sourcessources– Includes 23 major data sources (e.g., NHIS)Includes 23 major data sources (e.g., NHIS)

HP 2010 Goal: HP 2010 Goal: Gonorrhea (25-2)Gonorrhea (25-2)

Reduce gonorrhea to 19 cases per Reduce gonorrhea to 19 cases per 100,000 population100,000 population

Progress monitored by information Progress monitored by information gathered from State and local Health gathered from State and local Health Department STD ProgramsDepartment STD Programs

Rate (per 100,000 population)

Gonorrhea2010 Target

0

100

200

300

400

500

1970 73 76 79 82 85 88 91 94 97 2000 03

Gonorrhea — Rates: United States, 1970–2003 Gonorrhea — Rates: United States, 1970–2003 and the Healthy People 2010 targetand the Healthy People 2010 target

National GC Control Program

Reasons for decline in gonorrhea rates:1. Increased screening2. Increase use of sensitive diagnostic tests3. Improved reporting and case finding

475.0

113.5 (2004)

Note: The Healthy People 2010 (HP2010) objective for gonorrhea is 19.0 cases per 100,000 population.


MaleFemale2010 Target

0

120

240

360

480

600

1981 83 85 87 89 91 93 95 97 99 2001 03

Gonorrhea Rates by Gender: United States, 1981–2003Gonorrhea Rates by Gender: United States, 1981–2003

W: 116.5W: 116.5

M: 110.0 (2004)M: 110.0 (2004)

Gonorrhea by Age and Gender Gonorrhea by Age and Gender United States, 2004United States, 2004

Men Rate (per 100,000 population) Women

Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-145.8


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

252.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

430.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

302.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

178.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

124.5


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

89.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

48.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

17.0


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

4.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

110.2


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14 36.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

610.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

569.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

269.7


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

114.2


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

60.3


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

32.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

11.7


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

2.5


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

0.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

116.7

Gonorrhea Rates by state: United Gonorrhea Rates by state: United States and outlying areas, 2004States 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.

Rate per 100,000population

<=19.019.1-100.0>100.0

VT 13.9 NH 10.3 MA 47.5 RI 75.8 CT 82.2 NJ 77.5 DE 109.4 MD 150.6

Guam 69.7

Puerto Rico 6.9 Virgin Is. 68.9

(n= 8)(n= 25)(n= 20)

182.3

87.4

72.8151.8

85.0 67.1

109.2

181.7

94.9

7.5

162.8 110.6

42.4

93.367.0

234.4

16.1

172.4

58.4

248.6

161.6

9.6

65.9137.3

69.7

97.6

180.7

17.4

179.0

126.8

36.6

90.9

221.1

39.8

145.1

110.2

25.6

116.0

45.8

49.3

92.3

11.8

Gonorrhea Rates by race and ethnicity: United Gonorrhea Rates by race and ethnicity: United States, 1981–2004 States, 1981–2004

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.


WhiteBlackHispanicAsian/Pac IslAm Ind/AK Nat2010 Target

0

500

1,000

1,500

2,000

2,500

1981 83 85 87 89 91 93 95 97 99 2001 03

Local TrendsLocal Trends

Reported Sexually Transmitted DiseasesReported Sexually Transmitted DiseasesLos Angeles County, 2004Los Angeles County, 2004

Chlamydia38,46475%

Gonorrhea9,69619%

AIDS2,2154%

P&S4591%

Congenital Syphilis

230%

Early Latent3811%

Source: LAC DHS STD/ACD Programs 2004

Gonorrhea Rates* Gonorrhea Rates* Los Angeles County, 1993-2004Los Angeles County, 1993-2004

129

104

89

65 64 66 6673

7984 86

103

0

20

40

60

80

100

120

140

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Introduction of nucleicamplification tests

Healthy People 2010 Objective

*Per 100,000 population

Reported Gonorrhea Rates, by Gender* Reported Gonorrhea Rates, by Gender* Los Angeles County, Los Angeles County,

1993-20031993-2003

0

20

40

60

80

100

120

140

160

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Male Gonorrhea

Female Gonorrhea

*Per 100,000 population

231.0

134.1

Healthy People 2010 Objective

Introduction of nucleicamplification tests

113.2113.2

92.292.2

Gonorrhea Rates* by Age and Gender Gonorrhea Rates* by Age and Gender Los Angeles County, 2004Los Angeles County, 2004

0

50

100

150

200

250

300

350

400

450

10-14 15-19 20-24 25-29 30-34 35-44 45-54

Male Female

*Per 100,000 LA County population

Gonorrhea Rates* by Gender and Race/EthnicityGonorrhea Rates* by Gender and Race/EthnicityLos Angeles, 2004Los Angeles, 2004

0

100

200

300

400

500

600

700

800

Asian/PI Black Hispanic White

Male Female

*Per 100,000 LA County population

Key Points to PonderKey Points to Ponder

Second most common bacterial STDSecond most common bacterial STD

GC rates declined because of:GC rates declined because of:– Increased screeningIncreased screening– Increased use of sensitive testsIncreased use of sensitive tests– Improved reporting/case findingImproved reporting/case finding

GC rates leveled off because of true increases in GC rates leveled off because of true increases in Gc among some groups (e.g., MSM)Gc among some groups (e.g., MSM)

Rates are high among young females, adult Rates are high among young females, adult males, and African Americansmales, and African Americans

Data LimitationsData Limitations

Incomplete case reportingIncomplete case reporting

– Reporting delaysReporting delays

– Missing informationMissing information

Reporting biasReporting bias

– Stigmatized conditionStigmatized condition

– Public vs. PrivatePublic vs. Private

Additional ResourcesAdditional Resources

Centers for Disease Control and Centers for Disease Control and Prevention (CDC)Prevention (CDC)

www.cdc.gov/std/stats/www.cdc.gov/std/stats/ www.healthypeople.gov/www.healthypeople.gov/

Los Angeles County STD Program Los Angeles County STD Program www.ladhs.org/std/stdfacts.htmwww.ladhs.org/std/stdfacts.htm

STD RatesSTD Rates

Number of new events in specific periodNumber of new events in specific period

Average population* during specific periodAverage population* during specific periodX 10n

Essential for comparing dx in different populations:

Pop A: 1,000/10,000 = 100 cases per 1000 population

Pop B: 1,000/1,000,000 = 1 case per 1000 population

*Assumes average population and “population at risk” are comparable.

=

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