Maricopa County STD Update

Reportable STDs in Arizona(all within 5 working days)

STD reporting forms available at: http://www.maricopa.gov/publichealth/Services/STD/reports.aspx

• Chlamydia • Gonorrhea• Syphilis • Genital Herpes• Chancroid (H. ducrei)• HIV http://www.azdhs.gov/phs/oids/downloads/cdr_form.pdf

Did you know?• Up to 80% of persons with an STD do not

experience symptoms• 25% of young adults in the U.S. are infected

with one or more STD’s• A person is diagnosed with an STD every 26.8

minutes in Maricopa County• Every day in America, 12,000 teenagers

contract a sexually transmitted disease.• A girl is four times more likely to contract an

STD than she is to become pregnant

Total Syphilis CasesMaricopa County

0

100

200

300

400

500

600

700

800

900

Late 144 165 181 228 314 443 436 390 315 239 284 425 471 364 303

Early 197 307 364 463 394 405 299 309 261 229 317 363 391 281 290

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Primary and secondary syphilis — Rates by county: United States, 2009

<0.2 (n = 5)

0.21–2.2 (n = 19)

>2.2 (n = 30)

2.1

1.5

5.2

3.5

0.4

0.0

0.6 0.3

6.1

2.7

2.7

6.8

0.2

1.1

3.1

0.60.0

0.3

1.4

0.8

8.18.9

9.8

5.7

6.3

3.8

3.1

2.3

2.5

6.5

2.9

2.7

16.8

9.6

5.8

2.20.42.1

3.6

2.6

0.8

1.1

Puerto Rico5.7

Guam1.1

Rate per 100,000population

VirginIslands

0.0

VTNHMARICTNJDEMDDC

0.01.13.71.91.92.43.15.6

27.5

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 100,000 population.

0

10

20

30

40

50

60

70

Unknown 1 2 9 2 6 3 3 4 5 2 3 3

Late Latent 15 35 38 21 32 16 11 14 10 17 26 25

Early Latent 12 7 13 19 14 16 18 4 8 4 3 10

P and S 12 12 9 14 17 5 11 14 20 10 15 23

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

Syphilis CasesBy Diagnosis

2010

20 248 6

191210

150 156

202326

4559

41

10996 96

8699

139

0

25

50

75

100

125

150

175

200

225

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Female Male

Primary-Secondary SyphilisBy Gender2001-2010

Early Syphilis Cases By Sexual Preference

2001-2010

7469

142 133148

117

180

244

385

271

216207

258

215175

112

8165

2920

0

100

200

300

400

500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Heterosexual MSM

Congenital Syphilis—Infants—Rates by Year of Birth and State, United States and Outlying Areas, 2009

NOTE: The total rate of congenital syphilis for infants by year of birth for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 10.0 per 100,000 live births.

1.2

0.0

10.8

7.5

0.0

0.0

11.6 0.0

6.0

2.7

0.0

31.5

4.1

0.0

0.0

0.00.0

0.0

1.4

0.0

17.420.6

9.4

8.9

7.8

1.9

4.6

3.1

1.1

15.4

7.4

3.7

17.4

24.4

8.9

3.40.00.0

27.3

0.0

7.3

<1.0 (n = 20))

1.1–10.0 (n = 23))>10.0 (n =11))

5.3Puerto Rico

10.3

Guam0.0

Rate per 100,000Live births

VirginIslands

0.0

VTNHMARICTNJDEMDDC

0.00.00.08.14.86.18.3

40.00.0

Congenital SyphilisCases / Infant Deaths

1996-2010

0

5

10

15

20

25

30

35

Stillbirth 3 5 4 7 1 3 0 1 3 2 0

Live Birth 21 23 16 18 11 19 10 20 17 10 12

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

20

28

2422

1012

25

12

21

12

20

Congenital Syphilis CasesBy Race2001-2010

0

5

10

15

20

25

Black 3 3 3 0 3 0 1 2 1 1

Hispanic 20 12 19 11 16 7 12 11 7 4

Native Amer 1 3 1 0 2 2 2 3 1 0

White 3 2 2 1 1 1 6 3 2 7

2001 2002 2003 2004 2005 2006 2007 2008* 2009* 2010

* In 2008 and 2009 there was one Asian case each year

• Maricopa County– Arizona Statute 36-693: “A physician shall at the time of

the first prenatal examination take a standard blood test for syphilis”.

– Requests that all physicians and midwives providing obstetrical services in Maricopa County perform a third trimester blood sample for syphilis between 24 and 32 weeks gestation.

– Require that all newborns in Maricopa County have blood drawn for syphilis testing.

Current Syphilis Screening Recommendations for Pregnant Women in Maricopa County

Congenital Syphilis Transmission

Weeks gestation

First0

(Conception)

~40

(Delivery)

12 28Second Third

New Infection

Screening

Chlamydia—Rates by State, United States and Outlying Areas, 2009

NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 406.3 per 100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

<300.0 (n = 10)

300.1–400.0 (n = 21)

>400.0 (n = 23)

327

303

399

386

309

753

305 185

472

346

595

435

252

225

478

369375

305

272

372

803556

411

398

445

398

420

457

341

478

438

413

626

503

469

311199405

400

468

313

375

Puerto Rico185

Guam352

Rate per 100,000population

VirginIslands

444

191

160

297

344

346

276

540

422

1,107

S ite o f M aricopa C ountyPublic H ealth C enter STD C lin ic

Phoenix Metropolitan AreaZip C ode Map

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CHLAMYDIA CASES2010

60

10

17

17

MARIC OPA C OU NT Y

85353

8505085054

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.

85085

85053

85042

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SHEA BLVD. 8525985268

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Public H ealth D epartm ent

85298

85286

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85395 8539285396

85266

85209

0

1000

2000

3000

4000

5000

6000

Female 8 3887 5878 1110 217 57 13

Male 3 950 2445 729 190 39 12

0 to 09 10 to 19 20 to 29 30 to 39 40 to 49 50 to 5960 and Over

Chlamydia CasesBy Age and Gender

2010

Gonorrhea—Rates by State, United States and Outlying Areas, 2009

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population.

34.9

29.4

63.2

66.4

8.3

144.3

Puerto Rico5.8

Guam33.5

23.5 10.9

87.2

81.4

185.7

120.4

7.2

12.5

54.5

13.942.8

77.2

44.1

92.4

246.4160.8

141.3

113.9

150.4

100.3

139.2

147.0

107.2

127.5

109.8

128.3

204.0

156.2

154.7

89.626.257.2

50.0

55.2

89.4

<19.0 (n = 8)

Rate per 100,000population

19.1–100.0 (n = 24)

>100.0 (n = 22)

49.0

VirginIslands104.7

VTNHMARICTNJDEMDDC

8.08.6

30.430.673.154.8

111.2113.5432.7

S ite o f M aricopa C ountyPublic H ealth C enter STD C lin ic

Phoenix Metropolitan AreaZip C ode Map

GLENDALE AVE.

PEORIA AVE.

THOMAS RD.

16T

H S

T.

CE

NT

RA

L A

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.

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UNION HILLS DR.

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85242

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85284

85226850448504885045

85281

85282

85251

8525685250

8525885302

85304

85306

85308

85310

850328502285023

85027 85024

8526085254

85255

85323

8533885326

85340

85309

853038530585307

85233

85202

8520485210

85201

85234

85296

85206

85205

85215

85220

85208

85207

85212

85236

85248

85224 85225

85249

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85331

85262

85351

8537385375

85335

85355

85374

85361

85363

85382

85381

85345

8520

3

8521

3

GONORRHEA CASES2010

60

10

17

17

MARIC OPA C OU NT Y

85353

8505085054

43R

D A

VE

.

85085

85053

85042

85379

SHEA BLVD. 8525985268

CAREFREE HW Y.

85297

85383

85387

Public H ealth D epartm ent

85298

85286

10

85395 8539285396

85266

0

200

400

600

800

Female 2 350 519 118 35 9 1

Male 0 183 639 270 110 35 8

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 5960 and Over

Gonorrhea CasesBy Age and Gender

2010

Patient-Delivered Partner Therapy(Bill Passed April 2008)

• 2008 Arizona Senate Bill 1078: • Amends A.R.S. 32-1401.27 and now allows

providers to dispense antimicrobial treatment to persons in contact with someone with a communicable disease without a physical exam including STDs.

Use of EPT by Arizona Providers• Survey of OB/GYN providers• 142 completed surveys representing providers

that delivered 32,768 (48%) of infants in Maricopa County

• 47% reported using EPT• Barriers:

– Inability to obtain medical/allergy history in partner– Concerns for liability/malpractice– Clinic policy of not prescribing to non-clinic patients

Expedited Partner Therapy• Amendment in effect since September 26, 2008• §ARS 32-1401 (27)(ss)(v)”Unprofessional Conduct”

– (ss) Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a doctor-patient relationship. This subdivision does not apply to:

– (v)Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.

– http://www.azleg.state.az.us

What to prescribe for EPT

• For partners of chlamydia cases:– Azithromycin 1 gram PO X 1 dose

• For partners of gonorrhea cases– Cefixime 400 mg PO X 1 dose

• Medication or prescriptions should be accompanied by partner information sheets

Educational Materials

• Provider and Pharmacy Fact Sheets• Partner fact sheets in English and Spanish• Frequently asked questions• Postcards to providers• http://azdhs.gov/phs/oids/std/

ADHS STD Annual Report

• 2009 STD Annual Report• 2009 STD Arizona Youth Report

http://www.azdhs.gov/phs/oids/std/index.htm

HIV and STDs Co-Infection

• Increased susceptibility; 2 to 5 times • Increased infectiousness; 10x HIV semen

concentration with gonorrhea• Early detection and treatment of STDs

STD Clinic1645 E. Roosevelt

Phoenix, AZ 85006

Maricopa County Department of Public Health

No appointment necessary Walk-In Clinic

$20.00 fee includes lab testing, exam, and on site treatment.

Clinic open 8 a.m. - 5 p.m.Monday through Friday

Registration Hours:7:30 a.m. - 4:00 p.mSTDaz.com

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