Gonorrhea EpidemiologyPrevention and Control

in Chicago

William Wong, MDSTI/HIV Prevention and Control Services

Division of STI/HIV/AIDSChicago Department of Public Health

Department of Public Health

“Providing the Prescription for a Healthy City”

Acknowledgements

Charmaine Murray, MPA

Jenna Khan, MPH

Irina Tabidze, MD, MPH

Reported Cases of Gonorrhea – Chicago, 2000-2008

Year

Reported Gonorrhea increased by 11.9%

in 2008

Reported Cases of Gonorrhea by Sex –

Chicago, 2000-2008

Year

Proportion of Reported Gonorrhea Cases by Sex, Race/Ethnicity and Age – Chicago, 2008

0%

20%

40%

60%

80%

100%

<10 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 >50

Age (years)

Perc

en

t

0%

20%

40%

60%

80%

100%

<10 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 >50

Age (years)

Perc

en

t

0%

20%

40%

60%

80%

100%

Male Female

Gender

0%

20%

40%

60%

80%

100%

Male Female

Gender

Reported Gonorrhea Morbidity by Provider Type – Chicago, 2008

Provider Type No. of Cases % MorbidityPMD 4,310 41.0%Hosp/EDs 3,436 32.7%STD Clinics 2,235 21.3%Corrections 301 2.9%Family Planning 128 1.2%School-Based Health Center 99 0.9%TOTAL 10,509 100%

Chlamydia, Gonorrhea, and Primary and Secondary Syphilis - Counties and Independent Cities Ranked by Number of Reported Cases: United States, 2008

Rank Chlamydia Gonorrhea Primary and Secondary Syphilis

1

Los Angeles County, CA

Cook County, ILLos Angeles County,

CA46,707 cases

472.8/100,000 population13,227 cases

250.3/100,000 population822 cases

8.3/100,000 population

2Cook County, IL Wayne County, MI New York County, NY

34,252 cases648.2/100,000 population

9,801 cases457.5/100,000 population

491 cases30.3/100,000 population

3Wayne County, MI

Los Angeles County, CA

Cook County, IL

19,218 cases968.1/100,000 population

8,959 cases90.7/100,000 population

488 cases9.2/100,000 population

U.S. Rate 401.3/100,000 population 111.6/100,000 population 4.5/100,000 population

HP2010Target

138.0/100,000 19.0/100,000 0.2/100,000

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services; November 2009.

Why did reported gonorrhea decrease annually since 2000, and then suddenly increase in

2008 in Chicago?

Significant Events Affecting Gonorrhea Case Reporting – Chicago, 2000-2008

Year

Cessation of Universal STD Screening at County Jail

Cessation of Universal STD Screening at County Jail Cessation of

Targeted STD Screening at County Jail

Cessation of Targeted STD Screening at County Jail

Closure of 31st Street STD Clinic

Closure of 31st Street STD Clinic

Closure of Mile Square STD Clinic

Closure of Mile Square STD Clinic

Advent of Electronic Laboratory Reporting,

CDPH EMR

Advent of Electronic Laboratory Reporting,

CDPH EMR

Targeted STD STD Screening

Restarted at County Jail

Targeted STD STD Screening

Restarted at County Jail

Closure of Evanston STD Clinic

Closure of Evanston STD Clinic

County STD Clinic Charges Fees for

STD Visits

County STD Clinic Charges Fees for

STD Visits

Reported Chlamydia & Gonorrhea from CCJ Before and After Discontinuation of Universal

STD Screening April 2002-March 2004

BEFORE

April 2002 toMarch 2003

AFTER

April 2003 toMarch 2004

• Gonorrhea

• Chlamydia

• Gonorrhea

• Chlamydia

Broad JM, Cox T, Rodriguez S, Mansour M, Mennella C, Swallow-Murphy D, Raba J, Wong W. The Impact of Discontinuation of Male STD Screening Services at a Large Urban County Jail ― Chicago, 2002–2004. Sex Transm Dis 2009;36(2): S49-S52

Top 10 Community Areas with Highest Gonorrhea Rates -

Chicago, 2008

Community Area

Rate per 100,000

population

68 ENGLEWOOD 1069.1

37 FULLER PARK 1052.6

67 WEST ENGLEWOOD 1042.4

26 WEST GARFIELD PARK 1025.2

27 EAST GARFIELD PARK 996.1

40 WASHINGTON PARK 940.2

69 GREATER GRAND CROSSING 911.5

29 NORTH LAWNDALE 888.2

53 WEST PULLMAN 875.9

36 OAKLAND 802

Community Areas with High Gonorrhea Rates, STI Clinics, Federally Qualified Health Centers (FQHC), FQHC Look-Alikes (FQHCLA) and School-Based Health Centers (SBHC) – Chicago, South Side, 2008

Community Areas with High Gonorrhea Rates, STI Clinics, Federally Qualified Health Centers (FQHC), FQHC Look-Alikes (FQHCLA) and School-Based Health Centers (SBHC) – Chicago, West Side, 2008

Enhanced Gonorrhea Surveillance Projects – Chicago, 2010

• Gonococcal Isolate Surveillance Project (GISP)– Participant since 1996– Quinolone-resistant Neisseria gonorrhoea (QRNG) identified (2004)– CDC discontinues FQ recommendation for GC Tx (2007)– QRNG prevalent (8%) among GISP isolates (2009)– GC cases with decreased susceptibility to cephalosporins identified

(2009)

• Population-based Gonorrhea Behavioral Surveillance STD Surveillance Network (SSuN) – Participant since 2008– Sample of reported GC cases are assigned for DIS behavioral interview

Opportunities for Enhancing Gonorrhea Prevention and Control – Chicago, 2010

• Priority Populations: – Adolescents 15-24 years old– Pregnant Females– Incarcerated populations

• Screening:– Review sentinel surveillance and

prevalence monitoring data– Rebuild STI Screening Program in

the County Jail– Expanded STI Screening in

Chicago Public Schools– Validation of Rectal and

Pharyngeal NAATs

• Access-to-Care: – Prevent/Mitigate closure of

remaining STI Clinics– Strengthen referral networks– Optimize STD care in FQHCs,

EDs, and other settings – Evaluate/improve GC Treatment

Verification Program

• Partner Services:– Implement EPT in Illinois

• Community Engagement:– Engage community & adolescent

health coalitions, planning bodies– Conduct targeted community

education activities

Contact Information

William Wong, MD

Director, STI/HIV Prevention and Control ServicesMedical Director, Division of STI/HIV/AIDS

Chicago Department of Public HealthCity of Chicago

Phone: 312-742-7372Email: wong_will@cdph.org

Urgently Needed

• CALL TO ACTION

• $$$$$ / Funding

• Additional Resources

• Program Flexibility