Wisconsin STD Program

Overview of Gonorrhea Epidemiology and Program Prevention Efforts

Meeting February 2, 2010

Wisconsin Department of Health Services:Protecting and Promoting the Healthand Safety of the People of Wisconsin.

Douglas

26

Bayfield

Ashland

Saywer

1

Washburn

2Burnett

3

Polk

4

Barron Rusk

1

Price

Iron Vilas

4

Oneida

3

Lincoln

3Taylor

Chippewa

3St. Croix

9

Pierce

1

Dunn

5

Pepin

Eau Claire

10

Buffalo

1Trempealeau

Jackson

3

Monroe

16

Clark Marathon

26

Wood

6Portage

5

Juneau

7Adams

2

Sauk

14

LaCrosse

35

Vernon

Crawford

1

Richland

1

Grant

7

LaFayette

1

Green

3Rock

134

Dane

453Iowa

2

Columbia

14Dodge

36

Jefferson

18Waukesha

81

Walworth

15Kenosha ---- 160

Racine – 277

Ozaukee

19

Sheboygan

20

Fond du Lac

441Green Lake

Marquette

1

Waushara

4Winnebago

73Calumet

11Manitowoc

12

Kewaunee

4Brown

294Outagamie

67

Waupaca

2

Shawano

6

Menominee

3

Oconto

6

Langlade

1

Forest

2

Marinette

8

Florence

2 Door

Milwaukee --- 4,063

21Washington

6,062 = Total Cases

101-1000 >10001-100

Reported Cases of Gonorrhea by County 2008

Wisconsin:72 Counties

Reported Cases of Gonorrhea in Wisconsin 1999-2008

6 3 0 76 9 8 9

6 1 1 5 6 3 6 25 5 9 8

5 0 6 9 5 0 4 9

6 8 8 3 6 7 9 46 0 6 3

4 7 7 34 0 9 9 4 2 7 6

4 6 8 7

3 8 5 43 2 9 9

4 0 2 7

4 8 9 6 4 9 1 6

4 0 3 2

1 5 3 4

2 8 9 0

1 8 3 9 1 6 7 5 1 7 4 4 1 7 7 0 1 9 2 2 1 9 8 7 1 8 7 8 2 0 3 1

0

1 0 0 0

2 0 0 0

3 0 0 0

4 0 0 0

5 0 0 0

6 0 0 0

7 0 0 0

8 0 0 0

1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8

W i s c o n s i n M i l w a u k e e C o u n t y W I w /o M i l w C o u n t y

Cases

Year

Reported Rates of Gonorrhea per 100,000 Pop Wisconsin: 1999-2008

1 1 5 . 5

1 3 0 . 3

1 1 2 . 7 1 1 6 . 51 0 4

9 1 . 5

1 0 6 . 6

1 2 4 . 5 1 2 0

1 0 6 . 9

0

5 0

1 0 0

1 5 0

2 0 0

1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8

Year

Rate

Reported Rates of Gonorrhea per 100,000 PopMilwaukee County: 1999-2008

4 9 8

4 3 6 4 5 34 9 5

4 0 6

3 4 7

4 2 4

5 1 4 5 1 7

4 2 4

0

1 0 0

2 0 0

3 0 0

4 0 0

5 0 0

6 0 0

7 0 0

1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8

Rate

Year

WI Reported Rates of Gonorrhea per 100,000 Popby Gender: 1999-2008

115.5130.3

112 116104

92106

125 120106.5110 106

8897

8776

89105

9684

143154

135 135119

106123

145 144133

0

20

40

60

80

100

120

140

160

180

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Rate All Male Female

Rate

Year

Milwaukee County Reported Rates of Gonorrhea per 100,000 Pop by Gender: 1999-2008

498436 453

495

406347

424

514 517

424430370 371

411347

305369

459427

370

549492

523 518

439383

449

593 595527

0

100

200

300

400

500

600

700

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Rate All Male Female

Rate

Year

2 1 3 1

5 0 9 4 9 3

2 6 01 3 1 6 9 2 7 1 7 45 1

1 3 3

2 1 2 21 9 8 5

1 0 2 7

4 2 02 5 1

1 0 1 7 2 1 70

5 0 0

1 0 0 0

1 5 0 0

2 0 0 0

2 5 0 0

0 - 4 5 - 9 1 0 - 1 4 1 5 - 1 9 2 0 - 2 4 2 5 - 2 9 3 0 - 3 4 3 5 - 3 9 4 0 - 4 4 4 5 - 4 9 5 0 +

A g e g r o u p

Ra

te

W i s c o n s i n M i l w a u k e e C o u n t y

Reported Age-specific Gonorrhea Rates*:Wisconsin and Milwaukee County 2008

* Cases per 100,000 population.

Reported Cases of Gonorrhea by Age & Gender Milwaukee County & WI w/o Milwaukee County

2008

2 1 3

4 3 84 7 3

2 6 33 1 7

2

9 9 9

7 4 2

3 2 02 5 6

0 0

1 6 2

2 4 9

1 7 12 3 8

3 2 9

4 3 44 7 2

2 2 61 7 3

7 5

0

1 0 0

2 0 0

3 0 0

4 0 0

5 0 0

6 0 0

7 0 0

8 0 0

9 0 0

1 0 0 0

0 - 9 1 0 1 4 1 5 - 1 9 2 0 - 2 4 2 5 - 2 9 3 0 +

G o n o r r h e a

Ca

se

Re

po

rts

M a le M i lw C o u n t y F e m a le M i lw C o u n t y

M a le W I w /o M i lw C o . F e m a le W I w /o M i lw C o .

Reported Cases of Gonorrhea by Race & Gender Wisconsin 2008

2 0 5

6 6 8

1 5 0 5

1 8 5 9

7 2 1 0 7

5 1 0

1 0 4 2

0

2 0 0

4 0 0

6 0 0

8 0 0

1 0 0 0

1 2 0 0

1 4 0 0

1 6 0 0

1 8 0 0

2 0 0 0

W h i t e B l a c k H i s p a n i c U n k n o w n

M a l e F e m a l eRace/Gender

Reported Cases

Asians and Native Americans were less than 3% of Total

Reported Cases of Gonorrhea by Race & Gender Wisconsin w/o Milwaukee County 2008

1 5 5

5 6 1

3 2 6 2 9 4

3 7 4 4

1 1 3

2 0 5

0

2 0 0

4 0 0

6 0 0

8 0 0

1 0 0 0

W h i t e B l a c k H i s p a n i c U n k n o w n

M a l e F e m a l eRace/Gender

Reported Cases

Asians and Native Americans were less than 7% of Total

Reported Gonorrhea Cases by Gender & Race Milwaukee County 2008

5 01 0 7

1 1 7 9

1 5 6 5

3 5 6 3

3 9 7

8 3 7

0

2 0 0

4 0 0

6 0 0

8 0 0

1 0 0 0

1 2 0 0

1 4 0 0

1 6 0 0

W h i t e B l a c k H i s p a n i c U n k n o w n

M a l e F e m a l eRace/Gender

Reported Cases

Asians and Native Americans were less than 1% of Total

% of Total GC Cases Reported in Females by RaceWisconsin w/o Milwaukee County vs. Milwaukee County

2008

U n k n o w n , 1 7 . 5 %

N a t . A m e r . , 3 . 5 %

H i s p a n i c , 3 . 8 %

B l a c k , 2 5 . 0 %

W h i t e , 4 8 . 0 %

W h i t e , 4 . 1 %

B l a c k , 6 0 . 6 %

H i s p a n i c , 2 . 4 %

N a t . A m e r , 0 . 2 %

U n k n o w n , 3 2 . 4 %

Females WI w/o Milw Co

FemalesMilw County

Asian females were less than 1% of total Asian females were less than .1%of total

Percent of Total Percent of Total

% of Total GC Cases Reported in Males by RaceWisconsin w/o Milwaukee County vs. Milwaukee County

2008

U n k n o w n , 1 7 . 5 %

H i s p a n i c , 5 . 8 %

B l a c k , 5 1 . 0 %

W h i t e , 2 4 . 0 %

W h i t e , 3 . 0 %

B l a c k , 7 0 . 6 %

H i s p a n i c , 2 . 1 %

U n k n o w n , 2 3 . 8 %

MalesWI w/o Milw County

MalesMilw County

Asian and Native American Males were less than 3% of Total Asian and Native American Males were

less than 1% of Total

Percent of Total Percent of Total

941

10822 18

0

500

1,000

1,500

African American Am. Indian Asian/ Pacific Is. White

Ra

te*

Reported Gonorrhea Rates* by Race Wisconsin, 2008

52 – fold difference

* Cases reported with race specified per 100,000 population.

1,019

11328 28

0

500

1,000

1,500

African American Am. Indian Asian/ Pacific Is. White

Ra

te*

Reported Gonorrhea Rates* by Race Milwaukee County 2008

36 – fold difference

* Cases reported with race specified per 100,000 population.

Douglas

26

Bayfield

Ashland

Sawyer

1

Washburn

2Burnett

3

Polk

4

Barron Rusk

1

Price

Iron Vilas

4

Oneida

3

Lincoln

3Taylor

Chippewa

3St. Croix

9

Pierce

1

Dunn

5

Pepin

Eau Claire

10

Buffalo

1Trempealeau

Jackson

3

Monroe

16

Clark Marathon

26

Wood

6Portage

5

Juneau

7Adams

2

Sauk

14

LaCrosse

35

Vernon

Crawford

1

Richland

1

Grant

7

LaFayette

1

Green

3Rock

134

Dane

453Iowa

2

Columbia

14Dodge

36

Jefferson

18Waukesha

81

Walworth

15Kenosha ---- 160

Racine – 277

Ozaukee

19

Sheboygan

20

Fond du Lac

441Green Lake

Marquette

1

Waushara

4Winnebago

73Calumet

11Manitowoc

12

Kewaunee

4Brown

294Outagamie

67

Waupaca

2

Shawano

6

Menominee

3

Oconto

6

Langlade

1

Forest

2

Marinette

8

Florence

2 Door

Milwaukee --- 4,063

21Washington

6,062 = Total Cases

101-1000 >10001-100

Reported Cases of Gonorrhea by WI County 2008

Wisconsin:72 Counties

Milwaukee City Zip Code Areas

Zip Codes with Over 100Reported Cases of GC in 2008:

Zip Code – Number of Cases 53206 – 548 53209 – 402 53210 – 400 53212 – 390 53218 – 376 53216 – 333 53208 – 312 53225 – 175 53205 – 149 53204 – 127 53224 – 116 53233 – 115

These 12 zip codes represent 57%of all the gonorrhea reported

in Wisconsin in 2008.

Out of 4,032 cases reported from Milwaukee County in 2008

3,443 were reported fromthe 12 zip codes in the

City of Milwaukeenoted in the table –

this represents 85.4% of the reported cases in

Milwaukee County.

(12/43 Zip Code areas in Milwaukee City)

Milwaukee Zip Code GC Data 2008

Top Four Zip Code Areas for Reported Cases GC in 2008:

Zip Code – Cases 53206 – 548 53209 – 402 53210 – 400 53212 – 390

53211

53206

Capitol Dr.

North Ave.

27th

St

Hw

y 43 53212

53209

53216

53210

53205 5320253208

53217

Disease Intervention Activities in Wisconsin

Public health officers in each health department jurisdiction in WI are statutorily responsible to investigate each case of gonorrhea, including eliciting partners and other at-risk individuals for testing and treatment as necessary.

Two counties use limited criteria to follow-up on cases [Milwaukee and Brown (Green Bay)] Milwaukee Criteria:

F/u GC+ <= 16 males and females OR any pregnant female to verify Rx and notify partners

Milwaukee Field Activity for Gonorrhea Cases 2007 & 2008

Indicator 2007 2008 Percent Change

Cases Reported to the Program

4,662: 11% cases Interviewed

4,259:10% cases interviewed

-9% # cases reported

-1% cases interviewed

Cases Interviewed/FR Initiated ( that met the criteria for Interview)

539/607 (89%) 426/541 (78%) -11%

Cases Interviewed within 3 days

196/539 (36%) 163/426 (38%) +2%

Total Partners Initiated 391 290 -26%

Partners Examined 198/391 (51%)

(101/391 already Rx)

(58/198 not infected)

156/290 (54%)

(64/290 already Rx)

(39/156 not infected)

+3%

Partners Infected Brought to Treatment

61/198 (31%) 51/156 (33%) +2%

Partners Preventively Treated

66/198 (33%) 63/156 (40%) +7%

Partners Examined within 3 days

34/198 (17%) 39/156 (25%) +8%

Timeliness to Treatment

Family Planning Treatment Rates

Jan-June 2009Females

Milwaukee County:GC: 61%

Wisconsin w/o Milwaukee County:GC: 87%

Gonorrhea Positivity by Provider TypeWisconsin RVIPP Data 2008

0.6

10

1.9

11

2.6

0.80.13 0.2

6.5

4.5

0.2

3

0

5

10

15

20

Adult Corr. FP Juve. Det. STD Teen Clinic UnivHealth

Gonorrhea

Male

Female

% Positive

University of WI-Madison GC2009: Enrollment 42,000

24/3326 Tests Positive Female (4/24) cervical NAAT 0.3% Male (20/24) urine NAAT 0.6%

rectal culture 2.6%

pharyngeal culture 3.1%

Demographic characteristics of positives63% MSM (15/20)21% African American (5/24)

46% non-genital specimens (11/20 males)