Gonorrhea Morbidity and Prevention Efforts

in Los Angeles County

Binh Goldstein, PhD, EpidemiologistSarah Guerry, MD, Medical Director

Sexually Transmitted Disease ProgramLos Angeles County Department of Public Health

Reported Cases of Gonorrhea: LAC, 1998-2008

3194 32184165 4260 4366 4337

5252 5736 5518 5026 4644

2842

30283470 3420 3728

44284736 4853

4256

3565

2791

0

2000

4000

6000

8000

10000

12000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Nu

mb

er o

f C

ases

Female

Male

5,986 6,061

7,1997,743 7,800 8,078

9,696

10,494 10,411

9,302

8,280

Rates of Gonorrhea: LAC, 1998-2008

0

20

40

60

80

100

120

140

1998 2000 2002 2004 2006 2008

Year

Ra

te p

er

10

0,0

00

BothMaleFemale

Gonorrhea Cases by Race and Gender: LAC, 2008

Male GC CasesOther

301%

Black1,69645%

Asian1153%

Hispanic1,02128%

White (non-Hispanic)

84123%

N=4,644

Female GC Cases

Black1,73658%

Other161%

Asian963%

White (non-Hispanic)

35312%

Hispanic77226%

N=3,565

• Any person identified as Hispanic (alone or in combination) is included in the Hispanic category. Those in other race categories are non-Hispanic.

• Asian category includes Pacific Islander.

• Total N includes 592 female (16.6%) and 941 male (20.3%) cases with unknown race/ethnicity.

Rates of Gonorrhea by Age and Race: Females, LAC, 20081,969.3

1,717.3

809.0

310.1

Rates of Gonorrhea by Age and Race: Males, LAC, 2008

951.5

1,761.6

1,053.9

686.9

352.6

All ages

Number of GC Cases by

HD, SPA, and

Supervisorial District

LAC, 2008

Ages 15-24 years

Number of GC Cases by

SPA and Supervisorial

District

LAC, 2008

GC Morbidity by Provider Type, LAC 2008

Provider Type N Cases %

Private Practice/Group* 3,098 38.2%

DPH STD Clinic 1,166 14.4%

Community/Free Clinic 914 11.3%

HMO 844 10.4%

Adult Detention 444 5.5%

Sentinel FP Clinic 234 2.9%

Juvenile Detention 201 2.5%

Hospital 116 1.4%

High School/College 92 1.1%

Other 1,009 12.4%

Total 8,118 100.0%

*Includes non-sentinel FP and non-DPH STD clinics.

Timely Treatment of GC, LAC 2008

0%

20%

40%

60%

80%

100%

SentinelFP

DPH STD Women'sJail

Men's Jail JuvenileDetention

Other

Rx in < 14 D Rx in < 30 D Total Rx Not Rx

N=234 N=1,165 N=188 N=249 N=196 N=6,032*Excludes cases missing specimen collection

Ongoing Efforts (1)

• Screening in detention facilities

• GISP participant since 2003

• PDPT offered at DPH STD clinics since 2007

• Rectal and pharyngeal NAATs validated and used for MSM in county testing sites (including GLC, AHF, K6G unit) since 2008

• PHIs now follow all GC cases in the county as of October 2009

Ongoing Efforts (2)• Enhanced GC participant

• I Know/Don’t Think Know campaigns– Began in June 2007 to promote CT/GC annual

screening among young women of color– Promoted and made home test kits (self-collected

vaginal swab) available in June 2009

• Wall-to-wall screening pilot in a high risk high school – Health Awareness Program (October –

December 2009)

Enhanced GC: LAC, 2008• Symptomatic infection: Female = 45.4%, MSM=68.4%, Male

Heterosexual = 86.3%• No. sex partners in the 12 mo prior to infection:

No. partners

Females MSM Male Heterosexual

N % N % N %

1 38 33.3% 4 6.2% 13 21.0%

2 37 32.5% 5 7.7% 18 29.0%

3-4 24 21.1% 18 27.7% 19 30.6%

5-9 11 9.6% 16 24.6% 5 8.1%

10+ 4 3.5% 22 33.8% 7 11.3%

Total 114 100% 65 100% 62 100%

DTKKits Ordered

as of 10-28-09: first 20 wks

• 2,163 total orders• 1,093 kits returned

(50.5%)• 1,042 testable

specimens (95.3% of returned)

• 87 CT positives (8%), 10 GC positives (1%) (4 coinfected)

• 97% of orders = online• 13% of orders < age 19

Health Awareness Program

• Education portion and offered CT/GC screening to all students (grades 9-12) in a high school in a high morbidity area

• Found 47 CT cases out of 1,138 students tested (4% prevalence)

• Found 5 GC cases

• Followed up positives for treatment

Future Efforts

Focus on District 2:• Expand targeted high school wall-to-

wall screening

• I Know and home test kit campaigning

• Expand EPT use

• Community-embedded PHIs for partner and treatment follow-up

Binh Goldsteinbgoldstein@ph.lacounty.gov(213) 744-3089

Sarah Guerrysguerry@ph.lacounty.gov(213)744-3133