West Virginia Office of Epidemiology and Prevention Services 1

Gonorrhea Morbidityin West Virginia

Caroline A. Williams, MD, Director

Division of STD, HIV/AIDS and Hepatitis

Philadelphia, Pennsylvania

June 16, 2009

West Virginia Office of Epidemiology and Prevention Services 2

Gonorrhea Cases in West VirginiaBy Gender, 2004 - 2008

473

428

479 505

423

420 462345

429321

0

100

200

300

400

500

600

700

800

900

1,000

2004 2005 2006 2007 2008

Cas

es

Male Female

n=893 n=773 n=941 n=934 n=744

West Virginia Office of Epidemiology and Prevention Services 3

Gonorrhea Cases in West VirginiaBy Age Group, 2004 - 2008

215167

212 216176

336

276303 320

283

154

146

187 186

148

74

80

88 83

48

104

97

142 119

81

8107 9100

100

200

300

400

500

600

700

800

900

1,000

2004 2005 2006 2007 2008

Cas

es

<15/Unk 15-19 20-24 25-29 30-34 35+

n=893 n=773 n=941 n=934 n=744

West Virginia Office of Epidemiology and Prevention Services 4

Gonorrhea Cases in West VirginiaBy Race/Ethnicity, 2004 - 2008

322286

399 344

258

119

86

108 135

81

405455401 434452

0

100

200

300

400

500

600

700

800

900

1,000

2004 2005 2006 2007 2008

Cas

es

White, NH Black, NH Other/Unk

n=893 n=773 n=941 n=934 n=744

West Virginia Office of Epidemiology and Prevention Services 5

Estimated % of Population and % of Reported Gonorrhea Cases, by Race/Ethnicity, West Virginia, 2008

54.4

34.7

0.9 9.91.83.5 1.1

93.5

0

10

20

30

40

50

60

70

80

90

100

White NH Black NH Hispanic Other/Unk

Per

cent

% Population % Cases

West Virginia Office of Epidemiology and Prevention Services 6

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

2004 2005 2006 2007 2008

Rat

e

White, NH Black, NH Hispanic Asian/PI AI/AN All Race/Eth

Gonorrhea Cases per 100,000 PopulationBy Race/Ethnicity, West Virginia, 2004 - 2008

West Virginia Office of Epidemiology and Prevention Services 7

Gonorrhea Cases in West VirginiaBy Age, Gender, and Race/Ethnicity, 2008

77

87 20 70

25

21

1617

636291

187

0

50

100

150

200

250

300

350

Female (15-24) Male (15-24) Female (25+) Male (25+)

Cas

es

White, NH Black, NH Other/Unk

n=289 n=170 n=127 n=150

West Virginia Office of Epidemiology and Prevention Services 8

Gonorrhea Casesin West Virginia, 2008State Total = 744

HANCOCK

BROOKE

OHIO

MARSHALL

WETZEL

TYLERPLEASANTS

WOOD

JACK-SON

RITCHIE

WIRT

ROANE

CAL-HOUN

MONONGALIA

MARION

TAYLORDODD-RIDGE

LEWISGILMER

PRESTON

BARBOUR TUCKER

UP-SHUR

RANDOLPH

HARRISON

MORGAN BERKELEY

JEFFERSON

MINERAL

HAMPSHIRE

GRANT

HARDY

PENDLETONBRAXTON

WEBSTER

POCAHONTASNICHOLAS

GREENBRIERFAYETTE

CLAYPUTNAM

KANAWHA

BOONE

MASON

CABELL

WAYNELINCOLN

MINGO LOGAN

McDOWELL

WYOMING

RALEIGH

MERCER

SUM-MERS MONROE 11 - 183

4 - 10

2 - 3

CASES

0 - 1

West Virginia Office of Epidemiology and Prevention Services 9

Gonorrhea Casesin West Virginia, 2007State Total = 934

0

9 - 258

3 - 8

1 - 2

CASES

HANCOCK

BROOKE

OHIO

MARSHALL

WETZEL

TYLERPLEASANTS

WOOD

JACK-SON

RITCHIE

WIRT

ROANE

CAL-HOUN

MONONGALIA

MARION

TAYLORDODD-RIDGE

LEWISGILMER

PRESTON

BARBOUR TUCKER

UP-SHUR

RANDOLPH

HARRISON

MORGAN BERKELEY

JEFFERSON

MINERAL

HAMPSHIRE

GRANT

HARDY

PENDLETONBRAXTON

WEBSTER

POCAHONTASNICHOLAS

GREENBRIERFAYETTE

CLAYPUTNAM

KANAWHA

BOONE

MASON

CABELL

WAYNELINCOLN

MINGO LOGAN

McDOWELL

WYOMING

RALEIGH

MERCER

SUM-MERS MONROE

West Virginia Office of Epidemiology and Prevention Services 10

Gonorrhea Cases and Rates per 100,000 PopulationRanked by Cases, West Virginia, 2008

County

Rankout of 55Counties Population

% of StatePopulation

Cumulative% of StatePopulation Cases

% of StateCases

Cumulative% of State

CasesRate/100K

Kanawha 1 191,018 10.5% 10.5% 183 24.6% 24.6% 95.8

Cabell 2 94,631 5.2% 15.7% 153 20.6% 45.2% 161.7

Berkeley 3 102,044 5.6% 21.4% 68 9.1% 54.3% 66.6

Raleigh 4 79,357 4.4% 25.7% 51 6.9% 61.2% 64.3

Mercer 5 61,500 3.4% 29.1% 41 5.5% 66.7% 66.7

Monongalia 6 88,221 4.9% 34.0% 27 3.6% 70.3% 30.6

Wood 7 86,204 4.8% 38.7% 27 3.6% 73.9% 31.3

Harrison 8 68,853 3.8% 42.5% 20 2.7% 76.6% 29.0

Fayette 9 46,341 2.6% 45.1% 18 2.4% 79.0% 38.8

Marion 10 56,496 3.1% 48.2% 15 2.0% 81.0% 26.6

Gonorrhea Ranked by Cases

West Virginia Office of Epidemiology and Prevention Services 11

Gonorrhea Cases and Rates per 100,000 PopulationRanked by Rate, West Virginia, 2008

County

Rankout of 55Counties Population

% of StatePopulation

Cumulative% of StatePopulation Cases

% of StateCases

Cumulative% of State

CasesRate/100K

Cabell 1 94,631 5.2% 5.2% 153 20.6% 20.6% 161.7

Kanawha 2 191,018 10.5% 15.7% 183 24.6% 45.2% 95.8

Mercer 3 61,500 3.4% 19.1% 41 5.5% 50.7% 66.7

Berkeley 4 102,044 5.6% 24.8% 68 9.1% 59.8% 66.6

Raleigh 5 79,357 4.4% 29.1% 51 6.9% 66.7% 64.3

Summers 6 13,017 0.7% 29.8% 8 1.1% 67.7% 61.5

Wirt 7 5,757 0.3% 30.2% 3 0.4% 68.1% 52.1

Fayette 8 46,341 2.6% 32.7% 18 2.4% 70.6% 38.8

Ohio 9 44,106 2.4% 35.1% 14 1.9% 72.4% 31.7

Wood 10 86,204 4.8% 39.9% 27 3.6% 76.1% 31.3

Gonorrhea Ranked by Rates

12

Gonorrhea Ratesper 100,000Population,

West Virginia, 2008

• Seven county rates higher than the 2008 West Virginia rate (41.0)

• One county rate higher than the 2007 U.S. rate (118.9)

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

WETZEL

TUCKER

ROANE

RITCHIE

PRESTON

POCAHONTAS

PLEASANTS

HAMPSHIRE

GILMER

CLAY

CALHOUN

BRAXTON

BARBOUR

NICHOLAS

BOONE

WYOMING

TAYLOR

J ACKSON

GRANT

MARSHALL

WAYNE

WEBSTER

RANDOLPH

MINERAL

TYLER

MORGAN

PENDLETON

HANCOCK

PUTNAM

HARDY

MINGO

MASON

MONROE

LINCOLN

LEWIS

J EFFERSON

McDOWELL

MARION

DODDRIDGE

LOGAN

GREENBRIER

HARRISON

UPSHUR

BROOKE

MONONGALIA

WOOD

OHIO

FAYETTE

WEST VIRGINIA

WIRT

SUMMERS

RALEIGH

BERKELEY

MERCER

KANAWHA

U.S.

CABELL

U.S.

WV

West Virginia Office of Epidemiology and Prevention Services 13

Strengths of West Virginia’sGonorrhea Control Program

• WV is considered a low-incidence state for chlamydia, gonorrhea, syphilis and HIV/AIDS

• All GC cases are initiated to the field

• Active partner notification for all GC cases

• APTIMA is the testing method for the WV Office of Laboratory Services

• Colleges/universities and correctional facilities, including juvenile centers, offer Ct/GC testing