Sexually Transmitted Disease (STD) Surveillance Report, 2011 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD

Sexually Transmitted Disease (STD) Sexually Transmitted Disease (STD) Surveillance Report, 2011Surveillance Report, 2011

Minnesota Department of HealthSTD Surveillance System

www.health.state.mn.us/stdwww.health.state.mn.us/std

Introduction

Under Minnesota law, physicians and laboratories must report all laboratory-confirmed cases of chlamydia, gonorrhea, syphilis, and chancroid to the Minnesota Department of Health (MDH) within one working day.

The MDH does not maintain statistics for other, non-reportable STDs (ex: herpes, HPV/genital warts).

This slide set describes trends in reportable STDs in Minnesota by person, place, and time.

Analyses exclude cases reported from federal and private prisons.

STDs in Minnesota: Annual Review

Introduction

STD surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population.

STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions.


Interpreting STD Surveillance Data

Factors that impact the completeness and accuracy of STD data include:

Level of STD screening by healthcare providers Individual test-seeking behavior Sensitivity of diagnostic tests Compliance with case reporting Completeness of case reporting Timeliness of case reporting

Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the above factors.


Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

Interpreting STD Surveillance Data

The surveillance system only includes cases diagnosed in conjunction with a positive laboratory test. Cases diagnosed solely on symptoms are not counted.

Surveillance data represent cases of infection, not individuals. A person with multiple infections in a given year will be counted more than once.

Caution is warranted when interpreting changes in STD numbers that can seem disproportionately large when the number of cases is small.

Changes in Rate Calculations for 2011

This 2011 data release includes rates calculated using revised population estimates for the calendar years between 2000 and 2010 U.S. Censuses

Previously published rates dating back to 2001 have been updated in this release

Data from the 2010 U.S. Census, released in 2011 reflected substantial growth among populations of color and American Indians in MN. Populations with the greatest increase were Black or African American, Asian/Pacific Islander, and Hispanic/Latino.


National Context


Chlamydia—Rates by State, United States and Outlying Areas, 2010National Rate = 422.6 per 100,000 population

Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.

Gonorrhea—Rates by State, United States and Outlying Areas, 2010


National Rate = 99.6 per 100,000 population

Primary and Secondary Syphilis—Rates by State United States and Outlying Areas, 2010

National Rate = 4.5 per 100,000 population


Overview of STDs in Minnesota



STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 2001-2011

* P&S = Primary and Secondary


STDs in Minnesota:Number of Cases Reported in 2011

Total of 19,547 STD cases reported to MDH in 2011:

16,898 Chlamydia cases 2,283 Gonorrhea cases 366 Syphilis cases (all stages) 0 Chancroid cases

CHLAMYDIA



Rate per 100,000 persons

> 300151 - 30076 - 1500 - 75

2011 Minnesota Chlamydia Rates

by County

City of Minneapolis 848City of St. Paul 795Suburban# 271Greater Minnesota 198

(728 cases missing residence information)

# 7-county metro area, excluding the cities of Minneapolis and St. Paul

St. Louis

Itasca

Cass

LakePolk

Beltrami

Aitkin

Pine

Cook

Koochiching

Otter Tail

Clay

Roseau

Marshall

Becker

Todd

Stearns

Kittson

Swift

Lyon

Pope

Morrison

Wilkin

Renville

Carlton

Martin

Rice

Wright

Norman

FillmoreMowerNobles

Murray

Grant

Sibley

Brown

Rock

Redwood

Douglas

Jackson

Meeker

Goodhue

Winona

Isanti

Faribault

Dakota

Freeborn

Olmsted

Scott

Stevens

Anoka

Nicollet

McLeod

Chippewa

Wabasha

Carver

Pennington

Hubbard

Cro

w W

ing

Lake

of t

he W

oods

Cle

arw

ater

Kan

diyo

hi

Lincoln

Blue Earth

Mill

e La

cs

Houston

Steele

Trav

erse

Dodge

Wadena

Hennepin

Kan

abec

Lac Qui Parle

Benton

Big Stone

Cottonwood

Was

eca

Chisago

Le Sueur

Mahnomen

Yellow Medicine

Pipestone

Red Lake

Sherburne

Watonwan

Washington

Ramsey


Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

Chlamydia Infections by Residence at Diagnosis Minnesota, 2011

Total Number of Cases = 16,898


Chlamydia Rates by GenderMinnesota, 2001-2011


Chlamydia Rates by AgeMinnesota, 2001-2011


Age-Specific Chlamydia Rates by Gender Minnesota, 2011


Chlamydia Rates by Race/Ethnicity Minnesota, 2001-2011

* Persons of Hispanic ethnicity can be of any race.

2011 rates compared with Whites:Black = 11x higherAmerican Indian = 4x higherAsian/PI = 2x higherHispanic = 3x higher


Chlamydia Rates by Race/Ethnicity Minnesota, 2001-2011


GONORRHEA



2011 Minnesota Gonorrhea Rates

by County


City of Minneapolis 211City of St. Paul 132Suburban# 30Greater Minnesota 14

(91 cases missing residence information)


St. Louis

Itasca

Cass

LakePolk

Beltrami

Aitkin

Pine

Cook

Koochiching

Otter Tail

Clay

Roseau

Marshall

Becker

Todd

Stearns

Kittson

Swift

Lyon

Pope

Morrison

Wilkin

Renville

Carlton

Martin

Rice

Wright

Norman

FillmoreMowerNobles

Murray

Grant

Sibley

Brown

Rock

Redwood

Douglas

Jackson

Meeker

Goodhue

Winona

Isanti

Faribault

Dakota

Freeborn

Olmsted

Scott

Stevens

Anoka

Nicollet

McLeod

Chippewa

Wabasha

Carver

Pennington

Hubbard

Crow Wing

Lake

of t

he W

oods

Cle

arw

ater

Kandiyohi

Lincoln

Blue Earth

Mill

e La

cs

Houston

Steele

Trav

erse

Dodge

Wadena

Hennepin

Kan

abec

Lac qui Parle

Benton

Big Stone

CottonwoodWaseca

Chisago

Le Sueur

Mahnomen

Yellow Medicine

Pipestone

Red Lake

Sherburne

Watonwan

Was

hing

ton

Ramsey

> 10030 - 10011 - 290 - 10



Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2011

Total Number of Cases= 2,283


Gonorrhea Rates by GenderMinnesota, 2001-2011


Gonorrhea Rates by AgeMinnesota, 2001-2011


Age-Specific Gonorrhea Rates by GenderMinnesota, 2011


Gonorrhea Rates by Race/Ethnicity Minnesota, 2001-2011


2011 rates compared with Whites:Black = 26x higherAmerican Indian = 6x higherAsian/PI = 0x higherHispanic = 2x higher


Gonorrhea Rates by Race/Ethnicity Minnesota, 2001-2011


SYPHILIS



Syphilis Rates by Stage of Diagnosis Minnesota, 2001-2011

* P&S = Primary and Secondary


2011 Minnesota Primary & Secondary

Syphilis Rates by County


> 1.0

0.21 – 1.00 – 0.2


St. Louis

Itasca

Cass

LakePolk

Beltrami

Aitkin

Pine

Cook

Koochiching

Otter Tail

Clay

Roseau

Marshall

Becker

Todd

Stearns

Kittson

Swift

Lyon

Pope

Morrison

Wilkin

Renville

Carlton

Martin

Rice

Wright

Norman

FillmoreMowerNobles

Murray

Grant

Sibley

Brown

Rock

Redwood

Douglas

Jackson

Meeker

Goodhue

Winona

Isanti

Faribault

Dakota

Freeborn

Olmsted

Scott

Stevens

Anoka

Nicollet

McLeod

Chippewa

Wabasha

Carver

Pennington

Hubbard

Crow Wing

Lake

of t

he W

oods

Cle

arw

ater

Kandiyohi

Lincoln

Blue Earth

Mill

e La

cs

Houston

Steele

Trav

erse

Dodge

Wadena

Hennepin

Kanabec

Lac qui Parle

Benton

Big Stone

CottonwoodWaseca

Chi

sago

Le Sueur

Mahnomen

Yellow Medicine

Pipestone

Red Lake

Sherburne

Watonwan

Was

hing

ton

Ramsey

City of Minneapolis 15.2 (58 cases)City of St. Paul 4.9 (14 cases)Suburban# 2.4 (52 cases)Greater Minnesota 0.5 (13 cases)



Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2011

Total Number of Cases = 139


Primary & Secondary Syphilis Rates by GenderMinnesota, 2001-2011


Primary & Secondary Syphilis Rates by AgeMinnesota, 2001-2011


Age-Specific Primary & Secondary Syphilis Rates by Gender, Minnesota, 2011


*Includes persons reported with more than one race

Primary & Secondary Syphilis Cases by RaceMinnesota, 2011

Total Number of Cases = 139


Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 2001-2011


CHLAMYDIA AND GONORRHEA AMONGADOLESCENTS & YOUNG ADULTS

(15-19 year olds) (20-24 year olds)



Chlamydia Cases in 2011 (n = 16,898)

MN Population in 2010 (n = 5,303,925)

Chlamydia Disproportionately Impacts Youth


Gonorrhea Disproportionately Impacts Youth

MN Population in 2010 (n = 5,303,925)

Gonorrhea Cases in 2011 (n = 2,283)


Characteristics of Adolescents & Young Adults† Diagnosed With Chlamydia or Gonorrhea in 2011

† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.* Total includes 5 cases diagnosed in transgendered persons



Characteristics of Adolescents & Young Adults† Diagnosed With Chlamydia or Gonorrhea in 2011

† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.


Chlamydia Rates Among Adolescents & Young Adults† by Gender in Minnesota, 2001-2011

† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.


Chlamydia — Positivity Rates by Age and Gender MIPP† Clinics, 2002-2011

† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.


Chlamydia Cases Among Adolescents and Young Adults†

by Gender and Race, Minnesota, 2011

Males (n = 2,998) Females (n = 8,876)



Chlamydia Rate Among Adolescents and Young Adults† by Race, Minnesota, 2011



Chlamydia — Positivity Rates Among 15-24 Year-olds by Race MIPP† Clinics, 2002-2011



Gonorrhea Rates Among Adolescents & Young Adults† by Gender in Minnesota, 2001-2011



Gonorrhea — Positivity Rates by Age and Gender MIPP† Clinics, 2002-2011



Gonorrhea Cases Among Adolescents and Young Adults†

by Gender and Race, 2011

Males (n = 476) Females (n = 914)



Gonorrhea Rate Among Adolescents and Young Adults† by Race, Minnesota, 2011



Gonorrhea — Positivity Rates Among 15-24 Year-olds by Race MIPP† Clinics, 2002-2011



Summary of Chlamydia and Gonorrhea Among Adolescents and Young Adults†, Minnesota, 2011

Adolescents and young adults accounted for 69% of chlamydia and 65% of gonorrhea cases diagnosed in Minnesota.

74% of chlamydia or gonorrhea cases diagnosed among adolescents and young adults were females.

Whites and Blacks accounted for 43% and 31% of chlamydia or gonorrhea cases, respectively.

32% of gonorrhea or chlamydia cases were in the Cities of Minneapolis and Saint Paul.


Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STDs in Minnesota: Annual Review

Topic of Interest:Early Syphilis Among

Men Who Have Sex With Men in Minnesota


Number of Early Syphilis† Cases by GenderMinnesota, 2001-2011

MSM=Men who have sex with men. Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, 2007, and 2009).† Early Syphilis includes primary, secondary, and early latent stages of syphilis.


Early Syphilis† Cases by Stage at Diagnosis Minnesota, 2001-2011

† Early Syphilis includes primary, secondary, and early latent stages of syphilis.


Early Syphilis† by Gender and Sexual Behavior Minnesota, 2001-2011

MSM=Men who have sex with men† Early Syphilis includes primary, secondary, and early latent stages of syphilis.


Early Syphilis† Cases Among MSM by Age Minnesota, 2011 (n=218)


Mean Age = 35.8 yearsRange: 15 to 64 years


Early Syphilis† (ES) Cases Co-infected with HIV, 2006-2011



Gay and bisexual men account for 88% of cases among men.

71% of cases among MSM are White, but a disproportionate number of cases (15%) are African American.

52% in the City of Minneapolis and 30% live in the suburbs

57% of cases are also infected with HIV.

Among cases interviewed by the MDH Partner Services Program: Commonly reported risk factors were meeting partners on the internet,

anonymous sex, and no condom use.

Characteristics of Early Syphilis† Cases Among MSM, Minnesota, 2011



What’s Being Done in Minnesota? The MDH Partner Services Program continues to follow up on early

syphilis cases and their sex partners.

In 2004 the MDH implemented the Syphilis Elimination Effort (SEE). SEE activities include:

Developed a clinician toolkit for syphilis testing and treatment; Created a new outbreak response plan; and Increased awareness among gay/bisexual men through advertising in

magazines, bars, and websites. SEP website: www.health.state.mn.us/sep - includes several archived provider

presentations and links to current awareness campaign materials

Physicians are encouraged to screen men who have sex with men at least annually and to ask about sex partners.


http://www.health.state.mn.us/sep

SURVEILLANCE SUMMARY


Summary of STD Trends in Minnesota From 2001-2011, the chlamydia rate increased by 90%. Gonorrhea increased for the

first time since 2007. Rates of reported syphilis increased slightly in 2011 compared to 2010.

Minnesota has seen a resurgence of syphilis over the past decade, with men who have sex with men being especially impacted.

Persons of color continue to be disproportionately affected by STDs. STD rates are highest in the cities of Minneapolis and Saint Paul. However, chlamydia

and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for 64% of the reported cases in 2011.

Adolescents and young adults (15-24 years) have the highest rates of chlamydia and gonorrhea, making up 69% of new infections in 2011.

Between 2010 and 2011, the chlamydia rate increased by 9% and the gonorrhea rate increased by 5%. Primary/secondary syphilis cases decreased by 8%. Men who have sex with men comprised 88% of all male cases in 2011; cases among women remain low.

Documents

Sexually Transmitted Disease (STD) Surveillance Report, 2011 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD