1. Sexually Transmitted Disease (STD) Surveillance Report, 2002 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD Surveillance System

2. Introduction This slide set describes new cases of chlamydia, gonorrhea, and primary & secondary syphilis in Minnesota by person, place, and time. The slides display data from cases diagnosed through 2002 and reported to the Minnesota Department of Health (MDH) STD Surveillance System.

3. 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.

4. Interpreting STD Surveillance Data Factors that impact the completeness and accuracy of the data:  Level of STD screening and individual test-seeking behavior  Sensitivity of diagnostic tests  Compliance with 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 factors described above. For example, in 2002 MDH added an active component to the previously passive STD Surveillance System. As a result, compliance with reporting improved and the number of chlamydia and gonorrhea cases reported to MDH increased by at least 7% and 5%, respectively, between 2001 and 2002 as an artifact of reporting.

5. National Context HIV/AIDS in Minnesota: Annual Review

6. United States: State-Specific Chlamydia Rates, 2001 SOURCE: Centers for Disease Control & Prevention. Sexually Transmitted Disease Surveillance, 2001. Atlanta, GA: US DHHS, September 2002. STDs in Minnesota: Annual Review

7. United States: State-Specific Gonorrhea Rates, 2001 SOURCE: Centers for Disease Control & Prevention. Sexually Transmitted Disease Surveillance, 2001. Atlanta, GA: US DHHS, September 2002. STDs in Minnesota: Annual Review

8. United States: State-Specific P&S Syphilis Rates, 2001 SOURCE: Centers for Disease Control & Prevention. Sexually Transmitted Disease Surveillance, 2001. Atlanta, GA: US DHHS, September 2002. STDs in Minnesota: Annual Review

9. Overview of STDs in Minnesota STDs in Minnesota: Annual Review

10. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STDs in Minnesota Rate per 100,000 by Year of Diagnosis, 1992-2002 * P&S = Primary and Secondary

11. STDs in Minnesota: Number of Cases Reported in 2002 Total of 13,304 STD cases reported to MDH in 2002:  10,107 Chlamydia cases  3,049 Gonorrhea cases  148 Syphilis cases (all stages)

12. CHLAMYDIA STDs in Minnesota: Annual Review

13. Rate per 100,000 persons 300 + 150 - 299 100 - 149 0 - 99 2002 Minnesota Chlamydia Rates by County City of Minneapolis 757 City of St. Paul 637 Suburban 136 Greater Minnesota 119 St. Louis Cook Lake Itasca Cass Polk Beltrami Aitkin Pine Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Hubbard Rice Wright Norman FillmoreMower Crow Wing Nobles Murray Grant Sibley Brown Clearwater Lake of the Woods Rock Redwood Douglas Jackson Kandiyohi Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Lincoln Blue Earth Scott Stevens Anoka Mille Lacs Houston SteeleDodge Traverse Wadena McLeod Nicollet Hennepin Kanabec Lac Qui Parle Chippewa Benton Wabasha Carver Pennington Big Stone Cottonwood Chisago Waseca Mahnomen Le Sueur 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.

14. Chlamydial Infections in Minnesota by Residence at Diagnosis, 2002 Total Number = 10,107 Minneapolis29% St. Paul 18% Greater MN 27% Suburban26%

15. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Gender Minnesota, 1992-2002

16. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Age Minnesota, 1992-2002

17. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Race/Ethnicity Minnesota, 1992-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

18. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Race/Ethnicity Excluding Blacks Minnesota, 1992-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

19. GONORRHEA STDs in Minnesota: Annual Review

20. 2002 Minnesota Gonorrhea Rates by County Rate per 100,000 persons 100 + 45 - 99 30 - 44 0 - 29 City of Minneapolis 363 City of St. Paul 207 Suburban 14 Greater Minnesota 4 St. Louis Cook Lake Itasca Cass Polk Beltrami Aitkin Pine Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Hubbard Rice Wright Norman FillmoreMower Crow Wing Nobles Murray Grant Sibley Brown Clearwater Lake of the Woods Rock Redwood Douglas Jackson Kandiyohi Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Lincoln Blue Earth Scott Stevens Anoka Mille Lacs Houston SteeleDodge Traverse Wadena McLeod Nicollet Hennepin Kanabec Lac Qui Parle Chippewa Benton Wabasha Carver Pennington Big Stone Cottonwood Chisago Waseca Mahnomen Le Sueur 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.

21. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review 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. Gonorrhea Infections in Minnesota by Residence at Diagnosis, 2002 Total Number = 3,049 Minneapolis46% St. Paul 19% Greater MN 12% Suburban23%

22. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Gender Minnesota, 1992-2002

23. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Age Minnesota, 1992-2002

24. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Race/Ethnicity Minnesota, 1992-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

25. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Race/Ethnicity Excluding Blacks Minnesota, 1992-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

26. PRIMARY & SECONDARY SYPHILIS STDs in Minnesota: Annual Review

27. 2002 Minnesota P&S Syphilis Rates by County Rate per 100,000 persons 3.3 + 1.1 – 3.2 0 – 1.0 City of Minneapolis 9.4 City of St. Paul 1.7 Suburban 0.7 Greater Minnesota 0.2 St. Louis Cook Lake Itasca Cass Polk Beltrami Aitkin Pine Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Hubbard Rice Wright Norman FillmoreMower Crow Wing Nobles Murray Grant Sibley Brown Clearwater Lake of the Woods Rock Redwood Douglas Jackson Kandiyohi Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Lincoln Blue Earth Scott Stevens Anoka Mille Lacs Houston SteeleDodge Traverse Wadena McLeod Nicollet Hennepin Kanabec Lac Qui ParleChippewa Benton Wabasha Carver Pennington Big Stone Cottonwood Chisago Waseca Mahnomen Le Sueur 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.

28. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review 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. Primary &Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2002 Total Number = 59 Minneapolis61% St. Paul 8% Suburban24% GreaterMN 7% 7%

29. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary &Secondary Syphilis Rates by Gender Minnesota, 1992-2002

30. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Age Minnesota, 1992-2002

31. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 1992-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

32. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 1997-2002 † † For 2001 and 2002, race categories include persons by race alone or in combination with one or more races. * Persons of Hispanic ethnicity can be of any race.

33. EMERGING TREND STDs in Minnesota: Annual Review

34. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review 82 early syphilis cases diagnosed in 2002, compared with 49 cases in 2001 56 cases among MSM in 2002, compared with 5 in 2001 Characteristics of the MSM cases (n=56): 88% White 84% live in Hennepin County Average age = 39 45% HIV+ * Early Syphilis includes primary, secondary, and early latent stages of syphilis † MSM = Men who have sex with men Increase in Early Syphilis* among MSM † Minnesota, 2002

35. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Similar Increase in Syphilis among MSM † in Other U.S. Cities Chicago Seattle (King County) Los Angeles New York San Francisco Boston Miami Houston St. Louis New Mexico Baltimore † MSM = Men who have sex with men

36. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review MDH launching awareness campaigns (e.g., Health Notices, press releases) Many physicians are screening more MSM Community-based programs intensifying outreach activities to reach MSM MDH implementing innovative prevention strategies (e.g., internet banners, partnering with venues) MDH Partner Services Program following up on cases and sex partners What’s Being Done in Minnesota?

37. SURVEILLANCE SUMMARY

38. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STD Rates by Person, Place, and Time STD rates are highest in Minneapolis and St. Paul STD rates are highest among persons of color Chlamydia and gonorrhea rates are highest among adolescents and young adults; Syphilis rates are highest among adults Between 2001-2002, the overall chlamydia, gonorrhea, and syphilis rates increased Beginning in 2002, MN has observed a significant and sustained increase in early syphilis cases among men who have sex with men (MSM); Approximately half are co-infected with HIV