1. Epidemiology of Neisseria gonorrhoeae Sexually Transmitted Disease Program Los Angeles County Department of Health Services

2. Facts about Gonorrhea National Trends –Counts –Rates –Health People 2010 Los Angeles County –Counts –Rates Key Points to Ponder Data Limitations Overview

3. Facts about Gonorrhea Second most common bacterial STD Incubation period is 2-7 days; GC divides every 20-30 minutes Males: purulent (pus) discharge Females: cervicitis (mostly asymptomatic) Causes PID, infertility, ectopic pregnancy, and conjunctivitis Increase transmission and susceptibility to HIV 2-5 fold

4. National Trends

5. Reported Sexually Transmitted Diseases United States, 2004 Source: CDC Sexually Transmitted Disease Report, 2004

6. Healthy People 2010 Health objectives for the Nation Based on initiatives –1979 Surgeon General’s Report, Health People –Healthy People 2000: National Health Promotion and Disease Prevention Objectives Measurement of health outcomes over time 467 HP2010 objectives tracked by 196 data sources –Includes 23 major data sources (e.g., NHIS)

7. HP 2010 Goal: Gonorrhea (25-2) Reduce gonorrhea to 19 cases per 100,000 population Progress monitored by information gathered from State and local Health Department STD Programs

8. Gonorrhea — Rates: United States, 1970–2003 and the Healthy People 2010 target National GC Control Program Reasons for decline in gonorrhea rates: 1. Increased screening 2. Increase use of sensitive diagnostic tests 3. Improved reporting and case finding 475.0 113.5 (2004) Note: The Healthy People 2010 (HP2010) objective for gonorrhea is 19.0 cases per 100,000 population.

9. Gonorrhea Rates by Gender: United States, 1981–2003 W: 116.5 M: 110.0 (2004)

10. Gonorrhea by Age and Gender United States, 2004

11. Gonorrhea Rates by state: United States and outlying areas, 2004 Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 112.1 per 100,000 population. The Healthy People 2010 target is 19.0 cases per 100,000 population.

12. Gonorrhea Rates by race and ethnicity: United States, 1981–2004 Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

13. Local Trends

14. Reported Sexually Transmitted Diseases Los Angeles County, 2004 Source: LAC DHS STD/ACD Programs 2004

15. Gonorrhea Rates* Los Angeles County, 1993-2004 Introduction of nucleic amplification tests Healthy People 2010 Objective *Per 100,000 population

16. Reported Gonorrhea Rates, by Gender* Los Angeles County, 1993-2003 *Per 100,000 population 231.0 134.1 Healthy People 2010 Objective Introduction of nucleic amplification tests 113.2 92.2

17. Gonorrhea Rates* by Age and Gender Los Angeles County, 2004 *Per 100,000 LA County population

18. Gonorrhea Rates* by Gender and Race/Ethnicity Los Angeles, 2004 *Per 100,000 LA County population

19. Key Points to Ponder Second most common bacterial STD GC rates declined because of: –Increased screening –Increased use of sensitive tests –Improved reporting/case finding GC rates leveled off because of true increases in Gc among some groups (e.g., MSM) Rates are high among young females, adult males, and African Americans

20. Data Limitations Incomplete case reporting –Reporting delays –Missing information Reporting bias –Stigmatized condition –Public vs. Private

21. Additional Resources Centers for Disease Control and Prevention (CDC) www.cdc.gov/std/stats/ www.healthypeople.gov/ www.cdc.gov/std/stats/ www.healthypeople.gov/ Los Angeles County STD Program www.ladhs.org/std/stdfacts.htm

22. STD Rates Number of new events in specific period Number of new events in specific period Average population* during specific period X 10 n Essential for comparing dx in different populations: Pop A: 1,000/10,000 = 100 cases per 1000 population Pop B: 1,000/1,000,000 = 1 case per 1000 population *Assumes average population and “population at risk” are comparable. =