1. Gonorrhea Morbidity and Prevention Efforts in Los Angeles County Binh Goldstein, PhD, Epidemiologist Sarah Guerry, MD, Medical Director Sexually Transmitted Disease Program Los Angeles County Department of Public Health

2. Reported Cases of Gonorrhea: LAC, 1998-2008 5,9866,061 7,199 7,743 7,800 8,078 9,696 10,494 10,411 9,302 8,280

3. Rates of Gonorrhea: LAC, 1998-2008

4. Gonorrhea Cases by Race and Gender: LAC, 2008 N=4,644N=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.

5. Rates of Gonorrhea by Age and Race: Females, LAC, 2008 1,969.3 1,717.3 809.0 310.1

6. Rates of Gonorrhea by Age and Race: Males, LAC, 2008 951.5 1,761.6 1,053.9 686.9 352.6

7. All ages Number of GC Cases by HD, SPA, and Supervisorial District LAC, 2008

8. Ages 15-24 years Number of GC Cases by SPA and Supervisorial District LAC, 2008

9. GC Morbidity by Provider Type, LAC 2008 Provider TypeN Cases% Private Practice/Group*3,09838.2% DPH STD Clinic1,16614.4% Community/Free Clinic91411.3% HMO84410.4% Adult Detention4445.5% Sentinel FP Clinic2342.9% Juvenile Detention2012.5% Hospital1161.4% High School/College921.1% Other1,00912.4% Total8,118100.0% *Includes non-sentinel FP and non-DPH STD clinics.

10. Timely Treatment of GC, LAC 2008 N=234N=1,165N=188N=249N=196N=6,032 *Excludes cases missing specimen collection

11. 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

12. 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)

13. 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 FemalesMSMMale Heterosexual N%N%N% 13833.3%46.2%1321.0% 23732.5%57.7%1829.0% 3-42421.1%1827.7%1930.6% 5-9119.6%1624.6%58.1% 10+43.5%2233.8%711.3% Total114100%65100%62100%

14. DTK Kits 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

15. 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

16. 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

17. Binh Goldstein bgoldstein@ph.lacounty.gov (213) 744-3089 Sarah Guerry sguerry@ph.lacounty.gov (213)744-3133