Gonorrhea Epidemiology Prevention and Control in Chicago William Wong, MD STI/HIV Prevention and Control Services Division of STI/HIV/AIDS Chicago Department of Public Health Department of Public Health “Providing the Prescription for a Healthy City”

Acknowledgements Charmaine Murray, MPA Jenna Khan, MPH Irina Tabidze, MD, MPH

Reported Cases of Gonorrhea – Chicago, Number of Cases Year Reported Gonorrhea increased by 11.9% in 2008

Reported Cases of Gonorrhea by Sex – Chicago, Year

Proportion of Reported Gonorrhea Cases by Sex, Race/Ethnicity and Age – Chicago, 2008

Reported Gonorrhea Morbidity by Provider Type – Chicago, 2008 Provider TypeNo. of Cases% Morbidity PMD4, % Hosp/EDs3, % STD Clinics2, % Corrections3012.9% Family Planning1281.2% School-Based Health Center990.9% TOTAL10,509100%

Chlamydia, Gonorrhea, and Primary and Secondary Syphilis - Counties and Independent Cities Ranked by Number of Reported Cases: United States, 2008 RankChlamydiaGonorrhea Primary and Secondary Syphilis 1 Los Angeles County, CACook County, ILLos Angeles County, CA 46,707 cases 472.8/100,000 population 13,227 cases 250.3/100,000 population 822 cases 8.3/100,000 population 2 Cook County, ILWayne County, MINew York County, NY 34,252 cases 648.2/100,000 population 9,801 cases 457.5/100,000 population 491 cases 30.3/100,000 population 3 Wayne County, MILos Angeles County, CACook County, IL 19,218 cases 968.1/100,000 population 8,959 cases 90.7/100,000 population 488 cases 9.2/100,000 population U.S. Rate 401.3/100,000 population111.6/100,000 population4.5/100,000 population HP2010 Target 138.0/100, /100,0000.2/100,000 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, Atlanta, GA: U.S. Department of Health and Human Services; November 2009.

Why did reported gonorrhea decrease annually since 2000, and then suddenly increase in 2008 in Chicago?

Significant Events Affecting Gonorrhea Case Reporting – Chicago, Number of Cases Year Cessation of Universal STD Screening at County Jail Cessation of Targeted STD Screening at County Jail Closure of 31 st Street STD Clinic Closure of Mile Square STD Clinic Advent of Electronic Laboratory Reporting, CDPH EMR Targeted STD STD Screening Restarted at County Jail Closure of Evanston STD Clinic County STD Clinic Charges Fees for STD Visits

Reported Chlamydia & Gonorrhea from CCJ Before and After Discontinuation of Universal STD Screening April 2002-March 2004 BEFORE April 2002 to March 2003 AFTER April 2003 to March 2004 Gonorrhea Chlamydia Gonorrhea Chlamydia Broad JM, Cox T, Rodriguez S, Mansour M, Mennella C, Swallow-Murphy D, Raba J, Wong W. The Impact of Discontinuation of Male STD Screening Services at a Large Urban County Jail ― Chicago, 2002–2004. Sex Transm Dis 2009;36(2): S49-S52

Top 10 Community Areas with Highest Gonorrhea Rates - Chicago, 2008 Community Area Rate per 100,000 population 68ENGLEWOOD FULLER PARK WEST ENGLEWOOD WEST GARFIELD PARK EAST GARFIELD PARK WASHINGTON PARK GREATER GRAND CROSSING NORTH LAWNDALE WEST PULLMAN OAKLAND802

Community Areas with High Gonorrhea Rates, STI Clinics, Federally Qualified Health Centers (FQHC), FQHC Look-Alikes (FQHCLA) and School-Based Health Centers (SBHC) – Chicago, South Side, 2008

Community Areas with High Gonorrhea Rates, STI Clinics, Federally Qualified Health Centers (FQHC), FQHC Look-Alikes (FQHCLA) and School-Based Health Centers (SBHC) – Chicago, West Side, 2008

Enhanced Gonorrhea Surveillance Projects – Chicago, 2010 Gonococcal Isolate Surveillance Project (GISP) –Participant since 1996 –Quinolone-resistant Neisseria gonorrhoea (QRNG) identified (2004) –CDC discontinues FQ recommendation for GC Tx (2007) –QRNG prevalent (8%) among GISP isolates (2009) –GC cases with decreased susceptibility to cephalosporins identified (2009) Population-based Gonorrhea Behavioral Surveillance STD Surveillance Network (SSuN) –Participant since 2008 –Sample of reported GC cases are assigned for DIS behavioral interview

Opportunities for Enhancing Gonorrhea Prevention and Control – Chicago, 2010 Priority Populations: –Adolescents years old –Pregnant Females –Incarcerated populations Screening: –Review sentinel surveillance and prevalence monitoring data –Rebuild STI Screening Program in the County Jail –Expanded STI Screening in Chicago Public Schools –Validation of Rectal and Pharyngeal NAATs Access-to-Care: –Prevent/Mitigate closure of remaining STI Clinics –Strengthen referral networks –Optimize STD care in FQHCs, EDs, and other settings –Evaluate/improve GC Treatment Verification Program Partner Services: –Implement EPT in Illinois Community Engagement: –Engage community & adolescent health coalitions, planning bodies –Conduct targeted community education activities

Contact Information William Wong, MD Director, STI/HIV Prevention and Control Services Medical Director, Division of STI/HIV/AIDS Chicago Department of Public Health City of Chicago Phone:

Urgently Needed CALL TO ACTION $$$$$ / Funding Additional Resources Program Flexibility