Wisconsin STD Program Overview of Gonorrhea Epidemiology and Program Prevention Efforts Meeting February 2, 2010 Wisconsin Department of Health Services: Protecting and Promoting the Health and Safety of the People of Wisconsin.

Douglas 26 Bayfield Ashland Saywer 1 Washburn 2 Burnett 3 Polk 4 BarronRusk 1 Price Iron Vilas 4 Oneida 3 Lincoln 3 Taylor Chippewa 3 St. Croix 9 Pierce 1 Dunn 5 Pepin Eau Claire 10 Buffalo 1 Trempealeau Jackson 3 Monroe 16 Clark Marathon 26 Wood 6 Portage 5 Juneau 7 Adams 2 Sauk 14 LaCrosse 35 Vernon Crawford 1 Richland 1 Grant 7 LaFayette 1 Green 3 Rock 134 Dane 453 Iowa 2 Columbia 14 Dodge 36 Jefferson 18 Waukesha 81 Walworth 15 Kenosha Racine – 277 Ozaukee 19 Sheboygan 20 Fond du Lac 44 1 Green Lake Marquette 1 Waushara 4 Winnebago 73 Calumet 11 Manitowoc 12 Kewaunee 4 Brown 294 Outagamie 67 Waupaca 2 Shawano 6 Menominee 3 Oconto 6 Langlade 1 Forest 2 Marinette 8 Florence 2 Door Milwaukee --- 4, Washington 6,062 = Total Cases > Reported Cases of Gonorrhea by County 2008 Wisconsin: 72 Counties

Reported Cases of Gonorrhea in Wisconsin Cases Year

Reported Rates of Gonorrhea per 100,000 Pop Wisconsin: Year Rate

Reported Rates of Gonorrhea per 100,000 Pop Milwaukee County: Rate Year

WI Reported Rates of Gonorrhea per 100,000 Pop by Gender: Rate Year

Milwaukee County Reported Rates of Gonorrhea per 100,000 Pop by Gender: Rate Year

Reported Age-specific Gonorrhea Rates*: Wisconsin and Milwaukee County 2008 * Cases per 100,000 population.

Reported Cases of Gonorrhea by Age & Gender Milwaukee County & WI w/o Milwaukee County 2008

Reported Cases of Gonorrhea by Race & Gender Wisconsin 2008 Race/Gender Reported Cases Asians and Native Americans were less than 3% of Total

Reported Cases of Gonorrhea by Race & Gender Wisconsin w/o Milwaukee County 2008 Race/Gender Reported Cases Asians and Native Americans were less than 7% of Total

Reported Gonorrhea Cases by Gender & Race Milwaukee County 2008 Race/Gender Reported Cases Asians and Native Americans were less than 1% of Total

% of Total GC Cases Reported in Females by Race Wisconsin w/o Milwaukee County vs. Milwaukee County 2008 Females WI w/o Milw Co Females Milw County Asian females were less than 1% of totalAsian females were less than.1%of total Percent of Total

% of Total GC Cases Reported in Males by Race Wisconsin w/o Milwaukee County vs. Milwaukee County 2008 Males WI w/o Milw County Males Milw County Asian and Native American Males were less than 3% of Total Asian and Native American Males were less than 1% of Total Percent of Total

Reported Gonorrhea Rates* by Race Wisconsin, – fold difference * Cases reported with race specified per 100,000 population.

Reported Gonorrhea Rates* by Race Milwaukee County – fold difference * Cases reported with race specified per 100,000 population.

Douglas 26 Bayfield Ashland Sawyer 1 Washburn 2 Burnett 3 Polk 4 BarronRusk 1 Price Iron Vilas 4 Oneida 3 Lincoln 3 Taylor Chippewa 3 St. Croix 9 Pierce 1 Dunn 5 Pepin Eau Claire 10 Buffalo 1 Trempealeau Jackson 3 Monroe 16 Clark Marathon 26 Wood 6 Portage 5 Juneau 7 Adams 2 Sauk 14 LaCrosse 35 Vernon Crawford 1 Richland 1 Grant 7 LaFayette 1 Green 3 Rock 134 Dane 453 Iowa 2 Columbia 14 Dodge 36 Jefferson 18 Waukesha 81 Walworth 15 Kenosha Racine – 277 Ozaukee 19 Sheboygan 20 Fond du Lac 44 1 Green Lake Marquette 1 Waushara 4 Winnebago 73 Calumet 11 Manitowoc 12 Kewaunee 4 Brown 294 Outagamie 67 Waupaca 2 Shawano 6 Menominee 3 Oconto 6 Langlade 1 Forest 2 Marinette 8 Florence 2 Door Milwaukee --- 4, Washington 6,062 = Total Cases > Reported Cases of Gonorrhea by WI County 2008 Wisconsin: 72 Counties

Milwaukee City Zip Code Areas Zip Codes with Over 100 Reported Cases of GC in 2008: Zip Code – Number of Cases – – – – – – – – – – – – 115 These 12 zip codes represent 57% of all the gonorrhea reported in Wisconsin in Out of 4,032 cases reported from Milwaukee County in ,443 were reported from the 12 zip codes in the City of Milwaukee noted in the table – this represents 85.4% of the reported cases in Milwaukee County. (12/43 Zip Code areas in Milwaukee City)

Milwaukee Zip Code GC Data 2008 Top Four Zip Code Areas for Reported Cases GC in 2008: Zip Code – Cases – – – – 390

Disease Intervention Activities in Wisconsin Public health officers in each health department jurisdiction in WI are statutorily responsible to investigate each case of gonorrhea, including eliciting partners and other at-risk individuals for testing and treatment as necessary. Two counties use limited criteria to follow-up on cases [Milwaukee and Brown (Green Bay)] Milwaukee Criteria: F/u GC+ <= 16 males and females OR any pregnant female to verify Rx and notify partners

Milwaukee Field Activity for Gonorrhea Cases 2007 & 2008 Indicator Percent Change Cases Reported to the Program 4,662: 11% cases Interviewed 4,259:10% cases interviewed -9% # cases reported -1% cases interviewed Cases Interviewed/FR Initiated ( that met the criteria for Interview) 539/607 (89%)426/541 (78%)-11% Cases Interviewed within 3 days 196/539 (36%)163/426 (38%)+2% Total Partners Initiated % Partners Examined198/391 (51%) (101/391 already Rx) (58/198 not infected) 156/290 (54%) (64/290 already Rx) (39/156 not infected) +3% Partners Infected Brought to Treatment 61/198 (31%)51/156 (33%)+2% Partners Preventively Treated 66/198 (33%)63/156 (40%)+7% Partners Examined within 3 days 34/198 (17%)39/156 (25%)+8%

Timeliness to Treatment Family Planning Treatment Rates Jan-June 2009 Females Milwaukee County: GC: 61% Wisconsin w/o Milwaukee County: GC: 87%

Gonorrhea Positivity by Provider Type Wisconsin RVIPP Data 2008 % Positive

University of WI-Madison GC 2009: Enrollment 42,000 24/3326 Tests Positive Female (4/24) cervical NAAT 0.3% Male (20/24) urine NAAT 0.6% rectal culture 2.6% pharyngeal culture 3.1% Demographic characteristics of positives 63% MSM (15/20) 21% African American (5/24) 46% non-genital specimens (11/20 males)