1. GC Outbreak in Philadelphia Greta Anschuetz, MPH Philadelphia Department of Public Health greta.anschuetz@phila.gov

2. Reported Cases of GC: Philadelphia 1990 – 2010 Year Number of Cases 36% increase from 2009

3. GC Reports by Specimen Collection Date 2009-2011 Month, Year Number of Cases 1 st Increase 2 nd Increase

4. Reported GC in Philadelphia, PA 20092010% Change Total4,8236,533+36% Gender Male2,4603,240+32% Female2,3633,293+39% Age Group 15-19 years1,5412,127+38% 20-24 years1,5212,173+43% 25+ years1,6962,144+26%

5. Percent Increase Age Group (Years) Percent Increase by Age and Gender

6. Ongoing GC Control Efforts Comprehensive city-wide GC/CT screening program (includes IPP funded sites, prison and High School screening) –100K females annually (8% CT pos; 2% GC pos) –65K males annually (8% CT pos; 3% GC pos) Partner services & rescreening for GC/CT infected HS students GISP SSuN site since July 2009: interview subset of GC cases –743 interviews (~7% of GC reports) –No changes in reported risk factors/markers over time 22% of male GC cases identify as MSM Anonymous partner in last 12 mos.: 35% MSM vs. 24% MSW vs. 10% among females

7. ZIPCases Rate Per 100,000 19132326855.3 19138146738.3 19121246655.8 19143390595.8 19139269510.6 19140308498.1 19124235375.6

8. 2009-2010 GC Targeted Initiatives August 2009: Added screening for asymptomatic ED patients in a high GC prevalence area (ZIP 19143) –Initially high CT positivity (6%) and GC positivity (4%) –Very slow uptake by ED staff –March 2011: Gained support of ED Director More specimens in past 3 weeks than in all of 2010! August 2010: Initiated Partner Services for all GC patients reported in same target area (ZIP 19143) for one month

9. 2009/10 Area of Interest Includes ZIP codes with more than 50 cases reported in 2010

10. 2011 GC Targeted Initiatives March 2011: Approached ED in ZIP with high % increase (19124) about screening asymptomatic patients –Still in development April 2011: Applied for CDC community approaches grant. Proposed case finding in social networks of the public high school April 2011: Launched youth oriented intervention in collaboration with Philadelphia AIDS Activities Coordinating Office: –Comprehensive media campaign (including social media) targeting youth –Expansion of condom availability –HIV subsequent to teen STD data analysis

11. Media Campaign and Condom Availability Launched Take Control Philly, a comprehensive youth targeted STD/HIV Prevention Initiative Unveiling of a consumer designed Philly labeled condom Adolescent oriented website (www.takecontrolphilly.org) –Educational component –Mail me condoms ~800 condom orders shipped via USPS

12. HIV Subsequent to Teen STD FemalesMales Cohort Selection Question: How many teens with an STD diagnosis are diagnosed with HIV in the future? STD+: Case of CT/GC or Syphilis as a teen from any provider/lab received by PDPH STD-: >1 negative from HS Screening Program, never a case as a teen

13. HIV Risk by Teen STD History Risk Ratios and 95% CIs *Adjusted for race/ethnicity and birth year All STDsCTGC All STDsCTGC

14. Conclusions GC increase in 2010 is widespread and not localized to any group/region in Philadelphia –Small percent of increase can be explained by one lab not reporting in 2009 (~200 cases) New initiatives focus on increasing condom availability and awareness among adolescents via media Large cohort analysis shows that having an STD as a teen increases the risk of a subsequent HIV diagnosis