1. Lower Hudson Valley Perinatal Network Serving Dutchess, Putnam, Rockland & Westchester Counties Presented at the Quarterly Education & Networking Conference April 22, 2008 Address the Risk: A Preconception/Interconception Focus on STIs and Other Infections Lower Hudson Valley Perinatal Data Book: STI/STD Data Profile

2. Chlamydial Infections in Adolescents and Adults In the United States, chlamydial genital infection is the most frequently reported infectious disease, and the prevalence is highest in persons aged ≤25 years. Asymptomatic infection is common among both men and women, and to detect chlamydial infections health-care providers frequently rely on screening tests. Annual screening of all sexually active women aged ≤25 years is recommended, as is screening of older women with risk factors (e.g., those who have a new sex partner or multiple sex partners). The benefits of C. trachomatis screening in women have been demonstrated in areas where screening programs have reduced both the prevalence of infection and rates of PID. Evidence is insufficient to recommend routine screening for C. trachomatis in sexually active young men, based on feasibility, efficacy, and cost-effectiveness. However, screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics). An appropriate sexual risk assessment should be conducted for all persons and might indicate more frequent screening for some women or certain men. CDC. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services, CDC, National Center for HIV, STD, and TB Prevention; 2005.Sexually Transmitted Disease Surveillance, 2004 U.S. Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Am J Prev Med 2001;20 (Suppl 3):90–4.

3. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference

4. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference Total Upstate NY2255.22275.81129.2424.6219129.3 Age Group

5. Gonococcal Infections in Adolescents and Adults In the United States, an estimated 600,000 new N. gonorrhoeae infections occur each year. Gonorrhea is the second most commonly reported bacterial STD. The majority of urethral infections caused by N. gonorrhoeae among men produce symptoms that cause them to seek curative treatment soon enough to prevent serious sequelae, but treatment might not be soon enough to prevent transmission to others. Among women, several infections do not produce recognizable symptoms until complications (e.g., PID) have occurred. Both symptomatic and asymptomatic cases of PID can result in tubal scarring that can lead to infertility or ectopic pregnancy. Because gonococcal infections among women frequently are asymptomatic, an essential component of gonorrhea control in the United States continues to be the screening of women at high risk for STDs. The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk. Women aged <25 years are at highest risk for gonorrhea infection. –Other risk factors for gonorrhea include a previous gonorrhea infection, other sexually transmitted infections, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use. The prevalence of gonorrhea infection varies widely among communities and patient populations. The USPSTF does not recommend screening for gonorrhea in men and women who are at low risk for infection. CDC. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services, CDC, National Center for HIV, STD, and TB Prevention; 2005.Sexually Transmitted Disease Surveillance, 2004 US Preventive Services Task Force. Screening for gonorrhea: recommendation Statement. Ann Fam Med 2005;3:263–7.

6. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 19/100,000

7. Total Upstate NY2255.22275.81129.2424.6219129.3 Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference Age Group HP2010 Goal 19/100,000

8. Syphilis Syphilis is a systemic disease caused by T. pallidum. Patients who have syphilis might seek treatment for signs or symptoms of: –primary infection (i.e., ulcer or chancre at the infection site) –secondary infection (i.e., manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymphadenopathy), –or tertiary infection (e.g., cardiac or ophthalmic manifestations, auditory abnormalities, or gummatous lesions). –Latent infections (i.e., those lacking clinical manifestations) are detected by serologic testing. Latent syphilis acquired within the preceding year is referred to as early latent syphilis all other cases of latent syphilis are either late latent syphilis or latent syphilis of unknown duration.

9. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 0.2/100,000

10. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 0.2/100,000

11. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 0.2/100,000

12. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 0.2/100,000

13. Source: NYS Department of Health Bureau of STD Control “Statistical Abstract 2001 – 2006” Prepared by the Lower Hudson Valley Perinatal Network for the 4-22-08 Quarterly Conference HP2010 Goal 0.2/100,000