Gonorrhea in Arizona: Epidemiology

and Program Efforts

Michelle Winscott, MD, MPH Epidemiologist

January 14, 2010

Arizona Department of Health ServicesSTD Control Programwinscom@azdhs.gov

Reported Gonorrhea Cases and Case Rates per 100,000 Population Arizona 2001-2008

3,999 3,9704,249 4,329

4,875

5,997

4,999

3,4493,230

75.372.5

75.5 74.2

80.6

96.1

77.7

52.849.4

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2001 2002 2003 2004 2005 2006 2007 2008 2009*

Nu

mb

er o

f C

ases

0

10

20

30

40

50

60

70

80

90

100

Rat

es

(per

10

0,00

0 p

op

ula

tio

n)

*2009 data estimated based upon available ADHS dataset Year 2010 Goal:

19 cases/100,000 population

Arizona 2001-2009

Reported Gonorrhea Case Rates per 100,000 Population by Gender Arizona 2001-2008

81.6 81.2 82.285.1 83.2

57.163.4

69.766.2

76.172.1

48.3

85.2

99.8

65.5

92.2

0

20

40

60

80

100

120

2001 2002 2003 2004 2005 2006 2007 2008

Rat

e (

per

100

,000

po

pu

lati

on

)

Males

Females

Arizona

Reported Gonorrhea Case Rates per 100,000 Population by Race/Ethnicity

Arizona 2003-2008

440.8

394.5 393.4404.8

387.3

348.7

257.6

566.5

0

100

200

300

400

500

600

2001 2002 2003 2004 2005 2006 2007 2008

Ra

te (

pe

r 1

00

,000

po

pu

lati

on

)Non-Hispanic WhiteBlackHispanicAmerican Indian/Alaskan NativeAsian/Native Hawaiian/Pacific IslanderArizona

The Maricopa County Laboratory, 2005-2008

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2005 2006 2007 2008

Num

ber

of T

ests

Gonorrhea Testing Trends via the Maricopa County Laboratory and the Arizona Infertility Prevention Project

The Arizona Infertility Prevention Project, 2005-2008

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2005 2006 2007 2008

Num

ber

of T

ests

1.3

8.4

216.9

263.1

110.5

52.0

37.3

18.4

11.2

5.9

0.0

2.0

0.9

0.4

3.0

123.4

218.2

155.2

86.7

77.8

43.7

30.2

24.1

11.3

6.4

2.9

<10

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

≥ 65

3002001000100200300

Case Rates (per 100,000 Population)

AgeMales Females

Arizona Department of Health Services - STD Control Program Arizona Case Rate = 52.9 per 100,000 Population

*Does not include unknown gender

Reported Gonorrhea Case Rates per 100,000 Population by Age Group and Gender, Arizona, 2008

N = 1869 cases

Refused race = 2N = 1577 cases

Refused race = 0

Race/Ethnicity among Arizona Gonorrhea Cases by Gender, 2008

Arizona Female Gonorrhea Cases, 2008

Hispanic, 25%

White, 24%

Black, 17%

American Indian/Alaska Native, 9%

Other, 1%

Unknown, 21%

Asian, <1%

Mixed, <1%

Native Hawaiian/Pacific Islander, <1%

Arizona Male Gonorrhea Cases, 2008

Hispanic, 27%

White, 24%Black, 20%

American Indian/Alaska Native, 5%

Other, 1%

Asian, 1%

Unknown, 22%

Mixed, <1%

Provider Type # Cases % Total Cases

Private Facility 1242 36%

STD/Public Health 795 23%

Hospital 640 19%

Indian Health Services 215 6%

Corrections 193 6%

Family Planning 166 5%

Public Provider 69 2%

Military 43 1%

Out of State 36 1%

Other 33 1%

Student Health 17 <1%

Total 3449 100%

Arizona Gonorrhea Cases and Percentages by Provider Type, 2008

N=795 cases N=640 cases N=193 cases N=1821 cases

Time to Treatment among Arizona Providers, by Percentage and Provider Type 2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

STD/PH Clinics Hospitals Corrections Other

0-14 days 15-30 days >30 days Unknown

Arizona 2008 Gonorrhea Cases and Rates, by County

Arizona Gonorrhea Rates (per 100,000 Population) by County 2008

54.451.3

24.4

0

10

20

30

40

50

60

Maricopa Pima Other Counties

Rat

e (p

er 1

00,0

00 P

op

ula

tio

n)

Arizona Gonorrhea Cases by County, 2008

2135

520405389

0

500

1000

1500

2000

2500

Maricopa Pima Other Counties Missing

Nu

mb

er o

f C

ases

S ite o f M aricopa C ountyPublic H ealth C enter STD C lin ic

Phoenix Metropolitan AreaZip C ode Map

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GONORRHEA CASES2008

60

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85297

85383

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Public H ealth D epartm ent

85298

85286

10

85395 8539285396

85266

Pima County: Tucson Metropolitan Area Gonorrhea Cases by Zip Code of Residence, 2008

8574685706

85737

85629

8574985743

85745

85641

85742

8573585713

8571885750

85730

85747

85704

85705

85653

85710

85747

85748

85708

85741

85641

85711

8571985712

85714

85716

85739

85715

85653

85654

85701

85739 85619

85742

Cases

0

1 - 5

6 - 17

18 - 35

36 - 60

61 - 114

Location of Pima County Health

Department STD Clinic

Gonorrhea in Arizona• Declining rates of gonorrhea despite

increased screening– Gonorrhea cases diagnosed in the Maricopa

and Pima County STD Clinics are interviewed and investigated

– Treatment verification in Maricopa County of gonorrhea cases reported without treatment

– Expedited Partner Therapy (2008)– Participating (Maricopa County) in GISP since

1987

Areas for Program Expansion

• Planned/Underway– Hospitals: presumptive treatment education and EPT discharge

planning– Gonorrhea and HIV co-morbidity analyses – Focused gonorrhea screening in high risk populations (2010 Arizona IPP gonorrhea screening)– Providers queried for missing data elements among gonorrhea

cases – Provider EPT surveys– STD screening in Maricopa County high schools

• Future– Expanding gonorrhea partner notification– Increasing treatment verification in corrections and hospitals– Expanding community and provider partnerships

Thank You!