gonorrhea in san francisco
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Gonorrhea in San Francisco. Kyle T Bernstein Chief, Epidemiology, Research and Surveillance STD Prevention and Control Services San Francisco Department of Public Health Gonorrhea Control in Region XI: Optimizing Strategies to Reduce Morbidity Phoenix, AZ January 14, 2010. - PowerPoint PPT PresentationTRANSCRIPT
Gonorrhea in San Francisco
Kyle T BernsteinChief, Epidemiology, Research and Surveillance
STD Prevention and Control ServicesSan Francisco Department of Public Health
Gonorrhea Control in Region XI: Optimizing Strategies to Reduce Morbidity
Phoenix, AZJanuary 14, 2010
GC Diagnoses, San Francisco City Clinic 2008
Female MSM MSW
N 37 550 94
White 32.4% 60.5% 15.9%
Hispanic 8.1% 22.0% 11.7%
Black 56.7% 8.3% 63.8%
API 2.7% 7.4% 8.5%
Median age 26 34 34
Mean/Median partners (3 months) 13 / 2 7 / 4 3 / 2
HIV infected 2.7% 35.8% 0%
History of GC (3 years) 8.1% 40.0% 12.7%
Symptomatic 67.5% 54.9% 95.7%
CT co-infx 13.5% 21.6% 13.8%
Non-STD Clinic GC, SSuN
Female MSM MSW
N 100 98 17
White 17.0% 65.3% 52.9%
Hispanic 10.0% 15.3% 0%
Black 60.0% 4.1% 32.3%
API 11.0% 12.2% 11.8%
College or more 16.0% 51.2% 27.3%
Median age 24 39 40
Incarcerated in past year 8.0% 1.0% 5.9%
Symptomatic 29.0% 18.4% 41.2%
Partner incarcerated 8.0% 1.0% 5.9%
Mean age difference (last partner) -2 +3 +7
Non-STD Clinic GC, SSuN
Female MSM MSW
N 100 98 17
Been to STD clinic in past year 98.0% 98.0% 70.6%
Mean/Median partners (3 months) 2.6 / 1 5.3/ 3 2.8/ 2
HIV infected 0% 42.9% 11.8%
Internet partners (3mo) 2.0% 41.8% 5.9%
Anonymous sex (3 mo) 19.0% 45.9% 35.3%
Cocaine (1 year) 12.0% 10.2% 11.8%
Crack (1 year) 8.0% 4.1% 5.9%
Meth (1 year) 4.0% 17.4% 5.9%
Poppers (1 year) 0% 26.5% 0%
Number of cases
8 to 134 to 83 to 41 to 30 to 1
Gonorrhea Among FemalesBy Census TractSan Francisco, 2008
Number of cases
41 to 5324 to 4113 to 24
6 to 130 to 6
Gonorrhea Among Men Who Have Sex with MenBy Census TractSan Francisco, 2008
Number of cases
8 to 206 to 83 to 62 to 30 to 2
Gonorrhea Among Heterosexual MenBy Census TractSan Francisco, 2008
Approach
Screen, Treat, Treat, Screen
• Screening for MSM and adolescents• Quick and appropriate treatment of index
patient• Quick and appropriate treatment of partners• Rescreening in 3-6 months
Screening for MSM and Adolescents
• SFSTD supports dual GC/CT screening at STD clinic, jails, Magnet, sex worker clinic, and primary care clinics– Annual urogenital screening for females
• <26 years old• Pregnant• IUD insertion
– Rectal and pharyngeal screening for MSM/transmen/transwomen every 3-6 months
• Diagnostic testing supported for patients with symptoms or who are contacts to GC
• Sexual Health Promotion Team targets MSM and adolescents geographically to promote screening
Quick and Appropriate Treatment of Index
• Surveillance staff verify treatment of reported GC cases
• Cefpodoxime 400mg + azithromycin 1 gram PO x 1
• Mosaic penA PCR for GC
• Review of current treatment protocols– Transition to Ceftriaxone
Quick and Appropriate Treatment of Partners
• Patient-delivered partner therapy (PDPT)– Available to all patients tested at STD-supported
clinical sites– Also available through InSpot– Evaluation of PDPT at STD clinic
Exposed Re-infection Crude RR 95% CI All Patients
PDPT 921 123 (13.4%) 0.89 0.72-1.10 No PDPT 1194 180 (15.1%) 1.0 --
MSM PDPT 724 114 (15.75%) 0.89 0.72-1.11 No PDPT 959 169 (17.62%) 1.0 --
MSW PDPT 144 6 (4.17%) 0.71 0.26-1.93 No PDPT 152 9 (5.92%) 1.0 --
Females PDPT 52 3 (5.77%) 2.39 0.41-13.85 No PDPT 83 2 (2.41%) 1.0 --
Rescreening in 3-6 months• All patients with GC encouraged to re-
screen
• Reminder Phone Call Pilot– Pre-pilot 29.6% of women rescreened– Pilot 56.5% of women rescreened
• Two sided exact test p=0.085
– No difference for CT
Acknowledgments
• Julia Marcus
• Robert Kohn
• Sally Stephens
• Ameera Snell
• Monica Lee
• Andrew Reynolds
• Susan Philip