Gonorrhea Epidemiology and

Prevention Program Efforts in Iowa

Karen Thompson

STD Program Manager

Iowa Department of Public Health

kthompso@idph.state.ia.us

515-281-4936

GC Testing in Iowa• 1972: GC Control Program was successful in decreasing the

prevalence of disease in Iowa.

• 1986: Chlamydia Control Project was modeled after the GC Program when CT became reportable. – State funding was used until federal funds became available.

• 1998: A change from GC culture and CT Syva Micro Trak to Abbott Lcx Amplified DNA probe dual test occurred.– GC testing was merged with CT Control Project and renamed IPP.– Separate screening criteria for each disease existed.

• 2003: Lack of availability of the Abbott Lcx prompted a switch to the BD Probe Tec by the University Hygienic Laboratory. – Still a dual test, but there was now only one screening criteria.

• 2006: The UHL made a move to the Gen-probe Aptima Combo 2.

– Still being used and one criteria is in place for both CT and GC.

Diagnoses of Gonorrhea Infections in Iowa

1990-2008

Legend

0 to 4

5 to 9

10 to 19

20 to 49

50 or More

Reported Cases of Gonorrhea: 1997

Linn

142

Sac1

Lee

10

Sioux

6

Ida

0

Polk

352

Tama

3

Clay

0

Lyon

0

Iowa

0

Kossuth0

Cass1

Jasper

4

Adair

0

Page0

Story

10

Clayton1

Benton

3

Clinton30

Cedar3

Jones0

Fayette

2

Dallas

7

Butler

2

Mills

1

Floyd

1

Davis

0

Plymouth

3

Boone

0

Wright

3

Monona

0

Woodbury

125

Shelby1

Webster24

Scott213

Taylor1

Hardin

7

Marion

2

Carroll1

Harrison0

Wayne

0

Guthrie

0

Warren1

Greene0

O'Brien

0

Crawford1

Jackson

3

Keokuk

1

Johnson

17

Union2 Henry

1

Lucas

0

Franklin

0

Dubuque

11Calhoun

3Grundy

1

Worth

0

Decatur

0

Madison

0

Marshall

10

Clarke

0

Pottawattamie

11

Hancock

0

Mahaska1

Hamilton

1

Louisa

1

Palo Alto

0

Allamakee

0

Adams

0

Fremont

2Ringgold

0

Howard0

Delaware

1

Cherokee

1

Bremer

7

Winneshiek

1

Mitchell

0

Monroe

1

Buchanan

5

Emmet

1

Wapello

1

Poweshiek

2

Audubon

0

Pocahontas

0

Osceola

0

Washington3

Buena Vista

0

Black Hawk

206

Van Buren

0

Cerro Gordo

3

Appanoose

0

Chickasaw0

Jefferson

1

Humboldt0

Dickinson

1Winnebago

0

Montgomery1

Muscatine

5

Des Moines

43

Linn229

Sac

1

Lee18

Sioux2

Ida1

Polk

481

Tama

5

Clay3

Lyon

1

Iowa

1

Kossuth

1

Cass

1

Jasper

4

Adair0

Page2

Story

30

Clayton0

Benton1

Clinton19

Cedar2

Jones4

Fayette

9

Dallas

12

Butler

0

Mills

3

Floyd9

Davis0

Plymouth

1

Boone

5

Wright0

Monona0

Woodbury109

Shelby

2

Webster

54

Scott

306

Taylor0

Hardin1

Marion

8

Carroll

3

Harrison0

Wayne0

Guthrie0

Warren

9

Greene2

O'Brien0

Crawford8

Jackson3

Keokuk0

Johnson62

Union1 Henry

14

Lucas0

Franklin1

Dubuque72

Calhoun1

Grundy0

Worth0

Decatur1

Madison

8

Marshall9

Clarke7

Pottawattamie42

Hancock2

Mahaska

5

Hamilton

1

Louisa0

Palo Alto4

Allamakee0

Adams0

Fremont0

Ringgold0

Howard1

Delaware1

Cherokee2

Bremer

3

Winneshiek

2

Mitchell1

Monroe1

Buchanan

3

Emmet

0

Wapello5

Poweshiek0

Audubon

0

Pocahontas0

Osceola0

Washington1

Buena Vista

2

Black Hawk233

Van Buren

0

Cerro Gordo12

Appanoose0

Chickasaw2

Jefferson

0

Humboldt

2

Dickinson5

Winnebago1

Montgomery

1

Muscatine

6

Des Moines64

Reported Cases of Gonorrhea: 2007

Legend

0 to 4

5 to 9

10 to 19

20 to 49

50 or More

2008 Estimated Population 2008 GC Cases, n = 1,700

GC Cases by Race and Ethnicity GC Cases by Race and Ethnicity Compared to Iowa’s PopulationCompared to Iowa’s Population

2008: Reported Cases of Gonorrhea by Race, Ethnicity and Gender

Total Cases = 1,700

Source: Iowa Department of Public Health STD Prevention Program

Number of Cases

Male Female

Will insert Rates by race, ethnicity, and gender slide here

2008 Estimated Population 2008 GC Cases, n = 1,700

GC Prevalence by Age Compared to GC Prevalence by Age Compared to Iowa’s PopulationIowa’s Population

2008: Statewide reported Cases of Gonorrhea by Age and Gender

Total Cases = 1,700Source: Iowa Department of Public Health STD Prevention Program

Will insert rate by gender and age slide here

Data Source: UHL and Polk Co. Health Dept.

Iowa Infertility Prevention Project2008 Gonorrhea Prevalence

Monitoring DataClinic Type Total Tests GC Positives Positivity Rate

Family Planning 43,105 252 0.6%

STD Clinics 5,404 278 5.1%

Integrated 3,940 128 3.2%

Student Health 2,807 18 0.6%

Corrections 2,612 23 0.9%

CHC 916 3 0.3%

Other 392 3 0.8%

Indian Health 123 4 3.3%

Total 59,299 709 1.2%

MLS2b and 3b: Timeliness to GC Treatment in IPP and STD

SettingsGC/GC/IPPIPP

Jan-Jun 07Jan-Jun 07 Jul-Dec 07Jul-Dec 07 Jan-Jun 08Jan-Jun 08 Jul-Dec 08Jul-Dec 08 Jan-Jun 09Jan-Jun 09

1414 90/104=.8790/104=.87 124/144=.8124/144=.866

50/95=.5350/95=.53 99/110=.9099/110=.90 91/117=.7891/117=.78

3030 100/104=.9100/104=.966

140/144=.9140/144=.977

84/95=.8884/95=.88 109/110=.9109/110=.999

111/117=.95111/117=.95

GC/GC/STSTDD

Jan-Jun 07Jan-Jun 07 Jul-Dec 07Jul-Dec 07 Jan-Jun 08Jan-Jun 08 Jul-Dec 08Jul-Dec 08 Jan-Jun 09Jan-Jun 09

1414 67/68=.9967/68=.99 70/72=.9770/72=.97 61/66=.9261/66=.92 54/61=.8954/61=.89 58/59=.9858/59=.98

3030 68/68=168/68=1 71/72=.9971/72=.99 63/66=.9563/66=.95 61/61=161/61=1 59/59=1.059/59=1.0

► IPP Goals are .85 (14 Days) and .95 (30 Days)► STD Goals are .95 (14 Days) and .98 (30 Days)

PS3: Timeliness to GC Interview

Jan-Jun 06Jan-Jun 06 Jul-Dec 06Jul-Dec 06 Jan-Jun 07Jan-Jun 07 Jul-Dec 07Jul-Dec 07 Jan-Jun 08Jan-Jun 08 Jul-Dec 08Jul-Dec 08

7 7 DaysDays

82/111=.782/111=.744

100/136=.100/136=.7474

132/193=.132/193=.6868

61/165=.3761/165=.37 22/129=.122/129=.177

129/198=.129/198=.6565

14 14 DaysDays

96/111=.896/111=.866

116/136=.116/136=.8585

168/193=.168/193=.8787

93/165=.5693/165=.56 34/129=.234/129=.266

141/198=.141/198=.7171

30 30 DaysDays

97/111=.897/111=.877

135/136=.135/136=.9999

168/193=.168/193=.8787

114/165=.6114/165=.699

41/129=.341/129=.322

161/198=.161/198=.8181

• Jan – Jun 2009– 7 days: 434/834 = .52 goal .5– 14 days: 511/834 = .61 goal .7– 30 days: 571/834 = .68 goal .9

• 258 or 30.9% Not Interviewed

Programmatic Response: • Iowa Disease Surveillance System (IDSS)

• EPT

• IPP Criteria• Pregnancy Testing Only Clinics• School Screening

• Performance Measure Monitoring

• Chlamydia Toolkit Revision

• Funding for Social Marketing • PCSI Opportunity with HIV Prevention