WELCOME!

Region IX Discussion on Gonorrhea Control

Hosted by CDC and Region IX IPP Coordinator

The disseminated findings and conclusions in this presentation have not been formally reviewedby CDC and should not be construed to represent

any agency determination or policy.

Regional Meetings Smaller meeting → more discussion

Learn from peers

Emphasize program improvement

Accommodate regional similarities (morbidity, resources, infrastructure, populations)

Meeting Objectives

Increase understanding of gonorrhea epidemiology, health disparities, and ability to develop antimicrobial resistance

Increase understanding of gonorrhea control strategies

Increase knowledge of gonorrhea control activities conducted in the region

Develop action plans for targeted, and more robust GC control efforts

Gonorrhea Control: Gonorrhea Control:

A Historical A Historical PerspectivePerspective

Kevin O’ConnorKevin O’ConnorDSTDPDSTDP

January 14, 2010January 14, 2010

Epidemiology 101

Why talk about GONORRHEA

now?

Why now?Why now?• GC in the west

• Loss of fluoroquinolones (and GC’s ability to develop antimicrobial resistance)

• Health disparities• ID populations at risk for other STDs and conditions

• Opportunities:• reaching those at-risk for GC also addresses CT• learn from our historic successes• success might not be that far away

* Not Anymore

*

After Cephalosporins: What Next?

Penicillin (in increasing doses) gone Tetracyclines gone Spectinomycin gone Fluoroquinolones gone

Oral cephalosporins going?

Injectable cephalosporins (Ceftriaxone)

This is the second MMWR in the past month that addresses gonorrhea... It is important we use this heightened awareness to reconsider what we are doing to prevent gonorrhea transmission and its sequelae and to begin new discussions about improving gonorrhea prevention. We will continue to keep you updated on developments as they occur and will work with you to address the growing urgency of this serious health concern.

John M. Douglas, Jr., MD Director, Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention

April 12, 2007 DCL announcing that fluoroquinolones are no longer recommended for the treatment of GC; shortly after ‘GC in the West’ MMWR article

Gonorrhea rates, U.S., 1941-2007

Rate (per 100,000 population)

Gonorrhea2010 Target

0

100

200

300

400

500

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

Gonorrhea rates, U.S., 1941-2007

Rate (per 100,000 population)

Gonorrhea2010 Target

0

100

200

300

400

500

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

GC Control Program

Rate (per 100,000 population)

Gonorrhea

2010 Objective 0

100

200

300

400

500

1970 73 76 79 82 85 88 91 94 97 2000

Note: The Healthy People 2010 (HP2010) objective for gonorrhea is 19.0 cases per 100,000 population

Gonorrhea Control Milestones

Gonorrhea Control Program

GC Culture DNA probe

GISP IPP

PCR

D/C TetracyclineD/C PCN

D/C Fluroquinolones in HI, PI, Asia

National Gonorrhea Control Program

Implemented in 1972 Federal funding to state and local agencies Establish screening programs for the

detection of gonorrhea in asymptomatic women

Screening facilities included public and private agencies

Partner services

Gilbert Gonorrhea - 1973

Female Screening VD clinicScreening/testing 4,356,670 582,922GC + 132,387 (3%) 109,889 (19%)

Partner Services 3 mos. Annual est.Interviews 64,154 ~259,000 (3 mos. only: April – June 1973)Contacts 61,439 ( 0.96 CI )Ct. examined 39,409 (~2/3)

Infected/treated 15,928 (.40) ~64,000Epi Rx 18,063

National Gonorrhea Control Program1973

Historic GC Control of Program

1973STD Clinic

842,000Cases reported in 1973

Targeted Screening

Partner Services109,000

females~ 13 % 64,000

~ 7 %110,000females~ 13%

Case Finding Sources and their Contribution to Overall

MorbiditySTD Clinic Private

Providers

TotalReported Cases

Targeted Screening

Partner Services

ER JDC

Your Jurisdiction:Where/how are cases

identified?STD Clinic Private

Providers

TotalAnnual

Morbidity

Targeted Screening

Partner Services

ER

Jail

GONORRHEAin

PITTSBURGH

Allegheny CountyGonorrhea

Gc control strengths: 5-day full service STD clinic w/ 6 DIS Low syphilis morbidity Males come to you & receive prompt dx/Rx Straightforward, quick interviews Named contacts very likely to be infected Existing female screening program Existing partnerships: community & providers

CT: No dx while in the clinic: PS more labor-

intensive Contacts not likely to test positive

Allegheny CountyGonorrhea

Gonorrhea control plan: Interview Gc+ males in the clinic Traditional contact tracing of partners Regularly audit GC screening sites; redirect

screening as needed Build on local partnerships

Hospitals, screening sites, JDC, community clinics, school-based clinics, MCH, healthy start

Annual STD update meeting & report, letters to GSP sites, medical bulletin

O = Other (Previous Rx) A = Epi treat C = Infected, brought to treatment

Allegheny County 1993 1994 2000# Total Cases 3,730 2,602 1,510# F Cases 1,847 1,335 827

GC Screening Program# F Tests 70,000+ 60,000+ 38,672# F Tests + 1,229 (66%) 856 (64%) 347

(42%)PS# Female cases ID’d by PS (partners brought to treat)

359 (20%) 235 (18%) ??

Allegheny CountyGonorrhea

Annual STD Progress Report (1993)

The decline in Gc is likely the result of several factors:

66% female GC cases identified by Gc Screening Program (1,229 of 1847)

1,050 STD clinic males interviewed, and…

359 female sex partners are infected, ‘brought to treatment’ 20% of reported female cases ( N = 1,847) 20% of female cases ‘brought’ every year after 1990

Female GC Case Finding in Allegheny County, 1993

1847Female

GC Cases

GC ScreeningProgram1,229

Partner Services

359

20%66%

Gonorrhea Morbidity Allegheny County, PA 1990-

2002

0500100015002000250030003500400045005000

1990 1992 1994 1996 1998 2000 2002

New PS strategy; ongoing screening

Focused PS effort ends

Screening reduced

END