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

Reported Cases of Gonorrhea: 1997 Legend 0 to 4 5 to 9 10 to 19 20 to 49 50 or More Reported Cases of Gonorrhea: 1997 Linn 142 Sac 1 Lee 10 Sioux 6 Ida Polk 352 Tama 3 Clay Lyon Iowa Kossuth Cass Jasper 4 Adair Page Story Clayton Benton Clinton 30 Cedar Jones Fayette 2 Dallas 7 Butler Mills Floyd Davis Plymouth Boone Wright Monona Woodbury 125 Shelby Webster 24 Scott 213 Taylor Hardin Marion Carroll Harrison Wayne Guthrie Warren Greene O'Brien Crawford Jackson Keokuk Johnson 17 Union Henry Lucas Franklin Dubuque 11 Calhoun Grundy Worth Decatur Madison Marshall Clarke Pottawattamie Hancock Mahaska Hamilton Louisa Palo Alto Allamakee Adams Fremont Ringgold Howard Delaware Cherokee Bremer Winneshiek Mitchell Monroe Buchanan 5 Emmet Wapello Poweshiek Audubon Pocahontas Osceola Washington Buena Vista Black Hawk 206 Van Buren Cerro Gordo Appanoose Chickasaw Jefferson Humboldt Dickinson Winnebago Montgomery Muscatine Des Moines 43 Maps are of 2007 data

Reported Cases of Gonorrhea: 2007 Linn 229 Sac 1 Lee 18 Sioux 2 Ida Polk 481 Tama 5 Clay 3 Lyon Iowa Kossuth Cass Jasper 4 Adair Page Story 30 Clayton Benton Clinton 19 Cedar Jones Fayette 9 Dallas 12 Butler Mills Floyd Davis Plymouth Boone Wright Monona Woodbury 109 Shelby Webster 54 Scott 306 Taylor Hardin Marion 8 Carroll Harrison Wayne Guthrie Warren Greene O'Brien Crawford Jackson Keokuk Johnson 62 Union Henry 14 Lucas Franklin Dubuque 72 Calhoun Grundy Worth Decatur Madison Marshall Clarke 7 Pottawattamie 42 Hancock Mahaska Hamilton Louisa Palo Alto Allamakee Adams Fremont Ringgold Howard Delaware Cherokee Bremer Winneshiek Mitchell Monroe Buchanan Emmet Wapello Poweshiek Audubon Pocahontas Osceola Washington Buena Vista Black Hawk 233 Van Buren Cerro Gordo Appanoose Chickasaw Jefferson Humboldt Dickinson Winnebago Montgomery Muscatine 6 Des Moines 64 Reported Cases of Gonorrhea: 2007 Legend 0 to 4 5 to 9 10 to 19 20 to 49 50 or More Maps are of 2007 data

GC Cases by Race and Ethnicity Compared to Iowa’s Population 2008 Estimated Population 2008 GC Cases, n = 1,700

2008: Reported Cases of Gonorrhea by Race, Ethnicity and Gender Number of Cases Male Female Total Cases = 1,700 Source: Iowa Department of Public Health STD Prevention Program

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

GC Prevalence by Age Compared to Iowa’s Population 2008 Estimated Population 2008 GC Cases, n = 1,700

2008: Statewide reported Cases of Gonorrhea by Age and Gender Total Cases = 1,700 Source: Iowa Department of Public Health STD Prevention Program

Will insert rate by gender and age slide here

Iowa Infertility Prevention Project 2008 Gonorrhea Prevalence Monitoring Data Clinic 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 Corrections 2,612 23 0.9% CHC 916 3 0.3% Other 392 0.8% Indian Health 123 4 3.3% Total 59,299 709 1.2% Data Source: UHL and Polk Co. Health Dept.

MLS2b and 3b: Timeliness to GC Treatment in IPP and STD Settings GC/IPP Jan-Jun 07 Jul-Dec 07 Jan-Jun 08 Jul-Dec 08 Jan-Jun 09 14 90/104=.87 124/144=.86 50/95=.53 99/110=.90 91/117=.78 30 100/104=.96 140/144=.97 84/95=.88 109/110=.99 111/117=.95 GC/STD 67/68=.99 70/72=.97 61/66=.92 54/61=.89 58/59=.98 68/68=1 71/72=.99 63/66=.95 61/61=1 59/59=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 06 Jul-Dec 06 Jan-Jun 07 Jul-Dec 07 Jan-Jun 08 Jul-Dec 08 7 Days 82/111=.74 100/136=.74 132/193=.68 61/165=.37 22/129=.17 129/198=.65 14 Days 96/111=.86 116/136=.85 168/193=.87 93/165=.56 34/129=.26 141/198=.71 30 Days 97/111=.87 135/136=.99 114/165=.69 41/129=.32 161/198=.81 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