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

GC Diagnoses, San Francisco City Clinic 2008 FemaleMSMMSW N White32.4%60.5%15.9% Hispanic8.1%22.0%11.7% Black56.7%8.3%63.8% API2.7%7.4%8.5% Median age2634 Mean/Median partners (3 months)13 / 27 / 43 / 2 HIV infected2.7%35.8%0% History of GC (3 years)8.1%40.0%12.7% Symptomatic67.5%54.9%95.7% CT co-infx13.5%21.6%13.8%

Non-STD Clinic GC, SSuN FemaleMSMMSW N White17.0%65.3%52.9% Hispanic10.0%15.3%0% Black60.0%4.1%32.3% API11.0%12.2%11.8% College or more16.0%51.2%27.3% Median age Incarcerated in past year8.0%1.0%5.9% Symptomatic29.0%18.4%41.2% Partner incarcerated8.0%1.0%5.9% Mean age difference (last partner)-2+3+7

Non-STD Clinic GC, SSuN FemaleMSMMSW N Been to STD clinic in past year98.0% 70.6% Mean/Median partners (3 months)2.6 / 15.3/ 32.8/ 2 HIV infected0%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%

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

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