Increasing Incidence of Gonorrhea in California (the talk formerly known as: “Gonorrhea Drips on in California”) Michael C Samuel 1, Virginia Loo 1, Denise Gilson 1, Duli Kodagoda 2, Stewart Coulter 1, Gail Bolan 1 1-California Department of Health Services, Sexually Transmitted Disease Control Branch, Berkeley, California 2-Los Angeles Department of Health Services, Sexually Transmitted Disease Program

Background / Purpose Increases in GC noted in several California counties since 1999 Similar increases noted elsewhere in US and internationally Analyze trends by demographic characteristics to better understand reasons for GC increases Is the increase “real”

Gonorrhea California vs. United States Rates, 1970–2000

GC Case-based surveillance in California - hybrid system –some counties: “AVSS” vital statistics system –some counties: California specific STD-MIS-like system –LA and SF each have unique systems (and separate cooperative agreements) –some counties have additional local data, especially from STD clinic –Statewide common denominator is “NETSS-like” selection of demographic and few other variables (Gender of partners NOT collected)

Additional Data Prevalence Monitoring Gonococcal Isolate Surveillance Project (GISP)

Gonorrhea RATES by Gender and Year California Data for 2001 are provisional and will increase slightly

Gonorrhea Male:Female Ratio by Year California

Female Gonorrhea Positivity CA Prevalence Monitoring (IPP) Data Family Planning STD Clinics

Female Gonorrhea Positivity CA Prevalence Monitoring (IPP) Data (“consistent series” clinics) Family Planning STD Clinics

Percent MSM among GISP* Isolates by California Clinic, *Gonococcal Isolate Surveillance Project Source: STD Control Branch, DCDC, CA DHS - Provisional 11/2001

Santa Cruz County Data

Counties with Increase in Male GC Cases 1999 to 2000 (<10 cases) 72% w/ 

Counties with Increase in Female GC Cases 1999 to 2000 (<10 cases) 79% w/ 

NORTH SOUTH CENTRAL BAY L.A. California Regions

Female Gonorrhea RATES by Region California

Male Gonorrhea RATES by Region California

Female Gonorrhea RATE by Age Group California

Male Gonorrhea RATE by Age Group California %  47% 

Male Gonorrhea RATE by Race/Ethnic Group California 2001

Female Gonorrhea RATE by Race/Ethnic Group California 2001

Female Gonorrhea Cases by Race/Ethnic Group California

Male Gonorrhea Cases by Race/Ethnic Group California

Explanation for Increases True increases in incidence –increases in MSM cases Increased CT screening mostly in women CT/GC dual test Slightly decreased specificity of amplified tests --> increased false positives Change in reporting (no evidence)

Conclusion Increases in reported male and female GC cases in almost all areas in California Increases higher in males, particularly in older age groups; GISP and other data support increase in MSM Race data incomplete, but very high rates among African Americans and noteworthy increase in white males IPP data does not support observed increase Enhanced GC Surveillance to be conducted in 2002 in sample of counties