1. Marion County Health Department 2011–2015 STI Assessment Katarina Ost Public Health Associate Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2016 PHAP Summer Seminar May 17, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2.  Background  Increase in incidence of reportable sexually transmitted infections (STIs) in Oregon (e.g., syphilis, gonorrhea, chlamydia)  Change in resource distribution in the state of Oregon  Objectives  Gather data on diagnosis location, demographics, and common risk factors  Synthesize data into comprehensive report  Use data to inform targeted outreach to practitioners and community  Define resources needed from the state health department Background and objectives

3. Methods  County data collected using ORPHEUS ( Oregon Public Health Epidemiologic User System)  This includes: Provider data on “inadequate treatments” in gonorrhea cases Risk factors (such as sexual orientation and app use) Demographic information  State data collected from Oregon Health Authority website  National data collected from CDC 2014 STD Surveillance Report  Geography:  Zip codes combined into areas of statistical significance within local regions  Maps created in ArcGIS  Data: Analyzed and cross-tabulated in STATA (statistical software)  Incidence calculated as “rate per 100,000”

4. Syphilis 2011–2015 Data collected from: CDC 2014 STD Surveillance Report, ORPHEUS, and Oregon Health Authority website The United States experienced a 36% increase in incidence per 100,000 Marion County had a 538% increase in incidence per 100,000 Oregon has experienced a 134% increase in incidence per 100,000 Marion County had a 1,138% increase in incidence per 100,000

5. Syphilis in Marion County 2014–2015  66 Cases (82% men; 18% women)  Race/ethnicity:  43% White  36% Hispanic (75% increase in incidence since 2014)  Age groups:  23% were in 35–44 year age group  33% were in 45–54 year age group  Sexual orientation  81% of cases identify as MSM  Increases in MSW (men who have sex with women) and women Data collected from: ORPHEUS

6. Syphilis in Marion County 2014–2015 (continued)  20% Co-infection (2015)  Defined as infection of chlamydia, gonorrhea, or hepatitis diagnosed within one month of syphilis diagnosis  13% decrease since 2014  25% Repeat infection (2015)  116% increase since 2014  Congenital syphilis:  160% increase (2011–2015)  2 cases in Marion County so far in 2016  Oregon State had two cases in 2014 and six cases in 2015 Data collected from: ORPHEUS and Oregon Health Authority websites

7. Data collected from: ORPHEUS

8. Trends in Mobile App Use in Marion County 2014–2015  21% of syphilis cases report using app  134% increase in percent (2014–2015)  62% of syphilis cases (MSM) report using app (2015)  Presents new challenges for managing contacts  Data were collected out of ORPHEUS risk factors section Data collected from: ORPHEUS

9. Gonorrhea 2011–2015 United States has experienced a 6.5% increase in incidence per 100,000 Oregon had a 52% increase in incidence per 100,000 Marion County had a 155% increase in incidence per 100,000 Data collected from: CDC 2014 STD Surveillance Report, ORPHEUS, Oregon Health Authority website

10. Gonorrhea in Marion County 2014–2015  252 cases (men 56%; women 44%)  Race/ethnicity:  53% White  18% Hispanic  Age groups:  43% were in 35–44 year age group Data collected from: ORPHEUS

12. Gonorrhea screening and treatment practices in Marion County 2015 Graphic: Left-hand side shows top 10 providers seeing gonorrhea cases in Marion County Right-hand side shows top 10 providers recorded as inadequately treating gonorrhea cases Read as “Provider B sees 11% of all cases in Marion County, and is responsible for treating 17% of all recorded inadequate treatments in the county” Gonorrhea 2015 (n=252)Gonorrhea Inadequate Treatment 2015 (18.7% of cases) RankProvider Name % of Cases RankProvider Name % of Inadequate Tx 1MCHD19.2%1B17.0% 2B11.0%2K14.9% 3C10.5%3C8.5% 4D7.3%4J6.4% 5E6.8%5D6.4% 6F5.9%6F4.3% 7G4.1%7L4.3% 8H3.7%8M4.3% 9I2.7%9N4.3% 10J2.3%10H4.3%  Gonorrhea inadequate treatments:  Defined as treatment outside of the CDC recommendations (2015)  Recorded by health department from ORPHEUS (ongoing surveillance by staff) Data collected from: ORPHEUS

13. Chlamydia 2011–2015 United States experienced a 0.6% increase in incidence per 100,000 Oregon had a 10.5% increase in incidence per 100,000 Marion County had a 12.2% increase in incidence per 100,000 Data collected from: CDC 2014 STD Surveillance Report, ORPHEUS, and Oregon Health Authority websites

14. Chlamydia in Marion County 2014–2015  1,711 cases (men 28%; women 72%)  Race/ethnicity  34% White  26% Hispanic  Age groups:  66% were in 25 and under age group Data collected from: ORPHEUS

16. Conclusion  Findings suggest:  Targeted outreach for each STI may decrease rates in Marion County  Provider Outreach may improve STI treatment and screening practices  Other steps should be taken to increase awareness of the problem

17. Next steps  Practitioner outreach  Completed at seven local practices  Scheduled at five local practices  Special population outreach  Internet partner services (IPS updates)  Media  Made the front page of the local paper  STI month Facebook/ Twitter campaign  MCHD STI program evaluation Note: Points above included in the Marion County Health Department STI Strategic Plan

18. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you! Katarina Ost lgv3@cdc.govlgv3@cdc.gov | (503) 577-4631 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support