2. Continuing Education Meeting: Update on Syphilis, Gonorrhea, and Chlamydia Jan-Jun 2002 Liz Lee Senior Epidemiologist Bureau of Epidemiology Houston Department of Health and Human services August 14th, 2002

3. STD’s in Houston/Harris County Syphilis Gonorrhea Chlamydia

4. In Houston/Harris County, Jan-Jun 2002

5. Syphilis - Treponema pallidum

6. Syphilis Stages of Main Concern Focus on Primary and Secondary Stage –INFECTIOUS! Infection within one year period (Early Latent Stage) is also of concern: –Indicates MISSED infectious syphilis cases Syphilis in Pregnancy  congenital syphilis

7. Primary and secondary syphilis — Reported rates: United States, 1970–2000 and the Healthy People year 2010 objective Note: The Healthy People 2010 (HP2010) objective for primary and secondary syphilis is 0.2 case per 100,000 population.

8. Primary and secondary syphilis — Rates by gender: United States, 1981–2000 and the Healthy People year 2010 objective

9. Primary and secondary syphilis — Rates by race and ethnicity: United States, 1981–2000 and the Healthy People year 2010 objective

10. Primary and secondary syphilis — Rates by state: United States and outlying areas, 2000 Note: The total rate of primary and secondary syphilis for the United States and outlying areas (including Guam, Puerto Rico and Virgin Islands) was 2.2 per 100,000 population. The Healthy People year 2010 objective is 0.2 per 100,000 population.

11. Harris County is among the 28 counties that account for over 50% of infectious syphilis cases in US Harris County

12. Syphilis in Houston/Harris County Alarm of potential outbreak among MSM population! MSM=“Men who have sex with men”

14. Syphilis in Houston/Harris County *No decrease in number of cases seen at the citywide level! *MSM cases continuing to increase!

18. Outbreak Level Citywide for Infectious (P&S) Syphilis in Houston/Harris June 2002, Citywide: –14 cases of infectious (P&S) syphilis Exceeds outbreak threshold 64% (9 of 14) cases were MSM cases Urgent need to work with MSM community to provide education and screening services!

20. P&S Rate, Citywide Jan-Jun in 2001 v. 2002 rates per 100,000 No change in rate! Healthy people 2010 goal: 0.2/100,000 per year

21. P&S Rate, Citywide Jan-July in 2001 v. 2002 rates per 100,000 Increase in rate!

22. Rates of Infectious (P&S) Syphilis by Gender (rates per 100,000) Increase in Males Decrease in Females

23. Rates of Infectious (P&S) Syphilis by Age Groups (rates per 100,000) Shift in Age Group: 20-29 y.o.  30-39 y.o.

24. Rates of Infectious Syphilis (P&S) by Race/Ethnicity (rates per 100,000) Largest increase in Whites Highest rate in Blacks

25. Rates of infectious (P&S) Syphilis by Race and Gender (rates in 100,000) Highest increase in White Males Highest rate in Black Males

26. Increasing Syphilis and HIV Co-Infection Rates

29. Rates: MSM, P&S J-J 2001 Rates of MSM P&S Syphilis by Zip Code Area, in Houston/Harris County, Jan-Jun 2001

30. Rates of MSM P&S Syphilis by Zip Code Area, in Houston/Harris County, Jan-Jun 2002

31. Congenital syphilis — Rates for infants <1 year of age: United States, 1981–2000 and the Healthy People year 2010 objective Note: The Healthy People 2010 (HP2010) objective for primary and secondary syphilis is 0.2 case per 100,000 population.The surveillance case definition for congenital syphilis changed in 1988.

32. Congenital Syphilis in Houston/Harris (rates per 100,000) Healthy People 2010 Objectives: 1 per 100,000!

33. Congenital Syphilis by Race/Ethnicity (rate per 100,000) *Highest rate in Blacks *Rate as of June already exceeds 2001 levels

34. In Houston/Harris County, Jan-Jun 2002

35. 4% Decrease in Gonorrhea Jan-Jun 2001 2559 cases reported 75/100,000 Jan-Jun 2002 2464 cases reported 72/100,000 Healthy People 2000 goal: 100/100,000 per year

39. Gonorrhea Rates by Race/Ethnicity *rates per 100,000 Highest rate among African-Americans Increase among Asians

41. 77004, 77021, 77033

42. Distribution of Gonorrhea by Provider

44. In Houston/Harris County, Jan-Jun 2002

45. No Change in Number of Chlamydia Cases Reported (<1% decline) Jan-Jun 2001 5497 cases reported 162/100,000 Jan-Jun 2002 5522 cases reported 162/100,000

47. Largest proportion among 14-19 y.o.

50. 77088 77033

51. Distribution of Reported Chlamydia by Provider

52. Take Home Messages Houston is experiencing an outbreak of infectious syphilis Largest increase in infectious syphilis rates between 2001 to 2002 in White Males Urgent need to work with private sector and CBO’s to target intervention program in high risk areas: –Provider/DIS--enhance education and screening Increase in congenital syphilis in Houston –Urgent need to improve screening of women of reproductive age and provide quality prenatal care and appropriate referrals to get adequate treatment

53. Additional Resources www.stdhivtraining.org –On-Line Chlamydia Course Latest screening, diagnosis, and treatment of chlamydia www.houstonhealth.org –Selected slides from this presentation Syphilis, gonorrhea, and chlamydia in Houston/Harris County