1. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. San Francisco, CA San Francisco County n = 3,173 Use of Emergency Facilities for the Treatment of Neisseria gonorrhoeae Infection in the United States Newman L 1, Donnelly J 2, Marcus J 3, Martins S 4, Stenger M 5, Stover J 6, Nelson R 1, Weinstock H 1, on behalf of the STD Surveillance Network SSuN 1 Division of STD Prevention, CDC, Atlanta, GA; 2 Colorado Department of Public Health, Denver, CO; 3 San Francisco Department of Public Health, San Francisco, CA; 4 Minnesota Department of Health, St. Paul, MN; 5 Washington State Department of Health, Olympia, WA; 6 Virginia Department of Health, Richmond, VA - USA Treatment of Neisseria gonorrhoeae (NG) in emergency medical facilities (EMF) in the United States (US) is not optimal: Patients don’t always get appropriate antimicrobial treatment In 2007, 15.8% of gonorrhea patients seen in EMFs in Colorado (CO) and Virginia (VA) inappropriately received quinolones, in contrast to 2.2% of patients seen in STD clinics (Dowell, 2008) Care generally costs more than in clinical outpatient settings Poor environment for HIV prevention interventions In 2007, only 5.7% of patients reported with gonorrhea in EMFs in CO had documented testing for HIV at the time of the visit, in contrast to 22.4% of patients seen in non-EMF settings (Donnelly, 2007) Limited capacity for partner management National case report data do not provide sufficient data on provider type or antimicrobial treatment of patients with gonorrhea Background Table 1. Proportion of cases of Neisseria gonorrhoeae infection diagnosed in selected facility types by patient characteristics To use a sample of gonorrhea cases to describe Characteristics of patients diagnosed with gonorrhea in EMFs How patients diagnosed with gonorrhea in EMFs differ from those diagnosed in other settings (e.g., STD and primary care clinics) Objectives Gonorrhea case report data obtained through STD Surveillance Network (SSuN) sentinel surveillance system 11 counties and independent cities around San Francisco, California (CA); Denver, CO; Minneapolis, Minnesota (MN); Richmond, VA; and Seattle, Washington (WA) (Figure 1) Analysis of all cases of reported gonorrhea in SSuN counties reported from January 1, 2007 through December 31, 2008 (SF and MN data through July 31, 2008) Provider type available for 97.4% of 17,613 cases Chi-square or Cochran-Mantel-Haenszel test considered significant if p<0.05 2000 U.S. census data used to determine if case lived in census tract with >20% of population living below the federal poverty line (Krieger 2003) Methods Results One in six gonorrhea cases in a US sample are diagnosed in EMFs More likely to be female, younger, black, seeking care on weekends, and living in poorer neighborhoods Wide variation between areas Interventions are needed to ensure patients receive appropriate treatment and prevention services Non-emergency care alternatives must be made available and acceptable to affected communities More in-depth analysis needed to understand this population Conclusions The authors are grateful for the assistance of Darlene Davis (CDC) and the SSuN collaborators in Colorado, Minnesota, San Francisco, Virginia, and Washington. For more information, please contact: Dr. Lori Newman, len4@cdc.gov, (404) 639-6183len4@cdc.gov Acknowledgements Figure 1. Participating SSuN counties and number of reported gonorrhea cases (N=17,613) by area, 2007-2008, US Seattle, WA King, Pierce, & Snohomish Counties n = 4,546 Richmond, VA Chesterfield & Henrico Counties and Richmond City n = 3,659 Denver, CO Adams, Arapaho, & Denver Counties n = 3,586 Minneapolis, MN Hennepin County n = 2,649 Figure 2. Proportion of cases of Neisseria gonorrhoeae infection diagnosed in EMFs, STD, and primary care clinics that are women (N=7,281) by area Limitations Limited geographic representativeness Unclear how to interpret wide variability between areas SSuN expanded to 12 areas in September 2008 Possible provider type misclassification EMF visits may be classified as “Other Hospital” or “Other Provider Type” Could result in underestimate of role of EMFs Figure 3. Proportion of cases of Neisseria gonorrhoeae infection diagnosed in EMFs, STD, and primary care clinics that are 15 to 29 years of age (N=11,317) by area Figure 4. Proportion of cases of Neisseria gonorrhoeae infection diagnosed in EMFs, STD, and primary care clinics that live in a census tract with >=20% of persons below poverty (N=4,647) by area Note: Women diagnosed in EMFs more commonly than in STD clinics in all areas Note: Younger patients diagnosed in EMFs more commonly than in STD clinics in all areas Note: Patients living in poverty census tracts diagnosed in EMFs more commonly than in STD clinics in all areas except CO