1. Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges Presented by: Julia A. Schillinger, MD, MSc CAPT USPHS Bureau of STD Control New York City Department of Health and Mental Hygiene jschilli@health.nyc.gov

2. Gonorrhea rates, by sex New York City, 1995-2009* Data based on cases reported to the NYC DOHMH; * Annualized based on half-year 2009 data April 2007: CDC alert: Discontinue FQ use September 2006: NYC joins GISP 2004: NYC STD clinic QRNG prevalence exceeds 5% April 2004: NYC DOHMH QRNG health alert January 2008: NYC makes AST for GC reportable

3. *excludes persons for whom sex or age were not reported

4. Male GC reported to the NYC DOHMH, 2000-2008, case rates, by age

5. Female GC reported to the NYC DOHMH, 2000-2008, case rates, by age

6. GC reported to the NYC DOHMH (n=10,483); case rates by race/ethnicity and sex, 2008 5 13 28 44 1,665 2,186 378 560 58 347 Other = 187 Unknown race/eth = 5,011

7. Male GC reported to the NYC DOHMH, 2000-2008, case rates, by race

8. Female GC reported to the NYC DOHMH, 2000-2008, case rates, by race

9. Male GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race

10. Female GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race

11. Case rate (per 100,000 population) of Neisseria gonorrhea reported to the New York City DOHMH, with percent reported from Bureau of STD clinics, 2000-2008, by sex

12. New York City United Hospital Fund (UHF) Neighborhoods

15. Percent fluoroquinolone resistance among gonorrhea isolates detected among BSTDC clinic patients, 2001-2008

16. NYC Bureau of STD Control Current GC Activities I GC (& CT) screening in NYC high schools Partner notification –GC cases dx’d in NYC school screening program –HIV-GC coinfected at select NYC facilities –InSPOT EZ Pass/VIP Program for core transmitters –HIV-GC co-infected, or 2 GC/12 mos eligible

17. NYC Bureau of STD Control Current GC Activities II Sentinel surveillance for antimicrobial resistance –Culture at Fort Greene clinic –Gonococcal Isolate Surveillance Project (GISP) Routine surveillance for antimicrobial resistance Sentinel surveillance network –Extract behavioral and clinical information on GC cases diagnosed in BSTDC clinics –Interview sample of non-BSTDC dx’d cases (SSuN project)

18. Challenges in GC control Large number of infections –Universal interventions unsustainable –Focused interventions staff-intensive Syphilis & HIV interview and PN consume staff resources NAATs commonly used test –Provide no information on resistance –Not approved for anorectal specimens Antibiotic resistance –Opted not to pursue EPT legislation for GC