1. Sexually Transmitted Disease (STD) Surveillance Report, 2012 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD Surveillance System www.health.state.mn.us/std

2. Introduction Under Minnesota law, physicians and laboratories must report all laboratory-confirmed cases of chlamydia, gonorrhea, syphilis, and chancroid to the Minnesota Department of Health (MDH) within one working day. The MDH does not maintain statistics for other, non- reportable STDs (ex: herpes, HPV/genital warts). This slide set describes trends in reportable STDs in Minnesota by person, place, and time. Analyses exclude cases reported from federal and private prisons. STDs in Minnesota: Annual Review

3. Introduction STD surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population. STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions. STDs in Minnesota: Annual Review

4. Interpreting STD Surveillance Data Factors that impact the completeness and accuracy of STD data include: Level of STD screening by healthcare providers Individual test-seeking behavior Sensitivity of diagnostic tests Compliance with case reporting Completeness of case reporting Timeliness of case reporting Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the above factors. STDs in Minnesota: Annual Review

5. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Interpreting STD Surveillance Data The surveillance system only includes cases with a positive laboratory test. Cases diagnosed solely on symptoms are not counted. Previous years data included only cases that had a case report form and a matching lab report. This years data additionally includes cases that had only a lab report and no corresponding case report form. This has increased the number of unknowns in some variables. Surveillance data represent cases of infection, not individuals. A person with multiple infections in a given year will be counted more than once. Caution is warranted when interpreting changes in STD numbers that can seem disproportionately large when the number of cases is small.

6. National Context STDs in Minnesota: Annual Review

7. ChlamydiaRates by State, United States and Outlying Areas, 2011 National Rate = 454.1 per 100,000 population Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2011 Surveillance Slides.

8. GonorrheaRates by State, United States and Outlying Areas, 2011 Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2011 Surveillance Slides. National Rate = 103.1 per 100,000 population

9. Primary and Secondary SyphilisRates by State United States and Outlying Areas, 2011 National Rate = 4.5 per 100,000 population Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2011 Surveillance Slides.

10. Overview of STDs in Minnesota STDs in Minnesota: Annual Review

11. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STDs in Minnesota Rate per 100,000 by Year of Diagnosis, 2002-2012 * P&S = Primary and Secondary

12. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

13. CHLAMYDIA STDs in Minnesota: Annual Review

14. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Rate per 100,000 persons > 300 151 - 300 76 - 150 0 - 75 2012 Minnesota Chlamydia Rates by County City of Minneapolis 927 City of St. Paul 795 Suburban # 250 Greater Minnesota 229 (1,176 cases missing residence information) # 7-county metro area, excluding the cities of Minneapolis and St. Paul St. Louis Itasca Cass Lake Polk Beltrami Aitkin Pine Cook Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Rice Wright Norman Fillmore Mower Nobles Murray Grant Sibley Brown Rock Redwood Douglas Jackson Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Scott Stevens Anoka Nicollet McLeod Chippewa Wabasha Carver Pennington Hubbard Crow Wing Lake of the Woods Clearwater Kandiyohi Lincoln Blue Earth Mille Lacs Houston Steele Traverse Dodge Wadena Hennepin Kanabec Lac Qui Parle Benton Big Stone Cottonwood Waseca Chisago Le Sueur Mahnomen Yellow Medicine Pipestone Red Lake Sherburne Watonwan Washington Ramsey

15. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area. Chlamydia Infections by Residence at Diagnosis Minnesota, 2012 Total Number of Cases = 18,048

16. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Gender Minnesota, 2002-2012

17. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Age Minnesota, 2002-2012

18. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Age-Specific Chlamydia Rates by Gender Minnesota, 2012

19. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race. 2012 rates compared with Whites: Black = 11x higher American Indian = 5x higher Asian/PI = 2x higher Hispanic = 3x higher

20. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

21. GONORRHEA STDs in Minnesota: Annual Review

22. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review 2012 Minnesota Gonorrhea Rates by County Rate per 100,000 persons City of Minneapolis 280 City of St. Paul 184 Suburban # 41 Greater Minnesota 18 (155 cases missing residence information) # 7-county metro area, excluding the cities of Minneapolis and St. Paul St. Louis Itasca Cass Lake Polk Beltrami Aitkin Pine Cook Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Rice Wright Norman Fillmore Mower Nobles Murray Grant Sibley Brown Rock Redwood Douglas Jackson Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Scott Stevens Anoka Nicollet McLeod Chippewa Wabasha Carver Pennington Hubbard Crow Wing Lake of the Woods Clearwater Kandiyohi Lincoln Blue Earth Mille Lacs Houston Steele Traverse Dodge Wadena Hennepin Kanabec Lac qui Parle Benton Big Stone Cottonwood Waseca Chisago Le Sueur Mahnomen Yellow Medicine Pipestone Red Lake Sherburne Watonwan Washington Ramsey > 100 30 - 100 11 - 29 0 - 10

23. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area. Gonorrhea Infections in Minnesota by Residence at Diagnosis, 2012 Total Number of Cases= 3,082

24. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Gender Minnesota, 2002-2012

25. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Age Minnesota, 2002-2012

26. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Age-Specific Gonorrhea Rates by Gender Minnesota, 2012

27. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race. 2012 rates compared with Whites: Black = 26x higher American Indian = 8x higher Asian/PI = 0x higher Hispanic = 2x higher

28. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

29. SYPHILIS STDs in Minnesota: Annual Review

30. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Syphilis Rates by Stage of Diagnosis Minnesota, 2002-2012 * P&S = Primary and Secondary

31. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review 2012 Minnesota Primary & Secondary Syphilis Rates by County Rate per 100,000 persons > 1.0 0.21 – 1.0 0 – 0.2 # 7-county metro area, excluding the cities of Minneapolis and St. Paul St. Louis Itasca Cass Lake Polk Beltrami Aitkin Pine Cook Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Rice Wright Norman Fillmore Mower Nobles Murray Grant Sibley Brown Rock Redwood Douglas Jackson Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Scott Stevens Anoka Nicollet McLeod Chippewa Wabasha Carver Pennington Hubbard Crow Wing Lake of the Woods Clearwater Kandiyohi Lincoln Blue Earth Mille Lacs Houston Steele Traverse Dodge Wadena Hennepin Kanabec Lac qui Parle Benton Big Stone Cottonwood Waseca Chisago Le Sueur Mahnomen Yellow Medicine Pipestone Red Lake Sherburne Watonwan Washington Ramsey City of Minneapolis 14.9 (57 cases) City of St. Paul 6.7 (19 cases) Suburban # 1.7 (37 cases) Greater Minnesota 0.2 (5 cases)

32. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area. Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2012 Total Number of Cases = 118

33. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Gender Minnesota, 2002-2012

34. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Age Minnesota, 2002-2012

35. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Age-Specific Primary & Secondary Syphilis Rates by Gender, Minnesota, 2012

36. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review *Includes persons reported with more than one race Primary & Secondary Syphilis Cases by Race Minnesota, 2012 Total Number of Cases = 118

37. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 2002-2012 * Persons of Hispanic ethnicity can be of any race.

38. CHLAMYDIA AND GONORRHEA AMONG ADOLESCENTS & YOUNG ADULTS (15-19 year olds) (20-24 year olds) STDs in Minnesota: Annual Review

39. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Cases in 2012 (n = 18,048) MN Population in 2010 (n = 5,303,925) Chlamydia Disproportionately Impacts Youth

40. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Disproportionately Impacts Youth MN Population in 2010 (n = 5,303,925) Gonorrhea Cases in 2012 (n = 3,082)

41. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

43. Chlamydia Rates Among Adolescents & Young Adults by Gender in Minnesota, 2002-2012 Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.

44. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Cases Among Adolescents and Young Adults by Gender and Race, Minnesota, 2012 Males (n = 3,119)Females (n = 9,370) Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.

45. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rate Among Adolescents and Young Adults by Race, Minnesota, 2012 Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.

46. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rates Among Adolescents & Young Adults by Gender in Minnesota, 2002-2012 Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.

47. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Cases Among Adolescents and Young Adults by Gender and Race, 2012 Males (n = 618)Females (n = 1192) Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.

48. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Gonorrhea Rate Among Adolescents and Young Adults by Race, Minnesota, 2012 Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.

49. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

50. STDs in Minnesota: Annual Review Topic of Interest: Early Syphilis Among Men Who Have Sex With Men in Minnesota Topic of Interest: Early Syphilis Among Men Who Have Sex With Men in Minnesota

51. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Number of Early Syphilis Cases by Gender Minnesota, 2002-2012 MSM=Men who have sex with men. Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, 2007, and 2009). Early Syphilis includes primary, secondary, and early latent stages of syphilis.

52. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Early Syphilis Cases by Stage at Diagnosis Minnesota, 2002-2012 Early Syphilis includes primary, secondary, and early latent stages of syphilis.

53. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

54. Early Syphilis Cases Among MSM by Age Minnesota, 2012 (n=158) MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis. Mean Age = 38 years Range: 15 to 74 years

55. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Early Syphilis (ES) Cases Co-infected with HIV, 2006-2012 MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis.

56. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review MSM=Men who have sex with men Early Syphilis includes primary, secondary, and early latent stages of syphilis.

57. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Whats Being Done in Minnesota? The MDH Partner Services Program continues to follow up on early syphilis cases and their sex partners. In 2004 the MDH implemented the Syphilis Elimination Effort (SEE). SEE activities include: Developed a clinician toolkit for syphilis testing and treatment; Created a new outbreak response plan; and Increased awareness among gay/bisexual men through advertising in magazines, bars, and websites. SEP website: www.health.state.mn.us/sep - includes several archived provider presentations and links to awareness campaign materialswww.health.state.mn.us/sep Physicians are encouraged to screen men who have sex with men at least annually and to ask about sex partners. STDs in Minnesota: Annual Review

58. SURVEILLANCE SUMMARY

59. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

60. Future Updates to STD Reporting New case report form to accommodate changes in gonorrhea treatment guidelines Case report form will be able to be filled out on a computer and printed to be mailed or faxed in Link will be put up on MDH website to indicate interest in future online provider portal for direct online reporting Letters will be sent in late May/early June to providers to introduce new case report form, provide link to sign up for future provider portal online reporting, and highlight new gonorrhea treatment guidelines Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review