1. Gonorrhea Increases In Washington State: Gonorrhea Increases In Washington State: Analyses for intervention planning May 2011 Mark R. Stenger Infectious Disease & Reproductive Health Assessment Unit, Washington State Department of Health

2. Objectives Describe GC incidence trends and recent increases Describe gender and behavioral trends Describe treatment trends Describe trends and changes in partner management Describe HIV co-morbidity among GC cases Discuss Program Response - interventions

3. Historical Context - Gonorrhea Cases and Incidence Rate Washington State 1920 - 2010

4. Gonorrhea Cases and Incidence Rate Washington State 1996 - 2010

5. Gonorrhea Incidence Rate by Race and Hispanic Ethnicity Washington State 2001 - 2010 Gonorrhea Incidence Rate by Non-Hispanic Race Washington State 2001 - 2010 Gonorrhea Incidence Rate by Hispanic Ethnicity Washington State 2001 - 2010

6. Gonorrhea Incidence Rate By Census Tract Washington State 2010

7. Gonorrhea Aberration Reporting System Washington State 2009-2011 Mantel-Haenszel Chi-Square test of trend for cases by week significant at <.0001 2011

8. Gonorrhea Incidence Rate by Gender Washington State 1996 - 2010

9. Gonorrhea Cases by Gender by Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

10. Male Gonorrhea Cases by Age Group by Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

11. Percent of Male Gonorrhea Cases Reporting MSM-risk by Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

12. Male Gonorrhea Cases by Age Group And MSM Risk Washington State 2010

13. Gonorrhea Cases by MSM, MSW & Female By Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

14. MSM Gonorrhea Cases by Age Group by Quarter, Washington State 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

15. MSM Gonorrhea Cases by Reported HIV Status by Quarter, Washington State 2008 – 2011* *Cases diagnosed through the 1st quarter of 2011, reported through May 2011 Incidence of Gonorrhea among PLWHA, Washington State 1994 – 2010 HIV Status of MSM Diagnosed with GC and Incidence of GC among HIV+

16. Percent of Cases with Treatment Reported by Quarter for All Cases 2009 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

17. Treatment Reported 1992 – 2010

18. Proportion of MSM Treated with Ceftriaxone By Quarter, 1992 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

19. Percent of All GC Cases Interviewed By Quarter 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

20. Programmatic Response: State Level GC ‘Summit’ in November 2010 Four counties in Puget Sound metropolitan area GISP STD clinic staff Provider Advisory – Revised Treatment Guidelines Pro-active identification of repeaters (<120 days from previous infection) Referral to local staff for partner management Public Health - Seattle & King County, Harborview STD Clinic Provider Advisory – Revised Treatment Guidelines Culturing all MSM at all anatomic sites in the clinic SSuN GC treatment failure surveillance Susceptibility testing and follow-up with patients with elevated alert values Renewed partner management focus on MSM GC

21. Acknowledgements Roxanne Kerani, PhD Public Health – Seattle & King County STD Control Program Mark Aubin Manager, STD Services Section Washington State Department of Health

22. Mean Number of Period Partners* Reported by MSM Cases by Quarter, 2008 - 2010 Number of partners reported in previous 2 months, Includes only cases completing interviews

23. Rectal GC Infections Reported by Quarter Washington State, 2008 – 2011* Cases diagnosed through the 1st quarter of 2011, reported through May 2011

24. Selected Venues Reported by Quarter for MSM Cases 2008 - 2010 Percent reporting having met sex partner in venue in last year, Includes only cases completing interviews

25. Percent of MSM Cases with History of GC In Previous Year, by Quarter 2009 - 2010