1. Gonorrhea Morbidity, Missouri, 2008 In 2008, there were 8,014 reported gonorrhea cases. Of these, 57% were in females, 65% were among Black, non-Hispanic persons, and 63% were in persons aged 15-24 years. Rates among Black, non-Hispanic persons were 26 times those in White, non-Hispanics.

2. Gonorrhea Morbidity, Missouri, 2008 The greatest number of cases (962) was reported among Black Females aged 15-19 years. The case rate in this group was 3,047 per 100,000. 22 times greater than the overall case rate. Among Black Females 20-24 years of age, the rate was 3,380 per 100,000. 25 times greater than the overall case rate.

3. Gonorrhea Morbidity, Missouri, 2008 In 2008, St. Louis City, St. Louis County, and Jackson County reported 5,966 gonorrhea cases. This represented 74.4% of all reported cases.

4. National Rankings by Cases 2007 Missouri: #8 St. Louis City: #20 Jackson County: #21 St. Louis County: #28

5. Unofficial National Rankings by Rates 2007 St. Louis City: easily #1 (742.3) Jackson County: (385.2) St. Louis County: (230.6) The second highest rate among counties/independent cities ranked by cases was Orleans County, LA at 684.5

6. Gonorrhea Morbidity, Missouri, 2008 Missouri Population Estimates, 2007 HIV RegionMaleFemaleTotal St. Louis Region 1,007,557 1,080,388 2,087,945 Kansas City Region 598,787 628,058 1,226,845 Northwest Region 120,644 121,136 241,780 North Central Region 365,437 372,508 737,945 Southwest Region 539,008 557,750 1,096,758 Southeast Region 239,589 247,553 487,142 Missouri Total 2,871,022 3,007,393 5,878,415

7. GC in MO Epi Investigations In Missouri, priority has been given to syphilis and HIV for Partner Services. In 2008, there were 369 cases reported of early syphilis and 588 cases of newly reported HIV Disease. When time permits or as 700/900 morbidity goes down (never), it is expected that GC follow up would increase.

8. GC in MO Epi Investigations Four DIS jurisdictions (agencies) perform GC investigations: Kansas City Health Department St. Louis City Health Department St. Louis County Department of Health Missouri Department of Health & Senior Services (DHSS)

9. GC in MO Epi Investigations Missouri has a total of 43 staff that spend a percentage of their time as a STD/HIV DIS. 15 in KC (also work other communicable diseases) 4 in STL Co 9 in STL City (mostly HIV and CD focused, minimal STD) 15 DHSS (Outstate & STL City)

10. GC in MO Epi Investigations KCHD Interview Criteria STD clinic: GS positive males positives returning for treatment Epi Impact in 2008 Cases interviewed955 Contact index0.7

11. GC in MO Epi Investigations St. Louis City Interview Criteria ConnectCare clients GS positive males Positives returning for treatment Epi Impact in 2008 Cases interviewed132 Contact index1.2

12. GC in MO Epi Investigations St. Louis County Interview Criteria Select circumstances Epi Impact in 2008 Cases interviewed 9 Contact index0.8

13. GC in MO Epi Investigations DHSS Outstate MO Interview Criteria Co-infected with 700 and/or 900 provider request Epi Impact in 2008 Cases interviewed 46 Contact index1.5

14. GC Screeing in MO STD and IPP Providers ~80 IPP Providers 114 Local Public Health Agencies 3 dedicated full time STD clinics Use dual screening test (Gen Probe Aptima) 85,000 tests per year (55% IPP) IPP MOA Requires provision of Partner Services to GC/CT positive clients: Partner elicitation Partner notification – Three phone calls – Letter – Referral to DIS for assistance

15. GC in MO Treatment Verification KC, St. Louis County, and DHSS conducts follow- up for all inadequate treatment reported Cipro – FR assigned to DIS Other inadequate treatment – phone follow-up to provider No treatment – select follow-up

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