1. Pennsylvania Department of Health STD Program Telephone: 717-787-3981 Internet Address: www.state.pa.us/php/stdwww.state.pa.us/php/std Email: c-skowalew@state.pa.us Gonorrhea Overview

2. Reported Gonorrhea Pennsylvania 1976-2008 (Exclusive of Philadelphia)

3. 2008 Reported Gonorrhea By Report Source Pennsylvania (Exclusive of Philadelphia) N=10,796

4. Elk York Centre Berks Butler Lycoming Pike Bedford Clinton Clearfield Blair Indiana Somerset Luzerne Fayette Perry Bucks Lancaster Mercer Franklin Chester Clarion Schuylkill Cambria Monroe Huntingdon Greene Venango Allegheny Adams Washington Westmoreland Jefferson Mifflin Fulton Dauphin Armstrong Beaver Sullivan Juniata Union Carbon Lehigh Columbia Snyder Cumberland Lebanon Lawrence Tioga Erie Potter Bradford Warren McKean Crawford Wayne Forest Susquehanna Wyoming Cameron Montgomery Lackawanna NorthumberlandNorthampton Delaware Montour Philadelphia Northwest Southwest North CentralNortheast South CentralSoutheast 2008 Gonorrhea Culture Sites and Gonorrhea Case Rates* by County, 2008 Rates No Cases1 - 2526 - 5051 - 7576 - 125126 - 333 Health Districts * Rates are calculated per 100,000 population from the 2000 Census.

5. Reported Gonorrhea By Gender Pennsylvania (Exclusive of Philadelphia) CY 2000 through 2008

6. Reported Gonorrhea By Age Pennsylvania (Exclusive of Philadelphia) CY 2007 and 2008

7. 2008 Reported Gonorrhea By Age Pennsylvania (Exclusive of Philadelphia) By Gender

8. Reported Gonorrhea Pennsylvania 2008 Cases per 100,000 Population Select Populations

9. Gonorrhea Positivity Pennsylvania 2008 Select Populations

10. STD Prevention Activities Key Statewide Populations Individuals age 15 to 24 Individuals age 15 to 24 Black Males Black Males Black Females Black Females Men who have Sex with Men (MSM) in selected counties (e.g., Allegheny County) Men who have Sex with Men (MSM) in selected counties (e.g., Allegheny County)

11. Challenges Budget Cuts Budget Cuts Reduced Testing OpportunitiesReduced Testing Opportunities Restrictions on TravelRestrictions on Travel Loss of Staff (e.g., directly lost ability to map data)Loss of Staff (e.g., directly lost ability to map data) State Facing a Reduction in ForceState Facing a Reduction in Force Bunker Mentality Setting-in with Other Departments and Agencies (resulting in less cooperation, reluctance to change, poor morale, etc.)Bunker Mentality Setting-in with Other Departments and Agencies (resulting in less cooperation, reluctance to change, poor morale, etc.) Political Changes Loss of Health Commissioner in Chester CityLoss of Health Commissioner in Chester City Other County/Municipal cut backs have resulted in a fracturing ofOther County/Municipal cut backs have resulted in a fracturing of existing long-term relations. State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT test Price)State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT test Price) Unrealistic Expectations Placed on Field Staff Is it reasonable for one DIS to cover 12 counties?Is it reasonable for one DIS to cover 12 counties? 29 Early Syphilis Cases 29 Early Syphilis Cases 3,241 Chlamydia Cases 3,241 Chlamydia Cases 573 Gonorrhea Cases 573 Gonorrhea Cases 1 Congenital Syphilis 1 Congenital Syphilis

12. PA’s Approach to High Morbidity Areas in the State Targeted Intervention Based on Data Morbidity Data Prevalence Data Mapping of Data Strategic allocation of resources Use a multitude of data sources to make “case” to local and district jurisdictions Involvement of a large number of stakeholders Frequent Follow-up of Partners Face-to-face meetings very critical Targeted Communication Health Alerts Press Releases

13. STD Prevention Activities A success story? “Know your enemy and know yourself and you can fight a hundred battles without disaster.” With the gonorrhea increase in Delaware County it was critical to determine: Was the increase real? Was the increase real? Where were the increases occurring? Where were the increases occurring? What populations were being impacted? What populations were being impacted? Who were the partners that need to be engaged? Who were the partners that need to be engaged?

14. Reported Gonorrhea Delaware County 2000-2008

16. GC Increase in Delaware County LocationDisease 2007 Disease Counts Estimated 2006 Population Case Rate Per 100,000 Population Chester CityGonorrhea46036,8011249.97 DelawareGonorrhea921555,996165.65 StateGonorrhea12,71212,440,621102.18 PhiladelphiaGonorrhea5,2461,448,394362.19 LocationDisease 2006 Disease Counts Estimated 2006 Population Case Rate Per 100,000 Population Chester CityGonorrhea24736,801671.18 DelawareGonorrhea513555,99692.27 StateGonorrhea11,46612,440,62192.17 PhiladelphiaGonorrhea5,2181,448,394360.26

17. Key STD Prevention Activities in Delaware County Expanded Testing Services in Chester Expanded Testing Services in Chester Community Health FairsCommunity Health Fairs After School ScreeningAfter School Screening Expanded Clinical ServicesExpanded Clinical Services School-based ScreeningSchool-based Screening Collaboration with Family Planning and Hospital System to open a School-based Health Resource Center that screens students for GC/CT Heavy Media Exposure Health AlertsHealth Alerts Sustained Press Releases (at least 6)Sustained Press Releases (at least 6) Positive local newspaper coveragePositive local newspaper coverage Community-Based Meetings Youth ViolenceYouth Violence Key stakeholder MeetingsKey stakeholder Meetings Enhanced Disease Intervention Interviews Enhanced Disease Intervention Interviews Aggressive Partner Therapy Aggressive Partner Therapy