1. Gonorrhea Surveillance & Control New York State NYSDOH Bureau of STD Control CDC Gonorrhea Control Meeting New York, NY November 9, 2009

2. Trends in Reported Gonorrhea Cases by Sex, NYS, 1992-2008* # Gc Cases * Excludes NYC NYSDOH/BSTDC

3. Trends in Reported Gonorrhea Cases by Race/Ethnicity, NYS, 1992-2008* # Gc Cases * Excludes NYC NYSDOH/BSTDC

4. Rate of Gonorrhea by Age and Sex, NYS*, 2008 *Excludes NYC Rate( per 100,000 population)

5. CENTRAL NEW YORK REGION Niagara Orleans Erie Chautauqua Cattaraugus Genesee Wyoming Monroe Wayne Allegany Seneca Livingston Seneca Ontario Seneca Yates Steuben Chemung Schuyler Sullivan Orange Putnam Rockland Suffolk Richmond Bronx Orange Dutchess Orange Ulster Orange Westchester New York CAPITALDISTRICTREGION METROPOLITAN REGION WESTERN REGION St. Lawrence Jefferson Oswego Cayuga Lewis Oneida Cortland Tioga Madison Chenango Broome Herkimer Tompkins Onondaga Clinton Franklin Essex Hamilton Warren Fulton Schoharie Columbia Washington Delaware Saratoga Albany Greene Rensselaer Otsego Schenectady Montgomery Kings Queens Nassau Bronx NYSDOH/BSTDC

6. Rate of Gonorrhea by Region, NYS*, 1992-2008 *Excludes NYC

7. Gonorrhea Case Reports by Race/Ethnicity and Provider Type, NYS*, 2008 White Hispanic Black Other *Excludes NYC NYSDOH/BSTDC

8. 2008 Gonorrhea Cases Treatment Verification and Time to Treat Median time to treat =6.0 days *Excludes NYC NYSDOH/BSTDC

9. Challenges Budget Cuts Budget Cuts County contracts cut by 8% in 2008, 10% in 2009 = reduction in local STD servicesCounty contracts cut by 8% in 2008, 10% in 2009 = reduction in local STD services Restrictions on TravelRestrictions on Travel Loss of StaffLoss of Staff State budget restrictions impact federally-funded initiativesState budget restrictions impact federally-funded initiatives Laboratory Capacity State laboratory serves as reference lab onlyState laboratory serves as reference lab only Limited number of NYS-licensed labs with culture capacity, even fewer perform susceptibility testingLimited number of NYS-licensed labs with culture capacity, even fewer perform susceptibility testing Resource Allocation Fewer DIS to cover large geographic area or duties not limited to STDFewer DIS to cover large geographic area or duties not limited to STD Federal IPP dollars prescribedFederal IPP dollars prescribed

10. Optimizing Partner Management Strategies For Gonorrhea With Limited Resources Dennis Murphy Bureau of STD Control New York State Department of Heath dpm04@health.state.ny.us

11. Gonorrhea-Reported Rates: NYS Exclusive of NYC and United States, 1992-2008 * 2008 data not available

12. Gonorrhea-Rates by Race/Ethnicity: United States, 2003-2007

13. * These data should be interpreted with caution; 30% of NYS Race/Ethnicity data are missing ** 2006 American Indian Rate not included Gonorrhea-Rates by Race/Ethnicity: NYS Exclusive of NYC, 2003-2007*

14. Key Terms Core - Census tract with 50% of morbidity Adjacent - Census tract with 30% of morbidity Peripheral - Remaining Census tracts with 20% of morbidity

15. Key Terms (cont.) Self Selection - core infected patients are most likely to have selected their partners from the core area. Adjacent cases are most likely to become infected due to exposure with a core resident Force of Infectivity - the time period between infection and treatment

16. Characteristics of a Core Area Small population compared to adjacent and peripheral areas High population density Low social economic status of residents Frequently, but not necessarily minority residents High number of repeat infection

17. Gonorrhea Core Epidemiologic Tracts, Monroe County, NYS, 2007

18. New York State’s Approach to Gonorrhea Partner Services For transmission purposes all gonorrhea cases are not equal, therefore: –Intensely interview core residents –Only interview adjacent or peripheral cases if resources allow –Target gonorrhea screening to facilities and providers that serve the core population

19. New York State’s Approach to Gonorrhea Partner Services (cont.) Interview as many core gonorrhea positive cases as possible, but at a minimum 35% - 40% of the total Target STD clinic services to meet the needs of the core population Don’t be afraid to “tweek” the typical gonorrhea interview Look for social network

20. Evaluation Reason for Examination –Voluntary / Symptomatic –Screening –Epi Investigation

21. Reported Gonorrhea Cases and Core Epi Interventions, Monroe County: 2002-2007 Data Source: New York State Department of Health, Bureau of STD Control

22. Gonorrhea-Reported Rates: NYS Exclusive of NYC and Monroe County, 1992-2007

23. DATA SOURCES New York State Department of Health, Bureau of STD Control Division of STD Prevention. STD Surveillance, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention