1. Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting July 2009 Mark Stenger Epidemiologist III Washington State Department of Health Infectious Disease & Reproductive Health Assessment Unit

2. Overview Historical trends Trends by gender Trends by age group Trends by race & Ethnicity Trends by care setting Partner services Selected Behavioral data HIV-GC coinfection Challenges/Opportunities

3. Gonorrhea Cases and Incidence Rate* per 100,000, Washington State, 1992 - 2008 *Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervals Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

4. Gonorrhea Incidence Rate* per 100,000 by Gender, Washington State, 1992 - 2008 *Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervals Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

5. Gonorrhea Incidence Rate* per 100,000 by Age Group, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

6. Gonorrhea Incidence Rate* per 100,000 by Race**, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 **Missing race (~25%) redistributed by known proportions Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

7. Gonorrhea Incidence Rate* per 100,000 by Hispanic Ethnicity**, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 ** Missing ethnicity (~28%) redistributed by known proportions Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

8. Gonorrhea Incidence Rate* per 100,000 by Gender & Age Group Washington State, 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

9. Gonorrhea Incidence Rate* per 100,000 by County Washington State, 2008 *Crude case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

10. Gonorrhea Incidence Rate* per 100,000 by Census Tract Washington State, 2008 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

11. Gonorrhea Cases Diagnosed by Provider Type Washington State, 2008 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

12. Proportion of GC Cases with Treatment Reported by Year of Diagnosis, Washington State, 1992 - 2008 *Proportion of GC case reports with treatment indicated Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

13. Proportion of Treated Cases by Antibiotic Class* Washington State, 1992 - 2008 *Antibiotic class of treatment reported on case reports – may include CT dual treatment Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

14. Proportion of Gonorrhea Cases Interviewed Washington State, 1992 - 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

15. Proportion of Male Gonorrhea Cases Reporting MSM by Age Group Washington State, 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

16. Self-Reported Reason for Exam* Male GC Cases Washington State, 2008 *Of 478 cases randomly selected for interview, 306 cases interviewed (64% completion rate) Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

17. Self-Reported Reason for Exam* Female GC Cases Washington State, 2008 *Of 411 cases randomly selected for interview, 284 cases interviewed (69% completion rate) Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

18. Site of Infection* Female GC Cases Washington State, 2008 *N=1490 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

19. Site of Infection* Male GC Cases Washington State, 2008 *N=1588 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

20. Incidence of GC among HIV+ Males Washington State, 1996 - 2007 Data based on HIV/STD Registry matching Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

21. Challenges to GC Control in Washington State 2 separate epidemics: – younger heterosexuals – Older MSM Monitoring for emergent antibiotic resistance – Categorical STD clinic capacity eroding – Culture capacity rapidly disappearing Infrastructure for traditional DIS activities at risk

22. Opportunities for GC Control in Washington State Enhanced behavioral surveillance Improving case surveillance infrastructure – More timely – GIS capacity – Electronic reporting of lab data EPT and more appropriately targeted traditional partner management

23. Questions?