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Gonorrhea Morbidity and Prevention Efforts in Los Angeles County. Binh Goldstein, PhD, Epidemiologist Sarah Guerry, MD, Medical Director Sexually Transmitted Disease Program Los Angeles County Department of Public Health. Reported Cases of Gonorrhea: LAC, 1998-2008. 10,494. 10,411. 9,696. - PowerPoint PPT Presentation
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Gonorrhea Morbidity and Prevention Efforts
in Los Angeles County
Binh Goldstein, PhD, EpidemiologistSarah Guerry, MD, Medical Director
Sexually Transmitted Disease ProgramLos Angeles County Department of Public Health
Reported Cases of Gonorrhea: LAC, 1998-2008
3194 32184165 4260 4366 4337
5252 5736 5518 5026 4644
2842
30283470 3420 3728
44284736 4853
4256
3565
2791
0
2000
4000
6000
8000
10000
12000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Nu
mb
er o
f C
ases
Female
Male
5,986 6,061
7,1997,743 7,800 8,078
9,696
10,494 10,411
9,302
8,280
Rates of Gonorrhea: LAC, 1998-2008
0
20
40
60
80
100
120
140
1998 2000 2002 2004 2006 2008
Year
Ra
te p
er
10
0,0
00
BothMaleFemale
Gonorrhea Cases by Race and Gender: LAC, 2008
Male GC CasesOther
301%
Black1,69645%
Asian1153%
Hispanic1,02128%
White (non-Hispanic)
84123%
N=4,644
Female GC Cases
Black1,73658%
Other161%
Asian963%
White (non-Hispanic)
35312%
Hispanic77226%
N=3,565
• Any person identified as Hispanic (alone or in combination) is included in the Hispanic category. Those in other race categories are non-Hispanic.
• Asian category includes Pacific Islander.
• Total N includes 592 female (16.6%) and 941 male (20.3%) cases with unknown race/ethnicity.
Rates of Gonorrhea by Age and Race: Females, LAC, 20081,969.3
1,717.3
809.0
310.1
Rates of Gonorrhea by Age and Race: Males, LAC, 2008
951.5
1,761.6
1,053.9
686.9
352.6
All ages
Number of GC Cases by
HD, SPA, and
Supervisorial District
LAC, 2008
Ages 15-24 years
Number of GC Cases by
SPA and Supervisorial
District
LAC, 2008
GC Morbidity by Provider Type, LAC 2008
Provider Type N Cases %
Private Practice/Group* 3,098 38.2%
DPH STD Clinic 1,166 14.4%
Community/Free Clinic 914 11.3%
HMO 844 10.4%
Adult Detention 444 5.5%
Sentinel FP Clinic 234 2.9%
Juvenile Detention 201 2.5%
Hospital 116 1.4%
High School/College 92 1.1%
Other 1,009 12.4%
Total 8,118 100.0%
*Includes non-sentinel FP and non-DPH STD clinics.
Timely Treatment of GC, LAC 2008
0%
20%
40%
60%
80%
100%
SentinelFP
DPH STD Women'sJail
Men's Jail JuvenileDetention
Other
Rx in < 14 D Rx in < 30 D Total Rx Not Rx
N=234 N=1,165 N=188 N=249 N=196 N=6,032*Excludes cases missing specimen collection
Ongoing Efforts (1)
• Screening in detention facilities
• GISP participant since 2003
• PDPT offered at DPH STD clinics since 2007
• Rectal and pharyngeal NAATs validated and used for MSM in county testing sites (including GLC, AHF, K6G unit) since 2008
• PHIs now follow all GC cases in the county as of October 2009
Ongoing Efforts (2)• Enhanced GC participant
• I Know/Don’t Think Know campaigns– Began in June 2007 to promote CT/GC annual
screening among young women of color– Promoted and made home test kits (self-collected
vaginal swab) available in June 2009
• Wall-to-wall screening pilot in a high risk high school – Health Awareness Program (October –
December 2009)
Enhanced GC: LAC, 2008• Symptomatic infection: Female = 45.4%, MSM=68.4%, Male
Heterosexual = 86.3%• No. sex partners in the 12 mo prior to infection:
No. partners
Females MSM Male Heterosexual
N % N % N %
1 38 33.3% 4 6.2% 13 21.0%
2 37 32.5% 5 7.7% 18 29.0%
3-4 24 21.1% 18 27.7% 19 30.6%
5-9 11 9.6% 16 24.6% 5 8.1%
10+ 4 3.5% 22 33.8% 7 11.3%
Total 114 100% 65 100% 62 100%
DTKKits Ordered
as of 10-28-09: first 20 wks
• 2,163 total orders• 1,093 kits returned
(50.5%)• 1,042 testable
specimens (95.3% of returned)
• 87 CT positives (8%), 10 GC positives (1%) (4 coinfected)
• 97% of orders = online• 13% of orders < age 19
Health Awareness Program
• Education portion and offered CT/GC screening to all students (grades 9-12) in a high school in a high morbidity area
• Found 47 CT cases out of 1,138 students tested (4% prevalence)
• Found 5 GC cases
• Followed up positives for treatment
Future Efforts
Focus on District 2:• Expand targeted high school wall-to-
wall screening
• I Know and home test kit campaigning
• Expand EPT use
• Community-embedded PHIs for partner and treatment follow-up
Binh [email protected](213) 744-3089
Sarah [email protected](213)744-3133