11

STDs in STDs in Houston/Harris Houston/Harris

CountyCountyTrendsTrends

InterventionsInterventions

Emerging IssuesEmerging Issues

22

Reportable STDsReportable STDs

ChlamydiaChlamydia

ChancroidChancroid

GonorrheaGonorrhea

HIV/AIDSHIV/AIDS

SyphilisSyphilis

ChlamydiaChlamydia

ChancroidChancroid

GonorrheaGonorrhea

HIV/AIDSHIV/AIDS

SyphilisSyphilis

33

Why are STDs Important?Why are STDs Important?

Facilitate Transmission of HIV InfectionFacilitate Transmission of HIV Infection

Cause InfertilityCause Infertility

Cause PIDCause PID

Adverse Outcomes on PregnancyAdverse Outcomes on Pregnancy

17 Billion Dollar Cost Annually in USA17 Billion Dollar Cost Annually in USA

44

Emerging IssuesEmerging Issues

Syphilis OutbreaksSyphilis Outbreaks

HIV Co-InfectionHIV Co-Infection

Resurgence in Risky BehaviorResurgence in Risky Behavior

Partner Services InnovationPartner Services Innovation

Internet and STDsInternet and STDs

HepatitisHepatitis

55

How Are We Doing inHow Are We Doing in Houston?Houston?

In 2002, Houston Ranked:In 2002, Houston Ranked:

48th- Chlamydia (346.1/100,000)48th- Chlamydia (346.1/100,000)

45th- Gonorrhea (153.9/100,000)45th- Gonorrhea (153.9/100,000)

31st- P&S Syphilis (3.3/100,000)31st- P&S Syphilis (3.3/100,000)

66

ChlamydiaChlamydiaEPIDEMIOLOGYEPIDEMIOLOGY

77

Chlamydia: Crude Rate

8018

9092

10635

11499

10443

12144

11304

11793

0

2000

4000

6000

8000

10000

12000

14000

1995 1996 1997 1998 1999 2000 2001 2002

Ca

ses

0

50

100

150

200

250

300

350

400

Ra

te P

er

10

0,0

00

No. Rate

88

Chlamydia: U.S. to Houston

0

50

100

150

200

250

300

350

400

1995 1996 1997 1998 1999 2000 2001

Ra

te p

er

10

0,0

00

US Houston

99

Chlamydia: Gender-Specific Rates

0

2000

4000

6000

8000

10000

12000

1995 1996 1997 1998 1999 2000 2001 2002

Num

be

r o

f C

ase

s

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

Rat

e p

er

10

0,0

00

Female No. Male No.

Male Rate Female Rate

1010

Chlamydia: Average (1995-2001) Rates by Age

0

500

1000

1500

2000

2500

3000

3500

15-19 20-24 25-29 30-34 35-39 40-44 >44

Ra

te p

er

10

0,0

00

Male Female

1111

Chlamydia: Percent of Cases Identified

0

200

400

600

800

1000

1200

1400

1600

1800

City STD City FamilyPlanning/Maternity

Teen Clinics District Clinics CountyClinics/County

Family Planning

Jail

Cases

2001 2002

1212

GonorrheaGonorrheaEPIDEMIOLOGYEPIDEMIOLOGY

1313

Gonorrhea: Crude Rate

7191

6046

6633

7164

5905 6033

55015243

0

1000

2000

3000

4000

5000

6000

7000

8000

1995 1996 1997 1998 1999 2000 2001 2002

Cas

es

0.0

50.0

100.0

150.0

200.0

250.0

Rat

e pe

r 100

,000

No. Rate

1414

Gonorrhea: U.S. to Houston

0

100

200

300

1995 1996 1997 1998 1999 2000 2001

Ra

te p

er

10

0,0

00

U.S Houston

1515

Gonorrhea: Gender-Specific Rates

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1995 1996 1997 1998 1999 2000 2001 2002

Num

ber o

f Cas

es

0.0

50.0

100.0

150.0

200.0

250.0

300.0

Rat

e pe

r 100

,000

Male No. Female No. Male Rate Female Rate

1616

Gonorrhea: Average (1995-2001) Rates by Age Group

0

200

400

600

800

1000

1200

15-19 20-24 25-29

Ra

te p

er

10

0,0

00

Male

Female

1717

Gonorrhea: Percent of Total Cases from Providers

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

City STD Clinics Private Clinics & HMOs All other Sites

2001 2002

1818

SyphilisSyphilisEPIDEMIOLOGYEPIDEMIOLOGY

1919

SyphilisSyphilisHouston/Harris CountyHouston/Harris County

Syphilis: Crude Rate

0

500

1000

1500

2000

2500

3000

1995 1996 1997 1998 1999 2000 2001 2002

Cases

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Ra

te p

er

10

0,0

00

No. Rate

2020

Syphilis Syphilis Houston/Harris County vs U.S.Houston/Harris County vs U.S.

Syphilis: U.S. to Houston

0

10

20

30

40

50

60

70

80

90

1995 1996 1997 1998 1999 2000 2001

Ra

te p

er

10

0,0

00

U.S Houston

2121

Syphilis: Primary and SecondarySyphilis: Primary and SecondaryHouston/Harris CountyHouston/Harris County

Syphilis: Primary and Secondary Houston/Harris County

1995-2002

0

50

100

150

200

250

300

350

400

450

1995 1996 1997 1998 1999 2000 2001 2002

Nu

mb

er

of

Ca

se

s

2222

HDHHSHDHHSSTD InterventionsSTD Interventions

ScreeningScreening

TreatmentTreatment

EducationEducation

CounselingCounseling

Partner ServicesPartner Services

2323

ScreeningScreening

Syphilis, gonorrhea, chlamydia, hep Syphilis, gonorrhea, chlamydia, hep C,HIV testing in 3 STD clinicsC,HIV testing in 3 STD clinics

Family Planning (no hep C)Family Planning (no hep C)

Prenatal (no hep C)Prenatal (no hep C)

Outreach Contractors (no gc)Outreach Contractors (no gc)

2424

ScreeningScreening

Mobile Unit Outreach testingMobile Unit Outreach testing

Collaboration with CBOs in outreach Collaboration with CBOs in outreach

Bookstores, Bath houses, streets, barsBookstores, Bath houses, streets, bars

Mobile clinic planned for 2003Mobile clinic planned for 2003

Jail tanksJail tanks

Key HIV providers encouraged to testKey HIV providers encouraged to test

Contracts with 7 CBOs to do screeningContracts with 7 CBOs to do screening

2525

TreatmentTreatment

3 STD Clinics3 STD Clinics

Some treatment in Family Planning and Some treatment in Family Planning and Maternity Clinics except for syphilisMaternity Clinics except for syphilis

Facilitate treatment with private Facilitate treatment with private providers - provide some medsproviders - provide some meds

Facilitate treatment with Harris Co. JailFacilitate treatment with Harris Co. Jail

2626

TreatmentTreatment

DOT for chlamydiaDOT for chlamydia

Recommend epi profile based preventive Recommend epi profile based preventive treatment around syphilis outbreaktreatment around syphilis outbreak

Encouraging stat RPR testing around Encouraging stat RPR testing around outbreakoutbreak

Hope to provide on site treatment on Hope to provide on site treatment on mobile clinic in 2003mobile clinic in 2003

2727

VaccineVaccine

Hepatitis B vaccine in STD clinicsHepatitis B vaccine in STD clinics

Plans for Hep A vaccine in STD clinicsPlans for Hep A vaccine in STD clinics

2828

EducationEducation

9 Health Educators trained in STDs9 Health Educators trained in STDsCDBG health ed in K-12; and in K-12 CDBG health ed in K-12; and in K-12 HIV/STD Infoline HIV/STD Infoline Contracts with 23 CBOs for educationContracts with 23 CBOs for educationWork with CPG to emphasize STDsWork with CPG to emphasize STDsProvider alerts, media alerts, provider trainingProvider alerts, media alerts, provider trainingExpanding education to web sites, chat roomsExpanding education to web sites, chat rooms

2929

CounselingCounseling

Clinicians Clinicians

DISDIS

ContractorsContractors

3030

Partner ServicesPartner Services

DIS provide partner referrals and DIS provide partner referrals and notification for syphilis and HIVnotification for syphilis and HIV

Some chlamydia and gonorrheaSome chlamydia and gonorrhea

Clustering and social network outreachClustering and social network outreach

Counseling and testing contractors Counseling and testing contractors

3131

Partner ServicesPartner Services

Pursuing web based self-interviewPursuing web based self-interview

Self-referral through internet/emailSelf-referral through internet/email

DIS Liaison with Key ProvidersDIS Liaison with Key Providers

Working with CBOs on training DIS and Working with CBOs on training DIS and DIS on training CBOs to improve and DIS on training CBOs to improve and promote partner notificationpromote partner notification