Pennsylvania Department of Health STD ProgramTelephone: 717-787-3981Internet Address: www.state.pa.us/php/stdEmail: c-skowalew@state.pa.us

Gonorrhea Overview

Reported GonorrheaReported GonorrheaPennsylvania 1976-2008 (Exclusive of Philadelphia)Pennsylvania 1976-2008 (Exclusive of Philadelphia)

0

2000

4000

6000

8000

10000

12000

14000

Year

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of R

epor

ted

Cas

es

TOTALS

2008 Reported Gonorrhea2008 Reported GonorrheaBy Report SourceBy Report Source

Pennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)

43%

57%

Public

Private

N=10,796

Elk

York

Centre

Berks

Butler

Lycoming Pike

Bedford

Clinton

Clearfield

Blair

Indiana

Somerset

Luzerne

Fayette

PerryBucks

Lancaster

Mercer

FranklinChester

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

PotterBradfordWarren McKean

Crawford Wayne

Forest

Susquehanna

Wyoming

Cameron

Montgomery

Lackawanna

Northumberland Northampton

Delaware

Montour

Philadelphia

Northwest

Southwest

North Central Northeast

South Central Southeast

2008 Gonorrhea Culture Sites andGonorrhea Case Rates* by County, 2008

Rates

No Cases 1 - 25 26 - 50 51 - 75 76 - 125 126 - 333

Health Districts

* Rates are calculated per 100,000 population from the 2000 Census.

Reported Gonorrhea By GenderReported Gonorrhea By GenderPennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)

CY 2000 through 2008CY 2000 through 2008

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500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Nu

mb

er o

f C

ases

Male

Female

Reported Gonorrhea By AgeReported Gonorrhea By AgePennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)

CY 2007 and 2008CY 2007 and 2008

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500

1000

1500

2000

2500

3000

Under15

15-19 20-24 25-29 30-34 35-39 40-44 45+

Age

Nu

mb

er o

f C

ases

2007

2008

2008 Reported Gonorrhea By Age2008 Reported Gonorrhea By AgePennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)

By GenderBy Gender

0

200

400

600

800

1000

1200

1400

Under15

15-19 20-24 25-29 30-34 35-39 40-44 45+

Age

Nu

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ases

Male

Female

Reported GonorrheaReported GonorrheaPennsylvania 2008 Pennsylvania 2008

Cases per 100,000 Population Cases per 100,000 Population Select PopulationsSelect Populations

6915

294 315

622 641

0

100

200

300

400

500

600

700

Total White Black Population15-24

Black Male BlackFemale

Year

Num

ber

of R

epor

ted

Cas

es

State

Gonorrhea Positivity Gonorrhea Positivity Pennsylvania 2008 Pennsylvania 2008 Select PopulationsSelect Populations

10.52

2.56

0.45

1.62.08

0.75 0.92

4.66

1.67

6.19

01234567

Population

Per

cent

Pos

itive

STD Prevention ActivitiesSTD Prevention ActivitiesKey Statewide PopulationsKey Statewide Populations

• Individuals age 15 to 24Individuals age 15 to 24• Black MalesBlack Males• Black FemalesBlack Females• Men who have Sex with Men (MSM) in Men who have Sex with Men (MSM) in

selected counties (e.g., Allegheny County)selected counties (e.g., Allegheny County)

ChallengesChallenges

• 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 Bunker Mentality Setting-in with Other Departments and Agencies (resulting in

less cooperation, reluctance to change, poor morale, etc.)less cooperation, reluctance to change, poor morale, etc.)

• Political ChangesPolitical Changes• Loss of Health Commissioner in Chester CityLoss of Health Commissioner in Chester City• Other County/Municipal cut backs have resulted in a fracturing of Other County/Municipal cut backs have resulted in a fracturing of

existing existing long-term relationslong-term relations..• State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT

test Price)test Price)

• Unrealistic Expectations Placed on Field StaffUnrealistic 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 Cases29 Early Syphilis Cases• 3,241 Chlamydia Cases3,241 Chlamydia Cases• 573 Gonorrhea Cases573 Gonorrhea Cases• 1 Congenital Syphilis1 Congenital Syphilis

PA’s Approach to High PA’s Approach to High Morbidity Areas in the StateMorbidity 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

STD Prevention ActivitiesSTD Prevention ActivitiesA success story?A success story?

““Know your enemy and know yourself and you can fight a Know your enemy and know yourself and you can fight a hundred battles without disaster.”hundred battles without disaster.”

With the gonorrhea increase in Delaware County it was critical With the gonorrhea increase in Delaware County it was critical to determine: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?

Reported GonorrheaReported GonorrheaDelaware County 2000-2008 Delaware County 2000-2008

0

200

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1,000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Num

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TOTALS

®v

®v

Delaware

Ri

Vet e

ra

Avenue of the

States

Springbrooke

Edg

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CROZER-CHESTER MEDICAL CENTER

2007 Gonorrhea Cases by Census TractDelaware County - All Ages

0 0.5 10.25

Miles

2007 Gonorrhea Cases by Census Tract

1 - 5

6 - 10

11 - 15

16 - 25

26 - 65

GC Increase in Delaware CountyGC Increase in Delaware County

Location Disease

2007DiseaseCounts

Estimated 2006 Population

Case Rate Per 100,000 Population

Chester City Gonorrhea 460 36,801 1249.97

Delaware Gonorrhea 921 555,996 165.65

State Gonorrhea 12,712 12,440,621 102.18

Philadelphia Gonorrhea 5,246 1,448,394 362.19

Location Disease

2006DiseaseCounts

Estimated 2006 Population

Case Rate Per 100,000 Population

Chester City Gonorrhea 247 36,801 671.18

Delaware Gonorrhea 513 555,996 92.27

State Gonorrhea 11,466 12,440,621 92.17

Philadelphia Gonorrhea 5,218 1,448,394 360.26

Key STD Prevention ActivitiesKey STD Prevention Activitiesin Delaware Countyin Delaware County

• Expanded Testing Services in ChesterExpanded 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 Collaboration with Family Planning and Hospital System to open a School-based Health Resource Center that screens students for School-based Health Resource Center that screens students for

GC/CTGC/CT

• Heavy Media ExposureHeavy 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 MeetingsCommunity-Based Meetings• Youth Violence Youth Violence • Key stakeholder MeetingsKey stakeholder Meetings

• Enhanced Disease Intervention InterviewsEnhanced Disease Intervention Interviews

• Aggressive Partner TherapyAggressive Partner Therapy