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Wisconsin STD Program
Overview of Gonorrhea Epidemiology and Program Prevention Efforts
Meeting February 2, 2010
Wisconsin Department of Health Services:Protecting and Promoting the Healthand Safety of the People of Wisconsin.
Douglas
26
Bayfield
Ashland
Saywer
1
Washburn
2Burnett
3
Polk
4
Barron Rusk
1
Price
Iron Vilas
4
Oneida
3
Lincoln
3Taylor
Chippewa
3St. Croix
9
Pierce
1
Dunn
5
Pepin
Eau Claire
10
Buffalo
1Trempealeau
Jackson
3
Monroe
16
Clark Marathon
26
Wood
6Portage
5
Juneau
7Adams
2
Sauk
14
LaCrosse
35
Vernon
Crawford
1
Richland
1
Grant
7
LaFayette
1
Green
3Rock
134
Dane
453Iowa
2
Columbia
14Dodge
36
Jefferson
18Waukesha
81
Walworth
15Kenosha ---- 160
Racine – 277
Ozaukee
19
Sheboygan
20
Fond du Lac
441Green Lake
Marquette
1
Waushara
4Winnebago
73Calumet
11Manitowoc
12
Kewaunee
4Brown
294Outagamie
67
Waupaca
2
Shawano
6
Menominee
3
Oconto
6
Langlade
1
Forest
2
Marinette
8
Florence
2 Door
Milwaukee --- 4,063
21Washington
6,062 = Total Cases
101-1000 >10001-100
Reported Cases of Gonorrhea by County 2008
Wisconsin:72 Counties
Reported Cases of Gonorrhea in Wisconsin 1999-2008
6 3 0 76 9 8 9
6 1 1 5 6 3 6 25 5 9 8
5 0 6 9 5 0 4 9
6 8 8 3 6 7 9 46 0 6 3
4 7 7 34 0 9 9 4 2 7 6
4 6 8 7
3 8 5 43 2 9 9
4 0 2 7
4 8 9 6 4 9 1 6
4 0 3 2
1 5 3 4
2 8 9 0
1 8 3 9 1 6 7 5 1 7 4 4 1 7 7 0 1 9 2 2 1 9 8 7 1 8 7 8 2 0 3 1
0
1 0 0 0
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8
W i s c o n s i n M i l w a u k e e C o u n t y W I w /o M i l w C o u n t y
Cases
Year
Reported Rates of Gonorrhea per 100,000 Pop Wisconsin: 1999-2008
1 1 5 . 5
1 3 0 . 3
1 1 2 . 7 1 1 6 . 51 0 4
9 1 . 5
1 0 6 . 6
1 2 4 . 5 1 2 0
1 0 6 . 9
0
5 0
1 0 0
1 5 0
2 0 0
1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8
Year
Rate
Reported Rates of Gonorrhea per 100,000 PopMilwaukee County: 1999-2008
4 9 8
4 3 6 4 5 34 9 5
4 0 6
3 4 7
4 2 4
5 1 4 5 1 7
4 2 4
0
1 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8
Rate
Year
WI Reported Rates of Gonorrhea per 100,000 Popby Gender: 1999-2008
115.5130.3
112 116104
92106
125 120106.5110 106
8897
8776
89105
9684
143154
135 135119
106123
145 144133
0
20
40
60
80
100
120
140
160
180
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Rate All Male Female
Rate
Year
Milwaukee County Reported Rates of Gonorrhea per 100,000 Pop by Gender: 1999-2008
498436 453
495
406347
424
514 517
424430370 371
411347
305369
459427
370
549492
523 518
439383
449
593 595527
0
100
200
300
400
500
600
700
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Rate All Male Female
Rate
Year
2 1 3 1
5 0 9 4 9 3
2 6 01 3 1 6 9 2 7 1 7 45 1
1 3 3
2 1 2 21 9 8 5
1 0 2 7
4 2 02 5 1
1 0 1 7 2 1 70
5 0 0
1 0 0 0
1 5 0 0
2 0 0 0
2 5 0 0
0 - 4 5 - 9 1 0 - 1 4 1 5 - 1 9 2 0 - 2 4 2 5 - 2 9 3 0 - 3 4 3 5 - 3 9 4 0 - 4 4 4 5 - 4 9 5 0 +
A g e g r o u p
Ra
te
W i s c o n s i n M i l w a u k e e C o u n t y
Reported Age-specific Gonorrhea Rates*:Wisconsin and Milwaukee County 2008
* Cases per 100,000 population.
Reported Cases of Gonorrhea by Age & Gender Milwaukee County & WI w/o Milwaukee County
2008
2 1 3
4 3 84 7 3
2 6 33 1 7
2
9 9 9
7 4 2
3 2 02 5 6
0 0
1 6 2
2 4 9
1 7 12 3 8
3 2 9
4 3 44 7 2
2 2 61 7 3
7 5
0
1 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
1 0 0 0
0 - 9 1 0 1 4 1 5 - 1 9 2 0 - 2 4 2 5 - 2 9 3 0 +
G o n o r r h e a
Ca
se
Re
po
rts
M a le M i lw C o u n t y F e m a le M i lw C o u n t y
M a le W I w /o M i lw C o . F e m a le W I w /o M i lw C o .
Reported Cases of Gonorrhea by Race & Gender Wisconsin 2008
2 0 5
6 6 8
1 5 0 5
1 8 5 9
7 2 1 0 7
5 1 0
1 0 4 2
0
2 0 0
4 0 0
6 0 0
8 0 0
1 0 0 0
1 2 0 0
1 4 0 0
1 6 0 0
1 8 0 0
2 0 0 0
W h i t e B l a c k H i s p a n i c U n k n o w n
M a l e F e m a l eRace/Gender
Reported Cases
Asians and Native Americans were less than 3% of Total
Reported Cases of Gonorrhea by Race & Gender Wisconsin w/o Milwaukee County 2008
1 5 5
5 6 1
3 2 6 2 9 4
3 7 4 4
1 1 3
2 0 5
0
2 0 0
4 0 0
6 0 0
8 0 0
1 0 0 0
W h i t e B l a c k H i s p a n i c U n k n o w n
M a l e F e m a l eRace/Gender
Reported Cases
Asians and Native Americans were less than 7% of Total
Reported Gonorrhea Cases by Gender & Race Milwaukee County 2008
5 01 0 7
1 1 7 9
1 5 6 5
3 5 6 3
3 9 7
8 3 7
0
2 0 0
4 0 0
6 0 0
8 0 0
1 0 0 0
1 2 0 0
1 4 0 0
1 6 0 0
W h i t e B l a c k H i s p a n i c U n k n o w n
M a l e F e m a l eRace/Gender
Reported Cases
Asians and Native Americans were less than 1% of Total
% of Total GC Cases Reported in Females by RaceWisconsin w/o Milwaukee County vs. Milwaukee County
2008
U n k n o w n , 1 7 . 5 %
N a t . A m e r . , 3 . 5 %
H i s p a n i c , 3 . 8 %
B l a c k , 2 5 . 0 %
W h i t e , 4 8 . 0 %
W h i t e , 4 . 1 %
B l a c k , 6 0 . 6 %
H i s p a n i c , 2 . 4 %
N a t . A m e r , 0 . 2 %
U n k n o w n , 3 2 . 4 %
Females WI w/o Milw Co
FemalesMilw County
Asian females were less than 1% of total Asian females were less than .1%of total
Percent of Total Percent of Total
% of Total GC Cases Reported in Males by RaceWisconsin w/o Milwaukee County vs. Milwaukee County
2008
U n k n o w n , 1 7 . 5 %
H i s p a n i c , 5 . 8 %
B l a c k , 5 1 . 0 %
W h i t e , 2 4 . 0 %
W h i t e , 3 . 0 %
B l a c k , 7 0 . 6 %
H i s p a n i c , 2 . 1 %
U n k n o w n , 2 3 . 8 %
MalesWI w/o Milw County
MalesMilw County
Asian and Native American Males were less than 3% of Total Asian and Native American Males were
less than 1% of Total
Percent of Total Percent of Total
941
10822 18
0
500
1,000
1,500
African American Am. Indian Asian/ Pacific Is. White
Ra
te*
Reported Gonorrhea Rates* by Race Wisconsin, 2008
52 – fold difference
* Cases reported with race specified per 100,000 population.
1,019
11328 28
0
500
1,000
1,500
African American Am. Indian Asian/ Pacific Is. White
Ra
te*
Reported Gonorrhea Rates* by Race Milwaukee County 2008
36 – fold difference
* Cases reported with race specified per 100,000 population.
Douglas
26
Bayfield
Ashland
Sawyer
1
Washburn
2Burnett
3
Polk
4
Barron Rusk
1
Price
Iron Vilas
4
Oneida
3
Lincoln
3Taylor
Chippewa
3St. Croix
9
Pierce
1
Dunn
5
Pepin
Eau Claire
10
Buffalo
1Trempealeau
Jackson
3
Monroe
16
Clark Marathon
26
Wood
6Portage
5
Juneau
7Adams
2
Sauk
14
LaCrosse
35
Vernon
Crawford
1
Richland
1
Grant
7
LaFayette
1
Green
3Rock
134
Dane
453Iowa
2
Columbia
14Dodge
36
Jefferson
18Waukesha
81
Walworth
15Kenosha ---- 160
Racine – 277
Ozaukee
19
Sheboygan
20
Fond du Lac
441Green Lake
Marquette
1
Waushara
4Winnebago
73Calumet
11Manitowoc
12
Kewaunee
4Brown
294Outagamie
67
Waupaca
2
Shawano
6
Menominee
3
Oconto
6
Langlade
1
Forest
2
Marinette
8
Florence
2 Door
Milwaukee --- 4,063
21Washington
6,062 = Total Cases
101-1000 >10001-100
Reported Cases of Gonorrhea by WI County 2008
Wisconsin:72 Counties
Milwaukee City Zip Code Areas
Zip Codes with Over 100Reported Cases of GC in 2008:
Zip Code – Number of Cases 53206 – 548 53209 – 402 53210 – 400 53212 – 390 53218 – 376 53216 – 333 53208 – 312 53225 – 175 53205 – 149 53204 – 127 53224 – 116 53233 – 115
These 12 zip codes represent 57%of all the gonorrhea reported
in Wisconsin in 2008.
Out of 4,032 cases reported from Milwaukee County in 2008
3,443 were reported fromthe 12 zip codes in the
City of Milwaukeenoted in the table –
this represents 85.4% of the reported cases in
Milwaukee County.
(12/43 Zip Code areas in Milwaukee City)
Milwaukee Zip Code GC Data 2008
Top Four Zip Code Areas for Reported Cases GC in 2008:
Zip Code – Cases 53206 – 548 53209 – 402 53210 – 400 53212 – 390
53211
53206
Capitol Dr.
North Ave.
27th
St
Hw
y 43 53212
53209
53216
53210
53205 5320253208
53217
Disease Intervention Activities in Wisconsin
Public health officers in each health department jurisdiction in WI are statutorily responsible to investigate each case of gonorrhea, including eliciting partners and other at-risk individuals for testing and treatment as necessary.
Two counties use limited criteria to follow-up on cases [Milwaukee and Brown (Green Bay)] Milwaukee Criteria:
F/u GC+ <= 16 males and females OR any pregnant female to verify Rx and notify partners
Milwaukee Field Activity for Gonorrhea Cases 2007 & 2008
Indicator 2007 2008 Percent Change
Cases Reported to the Program
4,662: 11% cases Interviewed
4,259:10% cases interviewed
-9% # cases reported
-1% cases interviewed
Cases Interviewed/FR Initiated ( that met the criteria for Interview)
539/607 (89%) 426/541 (78%) -11%
Cases Interviewed within 3 days
196/539 (36%) 163/426 (38%) +2%
Total Partners Initiated 391 290 -26%
Partners Examined 198/391 (51%)
(101/391 already Rx)
(58/198 not infected)
156/290 (54%)
(64/290 already Rx)
(39/156 not infected)
+3%
Partners Infected Brought to Treatment
61/198 (31%) 51/156 (33%) +2%
Partners Preventively Treated
66/198 (33%) 63/156 (40%) +7%
Partners Examined within 3 days
34/198 (17%) 39/156 (25%) +8%
Timeliness to Treatment
Family Planning Treatment Rates
Jan-June 2009Females
Milwaukee County:GC: 61%
Wisconsin w/o Milwaukee County:GC: 87%
Gonorrhea Positivity by Provider TypeWisconsin RVIPP Data 2008
0.6
10
1.9
11
2.6
0.80.13 0.2
6.5
4.5
0.2
3
0
5
10
15
20
Adult Corr. FP Juve. Det. STD Teen Clinic UnivHealth
Gonorrhea
Male
Female
% Positive
University of WI-Madison GC2009: Enrollment 42,000
24/3326 Tests Positive Female (4/24) cervical NAAT 0.3% Male (20/24) urine NAAT 0.6%
rectal culture 2.6%
pharyngeal culture 3.1%
Demographic characteristics of positives63% MSM (15/20)21% African American (5/24)
46% non-genital specimens (11/20 males)