Continuing Education Meeting: Update on Syphilis, Gonorrhea, and Chlamydia Jan-Jun 2002

1
Continuing Education MeetingUpdate on
Syphilis, Gonorrhea, and Chlamydia Jan-Jun 2002
STD TRENDS IN HOUSTON

• Liz Lee
• Senior Epidemiologist
• Bureau of Epidemiology
• Houston Department of Health and Human services
• August 14th, 2002

2
STDs in Houston/Harris County

• Syphilis
• Gonorrhea
• Chlamydia

3
SYPHILIS

• In Houston/Harris County,
• Jan-Jun 2002

4
Syphilis - Treponema pallidum
5
Syphilis Stages of Main Concern

• Focus on Primary and Secondary Stage
• INFECTIOUS!
• Infection within one year period
• (Early Latent Stage) is also of concern
• Indicates MISSED infectious syphilis cases
• Syphilis in Pregnancy?congenital syphilis

6
Primary and secondary syphilis Reported
rates United States,19702000 and the Healthy
People year 2010 objective
Note The Healthy People 2010 (HP2010) objective
for primary and secondary syphilis is 0.2 case
per 100,000 population.
7
Primary and secondary syphilis Rates by
gender United States,19812000 and the Healthy
People year 2010 objective
8
Primary and secondary syphilis Rates by
race and ethnicity United States, 19812000 and
the Healthy People year 2010 objective
9
Primary and secondary syphilis Rates by
state United States and outlying areas, 2000
Note The total rate of primary and secondary
syphilis for the United States and outlying areas
(including Guam, Puerto Rico and Virgin Islands)
was 2.2 per 100,000 population. The Healthy
People year 2010 objective is 0.2 per 100,000
population.
10
Harris County is among the 28 counties that
account for over 50 of infectious syphilis
cases in US
11
Syphilis in Houston/Harris County
Alarm of potential outbreak among MSM
population! MSMMen who have sex with men
12
(No Transcript)
13
Syphilis in Houston/Harris County
No decrease in number of cases seen at the
citywide level! MSM cases continuing to increase!
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Outbreak Level Citywide for Infectious (PS)
Syphilis in Houston/Harris

• June 2002, Citywide
• 14 cases of infectious (PS) syphilis
• Exceeds outbreak threshold
• 64 (9 of 14) cases were MSM cases
• Urgent need to work with MSM community to provide
  education and screening services!

18
(No Transcript)
19
PS Rate, CitywideJan-Jun in 2001 v. 2002rates
per 100,000
No change in rate!
Healthy people 2010 goal 0.2/100,000 per year
20
PS Rate, CitywideJan-July in 2001 v. 2002rates
per 100,000
Increase in rate!
21
Rates of Infectious (PS) Syphilis by
Gender(rates per 100,000)
22
Rates of Infectious (PS) Syphilis by Age
Groups(rates per 100,000)
23
Rates of Infectious Syphilis (PS) by
Race/Ethnicity(rates per 100,000)
24
Rates of infectious (PS) Syphilis by Race and
Gender(rates in 100,000)
25
Increasing Syphilis and HIV Co-Infection Rates
26
(No Transcript)
27
(No Transcript)
28
Rates MSM, PS J-J 2001
Rates of MSM PS Syphilis by Zip Code Area, in
Houston/Harris County, Jan-Jun 2001
29
Rates of MSM PS Syphilis by Zip Code Area, in
Houston/Harris County, Jan-Jun 2002
30
Congenital syphilis Rates for infants lt1
year of age United States, 19812000 and the
Healthy People year 2010 objective
Note The Healthy People 2010 (HP2010) objective
for primary and secondary syphilis is 0.2 case
per 100,000 population.The surveillance case
definition for congenital syphilis changed in
1988.
31
Congenital Syphilis in Houston/Harris(rates per
100,000)
Healthy People 2010 Objectives 1 per 100,000!
32
Congenital Syphilis by Race/Ethnicity(rate per
100,000)
33
Gonorrhea

• In Houston/Harris County,
• Jan-Jun 2002

34
4 Decrease in Gonorrhea

• Jan-Jun 2001
• 2559 cases reported
• 75/100,000

• Jan-Jun 2002
• 2464 cases reported
• 72/100,000

Healthy People 2000 goal 100/100,000 per year
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
Gonorrhea Rates by Race/Ethnicityrates per
100,000
39
(No Transcript)
40
(No Transcript)
41
Distribution of Gonorrhea by Provider
42
(No Transcript)
43
Chlamydia
In Houston/Harris County, Jan-Jun 2002
44
No Change in Number of Chlamydia Cases
Reported(lt1 decline)

• Jan-Jun 2001
• 5497 cases reported
• 162/100,000

• Jan-Jun 2002
• 5522 cases reported
• 162/100,000

45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
Distribution of Reported Chlamydia by Provider
51
Take Home Messages

• Houston is experiencing an outbreak of infectious
  syphilis
• Largest increase in infectious syphilis rates
  between 2001 to 2002 in White Males
• Urgent need to work with private sector and CBOs
  to target intervention program in high risk
  areas
• Provider/DIS--enhance education and screening
• Increase in congenital syphilis in Houston
• Urgent need to improve screening of women of
  reproductive age and provide quality prenatal
  care and appropriate referrals to get adequate
  treatment

52
Additional Resources

• www.stdhivtraining.org
• On-Line Chlamydia Course
• Latest screening, diagnosis, and treatment of
  chlamydia
• www.houstonhealth.org
• Selected slides from this presentation
• Syphilis, gonorrhea, and chlamydia in
  Houston/Harris County