Sexually Transmitted Diseases What Me Worry ?

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Sexually Transmitted DiseasesWhat Me Worry ?
STD Trends and Prevention Strategies A State
Perspective August 8, 2007 Springfield, Illinois
Illinois Department of Public Health Office of
Health Protection, Division of Infectious
Diseases, STD Section
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Why You Should Care About STDs

• Very Common in US
• Often Asymptomatic
• STDs Facilitate Increased HIV Transmission
• Cause Significant Medical Psychological
  Complications
• Infertility
• Cancer
• Adverse Pregnancy Outcomes
• Newborn Illness and Death
• Some are Incurable
• High Health Care Cost - 16.6 Billion per year in
  US
• Teens-Young Adults, Women Economically
  Disadvantaged Are Disproportionately Affected
• Social Stigma Mixed Messages Hamper Prevention

Source Tracking the Hidden Epidemics, 2000 CDC
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Estimated Annual New Cases of STDs in USTotal
Incidence 15 Million
20,000
5 million
102,000
5.5 million
1 million
70,000
650,000
3 million
Source Tracking the Hidden Epidemics 2000, CDC
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Estimated Prevalence of Leading STDs
HIV(560,000)
Hepatitis B(750,000)
Chlamydia (3 million)
HPV (20 million)
Herpes (45 million)
Kaiser Family Foundation and American Social
Health Association. 1998.
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STDs are Sexist

• Transmission efficiency greater male to female
  than the reverse
• More women asymptomatic or with atypical,
  nonspecific Sx delayed care
• Diagnosis more difficult in women
• Complications more frequent in women, often
  severe or permanent

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High Rates In Teenagers

• Sex at Early Age
• 25 of Females Had Sex by 15 Yrs
• 80 of Females Had Sex by 19 Yrs
• Drug and Alcohol Usage
• Average Antibiotic Compliance Rate 54
• Biologic Factors
• Lack of Cervical Mucus Protection
• Denial, Risk Taking and Multiple Partners
• STD Education Abstinence-Only, Biology vs.
  Behaviors
• Environmental - Media Messages, Clubs, etc.

Source Journal of Adolescent Health 1991 12 91
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STD/HIV Interactions

• Enhanced HIV transmission
• Genital ulcer disease HSV, chancroid, syphilis
• Inflammatory STDs gonorrhea, chlamydia, trich
• Other ? bacterial vaginosis, ? candidiasis, ?
  HPV
• Adverse effects of STD on HIV progression
• HSV (?)
• Adverse effects of HIV on natural Hx or Rx of STD
• HSV Chancroid
• HPV Neurosyphilis
• Molluscum contagiosum PID

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Chlamydia Why Should We Care?

• High Prevalence and Incidence in Adolescents and
  Young Adults
• PID
• Infertility
• Ectopic Pregnancy
• Newborn Infection
• Facilitates HIV Transmission

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Illinois Reported Chlamydia Cases by Year,
1990-2006
No. Cases
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Reported Chlamydia Cases By Provider
TypeIllinois 2006
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Illinois Chlamydia Cases By Gender, 1990 - 2006
Cases
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Chlamydia Case Rates by Race EthnicityIllinois
1990 - 2006
1990-1999 Case Rates (oer 100,000) based on 1990
U.S. Census,2000 2001 2004 Case Rates based on
2000 U.S. Census. Racial categories include
persons of any or unknown ethnicity Hispanic
ethnicity includes persons of any race
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Reported Chlamydia Cases by Age GroupIllinois,
2006
Where age is known (n53,563)
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Reported Chlamydia Cases by Selected Counties and
Age Groups, Illinois 2006
County No. Cases Cases Ages 15-19 Cases Ages 20-24
Adams 162 39 43
Champaign 1,070 42 35
Coles 157 29 53
DeKalb 462 31 51
Jackson 411 34 48
Jefferson 104 36 40
Kankakee 512 38 35
Knox 211 43 31
Livingston 111 24 35
Macon 646 42 33
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Reported Chlamydia Cases by Selected Counties and
Age Groups, Illinois 2006
County No. Cases Cases Ages 15-19 Cases Ages 20-24
Madison 866 40 38
McDonough 118 16 72
McLean 512 37 39
Peoria 1,577 40 36
Rock Island 708 34 42
Sangamon 1,136 38 34
St. Clair 1,902 40 36
Stephenson 129 44 39
Vermilion 448 37 40
Total Illinois 53,586 34 36
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2006 Illinois Chlamydia Rates
200 - 399
100 - 199
Rate per 100,000 Population
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Change in Reported Chlamydia Cases for Illinois
Counties January December 2005 and 2006
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Gonorrhea Why Should We Care?

• PID
• Infertility
• Ectopic Pregnancy
• Newborn infection
• Facilitates HIV transmission
• Antibiotic Resistance
• Incidence in Adolescents and Young Adults

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Illinois Reported Gonorrhea Cases by Year,
1990-2006
No. Cases
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Reported Gonorrhea Cases By Provider
TypeIllinois 2006
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Illinois Gonorrhea Cases By Gender, 1990 - 2006
Cases
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Gonorrhea Case Rates By Race EthnicityIllinois
1990 -2006
Racial categories do not include persons of
Hispanic ethnicity Hispanic ethnicity includes
persons of any race
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Illinois Reported STD Case RatesDisparity
Between Racial/Ethnic Groups, 2005
African Americans Whites Hispanics Disparity African Americans vs. Whites Disparity Hispanics vs. Whites
Chlamydia 1,418 104 302 14 X 3 X
Gonorrhea 726 28 39 26 X 1.4 X
P/S Syphilis 11 3 4 4 X 1.3 X
Primary and Secondary
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2006 Illinois Gonorrhea Rates
gt300
gt 100 - 300
gt0 - 100
0
Rate per 100,000 Population
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Change in Reported Gonorrhea Cases for Illinois
Counties January December 2005 and 2006
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Syphilis Why Should We Care?

• Congenital infection
• Facilitates HIV transmission
• Late complications
• High rate of syphilis-HIV co-infection among MSM
  and increasing neurological involvement

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Illinois Reported Early Syphilis By Year, 1990 -
2006
No. Cases
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Reported Early Syphilis Cases by Provider
TypeIllinois 2006
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Illinois Reported Early Syphilis Cases By Gender,
1990 2006
Cases
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Illinois Reported Primary Secondary Syphilis
Cases By Age Group, 2006
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Illinois Reported Primary Secondary Syphilis
CasesBy Gender and Sexual Orientation, 2000-2006
heterosexual or sexual orientation not stated
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Illinois Reported Primary Secondary Syphilis
Case RatesBy Race/Ethnicity, 1990 - 2006
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2006 Illinois Primary and Secondary Syphilis Rates
gt10
gt 4 - 10
gt0 - 4
0
Rate per 100,000 population
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2006 Illinois Reported Early Syphilis Cases And
Change in Reported Cases Compared to 2005 by
County January - December
Increase
(21)
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Illinois Reported Primary and Secondary Syphilis
CasesMaleFemale Ratio, 1992-2006
Cases
1.001.00
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Illinois Primary Secondary SyphilisBy Gender
and Sexual Orientation, 2000-2006
heterosexual or sexual orientation not stated
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Illinois Primary and Secondary Syphilis Among
MSMPercent of Reported Cases By Race/Ethnicity,
2002 - 2006
Percent of Cases
Racial categories are non-Hispanic
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HIV Status By Gender and Sexual
Orientation Illinois Primary Secondary
Syphilis, 2006
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Illinois Primary Secondary Syphilis Among
MSM by Year and HIV Status, 2000 - 2006
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QuestionsFor Local Health Departments

• What activities and resources currently provided
  by the IDPH STD program are helpful and should
  continue?
• What activities and resources are needed that are
  not currently provided by the IDPH STD Program?

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Significant STD Challenges

• Degradation of Public Health Infrastructure
• Affordable, Accessible and High Quality Public
  and Private Diagnostic and Treatment Services
• Schizophrenic Public Messages and Attitudes About
  Sexuality and STD Prevention
• Absence of Social and Political Will for Long
  Term, Sustainable and Effective Prevention
  Education in Schools and Other Settings Serving
  Persons at Increased Risk
• Stigma, Discrimination and Marginalization
• Difficulty in Engaging Communities and Fostering
  Shared Responsibility for Prevention

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Significant Opportunities

• Renewed Attention for STD Prevention
• IDHS MCH Program Making STI Reduction and
  Prevention a Priority
• Targeted LHD Initiatives Developed Using CDC STD
  Program Planning Evaluation Process
• Interest From External Partners
• Overall High Quality LHD and IDPH Core Program
  Services
• Reporting and Surveillance
• Screening
• Accessibility of STD Medications
• Counseling and Sex Partner Referral
• Technical Assistance and Training

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IDPH STD Program For Questions and
AssistanceContact Us At217-782-274firstname.las
tname_at_Illinois.gov

• John Creviston Becky Rinozzi
• Marilyn Harris Ed Renier
• Steve Holmes Alice
  Studzinski
• Diana McGrath Richard Zimmerman
• Charlie Rabins Valerie Young