GC Outbreak in Philadelphia

Greta Anschuetz, MPH

Philadelphia Department of Public Healthgreta.anschuetz@phila.gov

Reported Cases of GC: Philadelphia1990 – 2010

11,914

10,580

6,565 6,415 6,5047,271

7,776 8,0617,277

5,7315,206 5,053 5,218 5,246 4,950 4,823

6,533

19,554

8,1708,026

15,429

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Year

Num

ber o

f Cas

es

36% increase from 2009

GC Reports by Specimen Collection Date 2009-2011

0

100

200

300

400

500

600

700

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep-

09O

ct-0

9N

ov-0

9D

ec-0

9Ja

n-10

Feb-

10M

ar-1

0A

pr-1

0M

ay-1

0Ju

n-10

Jul-1

0A

ug-1

0Se

p-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11Fe

b-11

Mar

-11

Month, Year

Num

ber o

f Cas

es

1st Increase2nd Increase

Reported GC in Philadelphia, PA 2009 2010 % Change

Total 4,823 6,533 +36%

Gender

Male 2,460 3,240 +32%

Female 2,363 3,293 +39%

Age Group

15-19 years 1,541 2,127 +38%

20-24 years 1,521 2,173 +43%

25+ years 1,696 2,144 +26%

0%

10%

20%

30%

40%

50%

60%

15-19 20-24 25-29 30-34 35+

% Increase Males% Increase Females

Perc

ent I

ncre

ase

Age Group (Years)

Percent Increase by Age and Gender

Ongoing GC Control Efforts• Comprehensive city-wide GC/CT screening program

(includes IPP funded sites, prison and High School screening) – 100K females annually (8% CT pos; 2% GC pos)– 65K males annually (8% CT pos; 3% GC pos)

• Partner services & rescreening for GC/CT infected HS students

• GISP• SSuN site since July 2009: interview subset of GC cases

– 743 interviews (~7% of GC reports)– No changes in reported risk factors/markers over time

• 22% of male GC cases identify as MSM• Anonymous partner in last 12 mos.: 35% MSM vs. 24% MSW

vs. 10% among females

ZIP Cases RatePer 100,000

19132 326 855.319138 146 738.319121 246 655.819143 390 595.819139 269 510.619140 308 498.119124 235 375.6

2009-2010 GC Targeted Initiatives

• August 2009: Added screening for asymptomatic ED patients in a high GC prevalence area (ZIP 19143)– Initially high CT positivity (6%) and GC positivity (4%)– Very slow uptake by ED staff – March 2011: Gained support of ED Director

• More specimens in past 3 weeks than in all of 2010!

• August 2010: Initiated Partner Services for all GC patients reported in same target area (ZIP 19143) for one month

2009/10 Area of Interest

Includes ZIP codes with more than 50 cases reported in 2010

2011 GC Targeted Initiatives• March 2011: Approached ED in ZIP with high % increase

(19124) about screening asymptomatic patients– Still in development

• April 2011: Applied for CDC community approaches grant. Proposed case finding in social networks of the public high school

• April 2011: Launched youth oriented intervention in collaboration with Philadelphia AIDS Activities Coordinating Office:– Comprehensive media campaign (including social media) targeting

youth– Expansion of condom availability

– HIV subsequent to teen STD data analysis

Media Campaign and Condom Availability

• Launched Take Control Philly, a comprehensive youth targeted STD/HIV Prevention Initiative

• Unveiling of a consumer designed Philly labeled condom

• Adolescent oriented website (www.takecontrolphilly.org)– Educational component – Mail me condoms

• ~800 condom orders shipped via USPS

HIV Subsequent to Teen STD

1 1 ,52 5 (32 % )S T D +

2 4 ,78 0 (68 % )S T D -

3 6 ,3 0 5 fem alesb o rn be tw e en 1 9 85 a n d 19 93

w /reco rd a t a g e 1 1 to 19 ye a rssc re en e d in H S S c re e n ing P ro g ram

4 ,9 53 (13 % )S T D +

3 4 ,08 2 (87 % )S T D -

3 9 ,0 3 5 m a lesb o rn be tw e en 1 9 85 a n d 19 93

w /reco rd a t a g e 1 1 to 19 ye a rssc re en e d in H S S c re e n ing P ro g ram

Females Males

Cohort Selection

Question: How many teens with an STD diagnosis are diagnosed with HIV in the future?

STD+: Case of CT/GC or Syphilis as a teen from any provider/lab received by PDPH STD-: >1 negative from HS Screening Program, never a case as a teen

HIV Risk by Teen STD HistoryRisk Ratios and 95% CIs

*Adjusted for race/ethnicity and birth year

3.01.7

5.83.0

2.1

5.7 4.1 4 4.2

0.1

1

10

100

Ever 1 to 2 3+ Ever 1 to 2 3+ Ever 1 2+

Fem

ales

2.3 1.94.1

1.4 1.5

4.82.7

1.0

11.4

0.1

1

10

100

Ever 1 to 2 3+ Ever 1 to 2 3+ Ever 1 2+

Mal

es

All STDs CT GC

All STDs CT GC

Conclusions• GC increase in 2010 is widespread and not localized to

any group/region in Philadelphia

– Small percent of increase can be explained by one lab not reporting in 2009 (~200 cases)

• New initiatives focus on increasing condom availability and awareness among adolescents via media

• Large cohort analysis shows that having an STD as a teen increases the risk of a subsequent HIV diagnosis