Laboratory Surveillance of Sexually Transmitted Disease

LA County Dept. of Health ServicesSexually Transmitted Disease Program

Laboratory Surveillance Unit

Chandra Higgins, MPHchiggins@ladhs.org

Reportable STDs in LA County

• Reporting requirements

• Dual reporting system

• Forms

Legal STD Reporting Requirements in California

Laboratory• Syphilis• Chlamydia• Gonorrhea

Health Provider• Syphilis• Chlamydia• Gonorrhea• Chancroid• PID (Pelvic

Inflammatory Disease)• NGU (Non-Gonococcal

Urethritis)

Reporting Responsibilities

Laboratory• All positives

• Report within one working day of identification

Health Provider• Known or suspect

• Report syphilis within one working day of identification. All others within 7 calendar days.

Reporting Responsibilities

Laboratory• Patient name &

limited demographics

• Provider name, address, phone

• Specimen accession, dates, test type & results

Health Provider• Patient name & full

demographics• Diagnosis, date of

diagnosis & onset• Name, address, &

phone of reporter

Medical Provider’s STD Reporting Form (p.1)

Medical Provider’s STD Reporting Form(p.1, continued)

Medical Provider’s STD Reporting Form (p.2)

Medical Provider’s STD Reporting Form(p.2, continued)

ProviderOnlyESy 0.3%CT 3.5%GC 4.8%

BothESy 51%CT 70%GC 66%

LaboratoryOnlyESy 49%CT 27%GC 29%

Reports to LA County STD ProgramChlamydia, Gonorrhea, and Syphilis 2004

Reporting Issues

• Improved enforcement of reporting laws• State investigations; non-compliance can

result in loss of lab license

• Identification of non-reporters is difficult• Dual reporting requirement facilitates

identification• Annual laboratory survey identifies

laboratories with deficient reporting practices

Reporting Issues(continued)

• Heaviest burden on laboratories• Often sole reporting source• Rely on providers for patient information• Referring laboratories withhold patient /

provider information from testing facilities

• Increased interstate testing has accompanied growth of managed care & core laboratories• Reporting requirements vary by state

Annual Laboratory Survey

• Monitor compliance with reporting guidelines

• Monitor trends in test utilization & laboratory practice

• Provide information on STD testing trends and recommendations

• Inform laboratories about STD Program function

Private Lab44%

Physician Office

7%

Private Hospital

33%

Other10%

PH/County6%

2004 STD Testing Laboratories

N=163

PH/County Hospital7%

Physician Office1%

Private Hospital6%

Other14%

Free Standing Private72%

Test Volume by Lab-Type 2004

Syphilis, Chlamydia, Gonorrhea

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

1995 1997 1999 2001 2003 2004

Tes

ts I

n M

illi

on

s

Syphilis Chlamydia Gonorrhea

L.A. County STD Testing 1995 – 2004

Nontreponemal90%

Treponemal10%

N=1,629,500

Syphilis Testing, 2004

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1995 1997 1999 2001 2003 2004

Test

s In

Mill

ions

Amplified DNA Probe EIA

Growth In Amplified Tests

Chlamydia, 1995 - 2004

SDA52%

TMA24%

PCR23%

LCR1%

Amplified Methods

2003 & 2004 Chlamydia Tests

PCR10%

LCR0%

SDA64%

TMA26%

2003 2004

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1995 1997 1999 2001 2003 2004

Test

s in

Mill

ions

Amplified DNA Probe Culture

Growth in Amplified Testing

Gonorrhea, 1995 - 2004

Gonorrhea19%

Syphilis18%

Hepatitis B13%

HPV/HVS16%

HIV13%

Chlamydia21%

L.A. County STD Testing

All 2004 Testing