Sexually Transmitted Disease (STD)
Surveillance Report, 2004
Minnesota Department of Health
STD Surveillance System
Introduction

This slide set describes new cases of chlamydia,
gonorrhea, and syphilis in Minnesota by person, place,
and time.

The slides display data from cases diagnosed through
2004 and reported to the Minnesota Department of
Health (MDH) STD Surveillance System.

Data analyses exclude federal and private prisoners.
Introduction

STD Surveillance is the systematic collection of data
from cases for the purpose of monitoring the frequency
and distribution of STDs in a given population.

STD surveillance data are used to detect problems,
prioritize resources, develop and target interventions,
and evaluate the effectiveness of interventions.
Interpreting STD Surveillance Data

Factors that impact the completeness and accuracy of the data include:
 Level of STD screening and individual test-seeking behavior
 Sensitivity of diagnostic tests
 Compliance with case reporting
 Timeliness of case reporting

Increases and decreases in STD rates can be due to actual changes in
disease occurrence and/or changes in one or more of the factors
described above.

For example, in 2002 MDH added an active component to the previously
passive STD Surveillance System. As a result, compliance with
reporting improved and the number of chlamydia and gonorrhea cases
reported to MDH increased by at least 7% and 5%, respectively,
between 2001 and 2002 as an artifact of reporting.
National Context
HIV/AIDS in Minnesota: Annual Review
United States: State-Specific Chlamydia Rates, 2003
276.8
280.1
156.8
261.0
218.3
213.4
176.4
329.7
342.7
192.5
298.7
324.1
221.0
302.3
274.1
268.2
383.3 277.2
168.1
334.4
289.3
234.9
403.2
266.9
315.2
372.3
143.5 266.5
327.4
195.0
289.9
356.0
Guam 344.0
316.7
Rate per 100,000
population
416.9
317.7
467.8
605.8
171.9
126.7
175.8
280.4
271.4
188.2
375.9
308.4
314.7
351.5
424.6
VT
NH
MA
RI
CT
NJ
DE
MD
253.6
(n= 3)
<=150.0
150.1-300.0 (n= 26)
>300.0
(n= 24)
440.2
Puerto Rico 71.1
Virgin Is. 378.1
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific Gonorrhea Rates, 2003
45.4
13.4
18.0
16.2
28.4
63.8
5.1
104.1
29.7
9.2
115.7
138.9
52.9
96.2
93.9
102.2
173.1 108.5
17.8
73.9
63.3
65.6
197.3
63.0
97.5
130.3
47.0
155.0
124.3
87.4
156.9
207.4
Guam 40.4
207.4
Rate per 100,000
population
206.6
112.9
264.4
89.0
15.7
9.8
45.1
91.0
90.0
92.5
139.7
147.2
181.7
146.9
220.4
VT
NH
MA
RI
CT
NJ
DE
MD
113.5
<=19.0
19.1-100.0
>100.0
(n= 9)
(n= 21)
(n= 23)
101.5
Puerto Rico 7.2
Virgin Is. 82.7
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific P&S Syphilis Rates, 2003
1.4
0.0
0.6
0.3
1.4
0.9
1.1
0.3
0.3
0.0
3.0
0.4
1.3
0.6
0.6
0.6
3.7
3.0
0.9
3.4
VT
NH
MA
RI
CT
NJ
DE
MD
2.5
0.9
1.8
3.8
0.8
1.7
0.1
1.1
1.1
0.8
1.8
2.3
1.9
2.3
Guam 0.6
1.4
2.5
Rate per 100,000
population
6.8
3.0
4.1
0.2
0.2
1.5
2.1
3.1
0.9
2.0
0.9
5.7
3.9
<=0.2
0.21-4.0
>4.0
(n= 5)
(n= 44)
(n= 4)
1.1
Puerto Rico 5.2
Virgin Is. 2.7
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides.
STDs in Minnesota: Annual Review
Overview of STDs in Minnesota
STDs in Minnesota: Annual Review
STDs in Minnesota
Rate per 100,000 by Year of Diagnosis, 1994-2004†
Gonorrhea
P&S* Syphilis
240
10
220
9
200
8
180
7
160
140
6
120
100
5
4
80
3
60
2
40
20
1
0
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
* P&S = Primary and Secondary.
Year
† While P&S syphilis numbers decreased in 2004, first quarter numbers for 2005 indicate an increase back to 2003 levels.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Rate of P&S Syphilis
Rate of Chlamydia and Gonorrhea
Chlamydia
STDs in Minnesota:
Number of Cases Reported in 2004

Total of 14,703 STD cases reported to MDH in 2004:



11,601 Chlamydia cases
2,957 Gonorrhea cases
145 Syphilis cases (all stages)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA
STDs in Minnesota: Annual Review
Kittson
2004 Minnesota
Chlamydia Rates
by County
Roseau
Lake of the Woods
Marshall
Koochiching
Pennington
Beltrami
Red Lake
Clearwater
Polk
Cook
St. Louis
Lake
Itasca
Norman
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Rate per 100,000 persons
Carlton
Wilkin
Otter Tail
Grant
0 - 75
76 - 150
Pine
Mille Lacs
Todd
Morrison
Douglas
Kanabec
Traverse
Big Stone Stevens
Pope
Stearns
Isanti
Chisago
Sherburne
Swift
Wright
Kandiyohi Meeker
McLeod
Ramsey
Carver
Renville
Nicollet
Le Sueur
Rice
Wabasha
Brown
Pipestone
Rock
Murray
Nobles
Cottonwood
Jackson
(407 cases missing residence information)
Goodhue
Redwood
Blue Earth
Watonwan
Martin
Faribault
Data Source: Minnesota STD Surveillance System
886
639
168
149
Dakota
Scott
Sibley
Lyon
Washington
Hennepin
Lac qui Parle
Yellow Medicine
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Anoka
Chippewa
Lincoln
151 - 300
> 300
Benton
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Waseca
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Chlamydia Infections in Minnesota
by Residence at Diagnosis, 2004
Total Number = 11,601
(407 missing residence information)
Minneapolis
24%
Greater MN
30%
St. Paul
16%
Suburban
30%
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Gender
Minnesota, 1994-2004
Males
400
Females
350
Rate per 100,000
300
250
200
150
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 1994-2004
1600
15-19
25-29
1400
20-24
30-39
Rate per 100,000
1200
1000
800
600
400
200
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 1994-2004
2500
White
American Indian
Hispanic*
Rate per 100,000
2000
Black
Asian/PI
1500
1000
500
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1994-2004
1000
Rate per 100,000
800
White
American Indian
Asian/PI
Hispanic*
600
400
200
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
GONORRHEA
STDs in Minnesota: Annual Review
Kittson
2004 Minnesota
Gonorrhea Rates
by County
Roseau
Lake of the Woods
Marshall
Koochiching
Pennington
Beltrami
Red Lake
Clearwater
Polk
Cook
St. Louis
Lake
Itasca
Norman
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Carlton
Wilkin
Rate per 100,000 persons
Otter Tail
Grant
Traverse
0 -19
Pine
Mille Lacs
Todd
20 - 100
> 100
Morrison
Douglas
Kanabec
Benton
Stevens
Pope
Stearns
Big Stone
Isanti
Chisago
Sherburne
Swift
Lac qui Parle
Hennepin
McLeod
Lyon
Ramsey
Carver
Renville
Scott
Sibley
Lincoln
Washington
Chippewa
Yellow Medicine
Le Sueur
(96 missing residence information)
Rice
Wabasha
Brown
Pipestone
Cottonwood
Blue Earth
Waseca
Steele Dodge
Nobles
Jackson
Martin
Faribault
Data Source: Minnesota STD Surveillance System
Freeborn
Mower
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Olmsted
Winona
Watonwan
Rock
276
190
40
21
Dakota
Goodhue
Redwood
Nicollet
Murray
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Anoka
Wright
Kandiyohi Meeker
Fillmore
Houston
STDs in Minnesota: Annual Review
Gonorrhea Infections in Minnesota
by Residence at Diagnosis, 2004
Total Number = 2,957
(96 missing residence information)
Greater MN
16%
Minneapolis
37%
Suburban
28%
St. Paul
19%
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Gender
Minnesota, 1994-2004
100
Males
Females
Rate per 100,000
80
60
40
20
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 1994-2004
15-19
25-29
400
20-24
30-39
350
Rate per 100,000
300
250
200
150
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 1994-2004
2000
White
American Indian
Hispanic*
1800
1600
Rate per 100,000
1400
Black
Asian/PI
1200
1000
800
600
400
200
0
1994
1995
1996
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
1997
1998
1999
2000
2001
2002
2003
2004
Year
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1994-2004
250
225
200
White
American Indian
Asian/PI
Hispanic*
Rate per 100,000
175
150
125
100
75
50
25
0
1994
1995
1996
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
1997
1998
1999
2000
2001
2002
2003
2004
Year
STDs in Minnesota: Annual Review
PRIMARY & SECONDARY SYPHILIS
STDs in Minnesota: Annual Review
Kittson
2004 Minnesota
P&S Syphilis
Rates by County
Roseau
Lake of the Woods
Marshall
Koochiching
Pennington
Beltrami
Red Lake
Clearwater
Polk
Cook
St. Louis
Lake
Itasca
Norman
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Wilkin
Carlton
Otter Tail
Rate per 100,000 persons
Mille Lacs
Pine
Todd
Grant
0 – 0.2
0.21 – 1.0
> 1.0
Morrison
Douglas
Kanabec
Traverse
Big Stone
Benton
Stevens
Pope
Stearns
Isanti
Chisago
Sherburne
Swift
Anoka
Wright
Kandiyohi Meeker
Lac qui Parle
Ramsey
Chippewa
Hennepin
McLeod
Yellow Medicine
Carver
Renville
Lyon
Dakota
Scott
Sibley
Lincoln
Goodhue
Redwood
Nicollet
Le Sueur
Rock
Murray
Nobles
Cottonwood
Jackson
Blue Earth
Martin
7-county metro area, excluding the
cities of Minneapolis and St. Paul
Wabasha
Watonwan
Steele
Waseca
Faribault
Data Source: Minnesota STD Surveillance System
Freeborn
Dodge Olmsted
Mower
4.2
1.0
0.4
0.0
#
Rice
Brown
Pipestone
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Washington
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Primary &Secondary Syphilis Infections
in Minnesota by Residence at Diagnosis, 2004
Total Number = 27
Greater MN
4%
Suburban
26%
Minneapolis
59%
St. Paul
11%
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates† by Age
Minnesota, 1994-2004
9.0
8.0
15-19
20-24
25-29
30-39
Rate per 100,000
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
† While
P&S syphilis numbers decreased in 2004, first quarter numbers for 2005 indicate an increase back to 2003 levels.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary &Secondary Syphilis Rates by Gender
Minnesota, 1994-2004
4.0
Males
Females
3.5
Rate per 100,000
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 1994-2004
40
White
American Indian
Hispanic*
35
Rate per 100,000
30
Black
Asian/PI
25
20
15
10
5
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 1997-2004
20
White
American Indian
Hispanic*
Rate per 100,000
15
Black
Asian/PI
10
5
0
1997
1998
1999
2000
2001
2002
2003
2004
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
ADOLESCENTS & YOUNG ADULTS
15-19 year olds
20-24 year olds
STDs in Minnesota: Annual Review
Chlamydia disproportionately impacts
adolescents & young adults
MN Population in 2000
Chlamydia Cases in 2004
(n = 4,919,479)
(n = 11,601)
25-34 yrs
24%
25-34 yrs
14%
35+ yrs
50%
15-24 yrs
14%
35+ yrs
6%
15-24 yrs
69%
<15 yrs
1%
<15 yrs
22%
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea disproportionately impacts
adolescents & young adults
MN Population in 2000
Gonorrhea Cases in 2004
(n = 4,919,479)
(n = 2,957)
25-34 yrs
27%
25-34 yrs
14%
35+ yrs
50%
35+ yrs
15%
15-24 yrs
14%
15-24 yrs
57%
<15 yrs
1%
<15 yrs
22%
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of adolescents & young adults diagnosed
with chlamydia or gonorrhea in 2004
(n=9,089)
Cases
% of Total
Male
2,068
23%
Female
7,020
77%
1
< 1%
White
3,886
43%
Black
2,557
28%
Am Indian
329
4%
Asian/PI
253
3%
2,064
23%
Transgender
Other/Unknown
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of adolescents & young adults
diagnosed with chlamydia or gonorrhea in 2004
(Continued)
Hispanic
Cases
566
% of Total
6%
Non-Hispanic
5,069
56%
Unknown
3,454
38%
Minneapolis
St. Paul
Suburban MN
Greater MN
Unknown
2,071
1,465
2,456
2,781
316
23%
16%
27%
31%
3%
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and
Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates for Adolescents & Young Adults
by Gender in Minnesota, 1994-2004
2000
1800
Males
Females
1600
Rate per 100,000
1400
1200
1000
800
600
400
200
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates for Adolescents & Young Adults
by Gender in Minnesota, 1994-2004
500
Males
450
Females
400
Rate per 100,000
350
300
250
200
150
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
EMERGING TRENDS:
-Drug Resistant Gonorrhea
-Syphilis among MSM
-Chlamydia Rate Double since 1996
STDs in Minnesota: Annual Review
Increasing Prevalence of Drug-Resistant
Gonorrhea in Minnesota
STDs in Minnesota: Annual Review
Background Information

CDC-recommended antibiotic treatments for gonorrhea:
 Ceftriaxone



Cefixime



Single dose therapy, administered by injection
Relatively expensive
Single dose therapy, administered orally
Production discontinued in 2002; No longer available
Ciprofloxacin, Ofloxacin, Levofloxacin (Quinolones)


Single dose therapy, administered orally
Spread of quinolone-resistant N. gonorrhoeae (QRNG) threatens the efficacy of
fluoroquinolones as the frontline treatment for gonorrhea
Prevalence of
Quinolone-Resistant N. Gonorrhoeae (QRNG)
1990s
2000
2001
QRNG prevalent in Asia, >40% in some countries
Hawaii discontinues use of fluoroquinolones following increase in
QRNG prevalence from 1.4% in 1997 to 9.5% in 1999
California discontinues use of fluoroquinolones after reaching
QRNG prevalence of 5% in 2001
2002
CDC recommends non-quinolone therapy for infections acquired
in HI, CA, and other areas with high QRNG prevalence
2003
Increases in QRNG reported in other U.S. states (e.g., MI, MA)
2004
Prevalence of QRNG in MN five times higher than in 2002
Prevalence of QRNG in Minnesota,
1999 - 2004
Year
# Resistant Isolates
# Isolates Tested
QRNG Prevalence
1999-2001
0
1,365
0%
2002
4
268
1.5%
2003
5
363
1.4%
2004
28
333
8.4%
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Prevalence of QRNG Among Male GISP† Participants
by Mode of Transmission in Minnesota,
2002 - 2004
Gay/Bisexual
Year
Heterosexual
# Resistant # Tested Prevalence # Resistant # Tested Prevalence
2002
0
38
0.0%
1
152
0.7%
2003
4
45
8.9%
1
168
0.6%
2004
18
67
26.9%
4
177
2.2%
The Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system established by the CDC to monitor antimicrobial resistance in
Gonorrhea among males. The Red Door Clinic in Minneapolis is one of the participating clinics. The data shown has been collected through this project.
†
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of the 2004 QNRG cases
(n = 28)

71% 0f the cases were White

32% of cases (9) were among men under 30 years of age, the
average age for cases was 32.5 years

22 of the 28 cases (79%) were among gay/bisexual males

Eighteen percent of cases among gay/bisexual males were also
HIV+

A majority of cases reported having multiple sex partners in the
previous 60 days

Two of the cases reported travel and sexual activity in areas with
high QNRG prevalence (Philippines and Hawaii)
What’s Being Done in Minnesota?

MDH has expanded the current QRNG surveillance system to
include women and Room 111 in St. Paul

MDH will use the data to guide future treatment recommendations

Healthcare providers are encouraged to obtain travel histories of
patients and to be alert for treatment failures. Gonorrhea infections
acquired in areas with high QRNG prevalence and among MSM
should receive non-quinolone therapy

Clinicians and laboratories are asked to report suspected treatment
failures and resistant gonococcal isolates to MDH

MDH Partner Services Program follows up on cases and sex
partners
Syphilis among Gay/Bisexual Men in
Minnesota
STDs in Minnesota: Annual Review
Early Syphilis Cases by Stage at Diagnosis
Minnesota, 1994-2004
100
80
Number of Cases
Primary
Secondary
Early Latent
60
40
20
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis* among Gay/Bisexual Men Minnesota,
2001-2004
• 48 early syphilis cases diagnosed in 2004, compared with:
• 92 cases in 2003
• 82 cases in 2002
• 49 cases in 2001
• 34 cases among gay/bisexual men in 2004, compared with:
• 71gay/bisexual men in 2003
• 56 gay/bisexual men in 2002
• 5 gay/bisexual men in 2001
• Characteristics of the 2004 gay/bisexual male cases (n=34):
80% White
71% live in Hennepin County
Average age = 37
32% HIV+
* Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Early Syphilis* among Gay/Bisexual Men Minnesota,
2004

While the number of cases in 2004 decreased, first quarter data for
2005 indicate an increase back to 2003 levels

Despite the decrease in 2004, cases among MSM remain high
compared to 2001 (34 versus 5)

MSM accounted for 81% of cases among males

Internet was the most common venue for meeting partners (78%)

Among MSM, most reported having anonymous sex (81%), and of
these 41% reported no condom use
* Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
What’s Being Done in Minnesota?

MDH is continuing awareness campaigns (e.g., Health Notices, press
releases)

Encouraging physicians to screen gay/bisexual men at least annually

Community-based programs intensifying outreach activities to reach
gay/bisexual men

MDH has implemented innovative prevention strategies (e.g., internet
banners, partnering with venues)

MDH Partner Services Program continues to follow up on cases and
sex partners
Doubling of the Chlamydia Rate Since 1996
STDs in Minnesota: Annual Review
Chlamydia in Minnesota
Rate per 100,000 by Year of Diagnosis, 1994-2004
Chlamydia
240
Rate of Chlamydia and Gonorrhea
220
200
180
236 per 100,000
160
140
120
100
80
115 per 100,000
60
40
20
0
1994
1995
1996
1997
1998
1999 2000
2001
2002
2003
2004
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates in Minnesota, 1996-2004

Since 1996 the rate of Chlamydia infection has doubled from 115 to
236 per 100,000

The rate has doubled both among men (54 to 126) and women (175
to 343)

Rates have almost tripled among 25-29 year olds (214 to 597) and
among 30-39 year olds (56 to 156)

Among 15-19 year olds rates have increased 1½ times (640 to 968)
and among 20-24 year olds rates have doubled (567 to 1372)
Chlamydia Rates in Minnesota, 1996-2004

Rates have also increased by race, doubling among Hispanics,
Whites and Asian/Pacific Islanders

In this time period, the chlamydia rate for Blacks and American
Indians increased by 32% and 60%, respectively

Rates have also increased by geography with the most marked
increases happening in Greater Minnesota and the suburban 7county metro area

In both areas the rate more than doubled, compared to an increase
of 25% in Minneapolis and 64% in St. Paul
What’s Behind the Increase?
The observed increase since 1996 is most likely due to the combination
of four factors:
1.
Improved testing technology with increased sensitivity
2.
Improved screening practices by clinicians
3.
Addition of active surveillance component
4.
Increase of the disease in the population
However, the effect of the first three factors would have leveled off
over time so the increase is most likely being driven by an actual
increase of the disease in the population.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

Between 2003-2004, the overall chlamydia rate increased while rates
of gonorrhea and early syphilis decreased

STD rates continue to be highest in Minneapolis and St. Paul

STD rates are highest among persons of color

Chlamydia and gonorrhea rates are highest among adolescents and
young adults; syphilis rates are highest among adults

While the number of early syphilis cases is down, the numbers
among gay/bisexual men are continue to be high

Prevalence of antibiotic-resistant gonorrhea has increased five fold
between 2002 and 2004
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review