Sexually Transmitted Disease (STD)
Surveillance Report, 2005
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
2005 and reported to the Minnesota Department of
Health (MDH) STD Surveillance System.

Data analyses exclude federal and private prisoners.
STDs in Minnesota: Annual Review
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.
STDs in Minnesota: Annual Review
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.
STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
United States: State-Specific Chlamydia Rates, 2004
287.6
284.2
161.8
285.6
244.1
229.3
203.8
351.2
331.3
215.9
308.0
409.2
236.3
307.5
301.2
298.5
372.9 297.6
164.0
344.4
311.0
300.8
482.0
275.1
295.2
344.3
152.3 292.9
373.7
157.1
288.5
444.2
Guam 457.2
295.8
394.7
Rate per 100,000
population
317.5
485.7
609.4
183.6
134.8
205.8
319.8
274.2
202.0
361.3
362.2
344.5
385.4
654.7
VT
NH
MA
RI
CT
NJ
DE
MD
250.0
(n= 2)
<=150.0
150.1-300.0 (n= 25)
(n= 26)
>300.0
422.0
Puerto Rico 92.5
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.
Virgin Is. 278.5
STDs in Minnesota: Annual Review
United States: State-Specific Gonorrhea Rates, 2004
45.8
9.6
16.1
17.4
36.6
58.4
7.5
92.3
39.8
11.8
97.6
172.4
42.4
90.9
65.9
137.3
162.8 110.6
25.6
85.0
67.1
72.8
179.0
69.7
93.3
49.3
161.6
126.8
116.0
67.0
151.8
221.1
Guam 69.7
182.3
181.7
Rate per 100,000
population
110.2
234.4
87.4
13.9
10.3
47.5
75.8
82.2
77.5
109.4
150.6
180.7
145.1
248.6
VT
NH
MA
RI
CT
NJ
DE
MD
109.2
<=19.0
19.1-100.0
>100.0
(n= 8)
(n= 25)
(n= 20)
94.9
Puerto Rico 6.9
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.
Virgin Is. 68.9
STDs in Minnesota: Annual Review
United States: State-Specific P&S Syphilis Rates, 2004
2.4
0.4
0.2
0.0
0.8
0.5
1.8
0.5
0.0
0.6
3.8
0.2
1.0
0.4
1.8
0.6
3.8
3.1
1.4
2.8
VT
NH
MA
RI
CT
NJ
DE
MD
1.9
0.9
0.7
4.4
1.0
2.1
0.2
1.6
1.6
1.1
2.3
2.2
1.7
2.8
Guam 0.0
2.0
3.7
6.3
Rate per 100,000
population
3.7
7.4
1.2
0.2
0.4
1.8
2.4
1.3
1.7
1.1
6.9
4.3
<=0.2
0.21-4.0
>4.0
(n= 7)
(n= 39)
(n= 7)
0.6
Puerto Rico 4.7
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2004 Surveillance Slides.
Virgin Is. 4.6
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, 1995-2005†
Gonorrhea
P&S* Syphilis
260
240
220
200
180
160
140
120
100
80
60
40
20
0
10
9
8
7
6
5
4
3
2
1
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
* P&S = Primary and Secondary.
Data Source: Minnesota STD Surveillance System
Year
STDs in Minnesota: Annual Review
Rate of P&S Syphilis
Rate of Chlamydia and Gonorrhea
Chlamydia
STDs in Minnesota:
Number of Cases Reported in 2005

Total of 15,875 STD cases reported to MDH in 2005:



12,187 Chlamydia cases
3,481 Gonorrhea cases
207 Syphilis cases (all stages)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA
STDs in Minnesota: Annual Review
2005 Minnesota
Chlamydia Rates
by County
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Mahnomen
Clay
Becker
Lake
St. Louis
Itasca
Hubbard
Cass
Aitkin
Crow Wing
Wadena
Otter Tail
Mille Lacs
Traverse
Big Stone
Rate per 100,000 persons
0 - 75
76 - 150
Pine
Todd
Grant
Carlton
Morrison
Douglas
Kanabec
Wilkin
151 - 300
> 300
Benton
Stevens
Pope
Stearns
Isanti
Sherburne
Kandiyohi
Swift
Chippewa
Wright
Meeker
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Washington
Ramsey
Hennepin
Lac Qui Parle
McLeod
Yellow Medicine
Chisago
Anoka
Renville
Carver
Scott
Dakota
717
598
184
158
Sibley
Lincoln Lyon
Redwood
Nicollet
Rice
Wabasha
Cottonwood
Blue Earth
Watonwan
Rock
Nobles
Jackson
Martin
Faribault
Data Source: Minnesota STD Surveillance System
Waseca
Brown
Murray
Pipestone
(509 cases missing residence information)
Goodhue
Le Sueur
Steele Dodge Olmsted
Freeborn
Mower
Fillmore
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Winona
Houston
STDs in Minnesota: Annual Review
Chlamydia Infections in Minnesota
by Residence at Diagnosis, 2005
Total Number = 12,187
(509 missing residence information)
Minneapolis
23%
Greater MN
31%
St. Paul
15%
Suburban
31%
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, 1995-2005
Males
400
Females
350
Rate per 100,000
300
250
200
150
100
50
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 1995-2005
1600
15-19
25-29
1400
20-24
30-39
Rate per 100,000
1200
1000
800
600
400
200
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 1995-2005
2500
White
American Indian
Hispanic*
Rate per 100,000
2000
Black
Asian/PI
1500
1000
500
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
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, 1995-2005
1000
Rate per 100,000
800
White
American Indian
Asian/PI
Hispanic*
600
400
200
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
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
2005 Minnesota
Gonorrhea Rates
by County
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Lake
St. Louis
Itasca
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Rate per 100,000 persons
Carlton
Wilkin
Otter Tail
Benton
Pope
Stearns
Isanti
Sherburne
Swift
Chisago
Anoka
Kandiyohi
Meeker
Wright
Chippewa
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Ramsey
Lac qui Parle
Hennepin
McLeod
Yellow Medicine
30 - 100
> 100
Washington
Stevens
Big Stone
Kanabec
Morrison
Douglas
Mille Lacs
Traverse
Todd
Grant
0 - 10
11 - 29
Pine
Carver
Renville
Dakota
Scott
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le Sueur Rice
Rock
Nobles
(132 missing residence information)
Goodhue
Wabasha
Brown
Murray
Pipestone
333
238
46
22
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Cottonwood
Jackson
Blue Earth
Watonwan
Waseca
Martin
Faribault
Data Source: Minnesota STD Surveillance System
Steele
Freeborn
Dodge Olmsted
Mower
Fillmore
Winona
Houston
STDs in Minnesota: Annual Review
Gonorrhea Infections in Minnesota
by Residence at Diagnosis, 2005
Total Number = 3,481
(132 missing residence information)
Greater MN
15%
Minneapolis
38%
Suburban
27%
St. Paul
20%
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, 1995-2005
100
Males
Females
Rate per 100,000
80
60
40
20
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 1995-2005
15-19
25-29
400
20-24
30-39
350
Rate per 100,000
300
250
200
150
100
50
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 1995-2005
2000
White
American Indian
Hispanic*
1800
1600
Rate per 100,000
1400
Black
Asian/PI
1200
1000
800
600
400
200
0
1995
1996
1997
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
1998
1999
2000
2001
2002
2003
2004
2005
Year
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1995-2005
250
225
200
White
American Indian
Asian/PI
Hispanic*
Rate per 100,000
175
150
125
100
75
50
25
0
1995
1996
1997
1998
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
1999
2000
2001
2002
2003
2004
2005
Year
STDs in Minnesota: Annual Review
PRIMARY & SECONDARY SYPHILIS
STDs in Minnesota: Annual Review
Lake of the Woods
Kittson
Roseau
2005 Minnesota
P&S Syphilis
Rates by County
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Lake
St. Louis
Itasca
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Carlton
Wilkin
Otter Tail
Morrison
Douglas
Benton
Stevens
Pope
Stearns
Big Stone
Isanti
Sherburne
Swift
Anoka
Wright
Meeker
Chippewa
Hennepin
Lac qui Parle
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Washington
Kandiyohi
Ramsey
McLeod
Yellow Medicine
0 – 0.2
0.21 – 1.0
> 1.0
Kanabec
Chisago
Grant
Rate per 100,000 persons
Pine
Mille Lacs
Traverse
Todd
Carver
Renville
Scott
Dakota
Sibley
Lincoln Lyon
Redwood
Nicollet
Le Sueur
Rice
Goodhue
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Wabasha
Brown
Pipestone Murray
Blue Earth Waseca
Faribault
Data Source: Minnesota STD Surveillance System
Steele
Freeborn
11.0
2.8
0.9
0.1
Dodge Olmsted
Mower
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Infections
in Minnesota by Residence at Diagnosis, 2005
Total Number = 70
Greater MN
4%
Suburban
24%
Minneapolis
61%
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 Gender
Minnesota, 1995-2005
4.0
Males
Females
3.5
Rate per 100,000
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 1995-2005
9.0
8.0
15-19
20-24
30-39
40-49
25-29
Rate per 100,000
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 1995-2005
40
White
American Indian
Hispanic*
35
Rate per 100,000
30
Black
Asian/PI
25
20
15
10
5
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
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, 2000-2005
20
White
American Indian
Hispanic*
Rate per 100,000
15
Black
Asian/PI
10
5
0
2000
2001
2002
2003
2004
2005
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 2005
(n = 4,919,479)
(n = 12,187)
25-34 yrs
23%
25-34 yrs
14%
35+ yrs
50%
15-24 yrs
14%
35+ yrs
6%
15-24 yrs
70%
<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 2005
(n = 4,919,479)
(n = 2,957)
25-34 yrs
28%
25-34 yrs
14%
35+ yrs
50%
35+ yrs
18%
15-24 yrs
14%
<15 yrs
1%
15-24 yrs
53%
<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 2005
(n=9,787)
Cases
% of Total
Male
2,339
24%
Female
7,362
76%
6
< 1%
White
3,937
41%
Black
2,686
28%
Am Indian
360
4%
Asian/PI
277
3%
2,447
25%
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
2005 (Continued)
Hispanic
Cases
602
% of Total
6%
Non-Hispanic
5,174
53%
Unknown
3,931
41%
Minneapolis
St. Paul
Suburban MN
Greater MN
Unknown
2,205
1,430
2,732
2,930
410
23%
15%
28%
30%
4%
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, 1995-2005
2000
1800
Males
Females
1600
Rate per 100,000
1400
1200
1000
800
600
400
200
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Cases Among Adolescents and Young Adults†
by Gender and Race, 2005
Males (n = 1,902)
Females (n = 6,619)
White
34%
Black
37%
Black
22%
White
44%
Amer Ind
4%
Asian / PI
3%
Other
2%
Amer Ind
3%
Unknown
22%
Asian/PI
2%
Other
2%
†
Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
Unknown
25%
STDs in Minnesota: Annual Review
Gonorrhea Rates for Adolescents & Young Adults
by Gender in Minnesota, 1995-2005
500
Males
450
Females
400
Rate per 100,000
350
300
250
200
150
100
50
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Cases Among Adolescents and Young Adults†
by Gender and Race, 2005
Males (n = 597)
Females (n = 1,231)
Black
39%
Black
57%
White
22%
White
28%
Amer Ind
4%
Unknown
17%
Other
1%
†
Asian/PI
0%
Amer Ind
3%
Unknown
23%
Other
4%
Asian / PI
2%
Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
EMERGING TRENDS:
-Drug Resistant Gonorrhea
-Syphilis among MSM
-Continuing Increase of the Chlamydia Rate
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
STDs in Minnesota: Annual Review
Prevalence of
Quinolone-Resistant N. Gonorrhoeae (QRNG)
1990s
2000
2001
2002
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
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
2005
Prevalence of QRNG in MN five times higher than in 2002
Prevalence of QRNG in MN continues to increase
STDs in Minnesota: Annual Review
Prevalence of QRNG in Minnesota,
1999 - 2005
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
330
8.5%
2005
25
365
6.8%
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Prevalence of QRNG by Mode of
Transmission in Minnesota, 2002 - 2005 †
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
23
85
27%
5
238
2.1%
2005
24
80
30%
1
279
0.4%
For 2002 and 2003 the isolates tested came only from The Gonococcal Isolate Surveillance Project (GISP). 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.
For 2004 and 2005 the numbers include isolates from Room 111 in St. Paul and include both males and females.
†
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of 2005 QRNG cases
(n = 25)

All cases were male.

72% of the cases were White

32% of cases (8) were 25 or younger and a majority of cases (52%)
were among men 30 years of age or younger. (Mean age – 33,
Median age – 29)

24 of 25 cases (96%) were among gay/bisexual males

Twelve percent of cases among gay/bisexual males were also HIV+

A majority of cases reported having multiple sex partners in the
previous 60 days
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
What’s Being Done in Minnesota?

MDH continues to test gonorrhea isolates from Room 111 and Red Door
Clinic for Quinolone resistance

In 2005 and 2006, through a project funded by APHL and CDC, MDH
conducted surveillance for QRNG among women tested at Red Door Clinic
and Room 111.

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
STDs in Minnesota: Annual Review
Syphilis among Gay/Bisexual Men in
Minnesota
STDs in Minnesota: Annual Review
Early Syphilis Cases by Stage at Diagnosis
Minnesota, 1995-2005
100
80
Number of Cases
Primary
Secondary
Early Latent
60
40
20
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis* among Gay/Bisexual Men
Minnesota, 2001-2005
Year
Early Syphilis Cases
Males Cases (%)
MSM Cases
(% of males)
2001
49
27 (55)
5 (18)
2002
82
70 (85)
56 (80)
2003
93
84 (90)
73 (87)
2004
48
41 (85)
34 (83)
2005
116
109 (94)
100 (92)
* Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Early Syphilis* Cases Among Gay/Bisexual Men
Minnesota, 2005

Gay and Bisexual men account for 92% of cases among men

83% of cases among MSM are White, and 36% are between the ages of 30
and 39 (mean age = 35)

Seventy-three (73) percent of cases live in Hennepin County, and 54% in
the City of Minneapolis

Thirty-eight (38) percent of cases are HIV+

Internet was the most common venue for meeting partners (67%)

Among MSM, most reported having anonymous sex (63%), and of these
53% 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
and to ask about sex partners

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
STDs in Minnesota: Annual Review
Continuing Increase of the Chlamydia Rate
STDs in Minnesota: Annual Review
Chlamydia in Minnesota
Rate of Chlamydia and Gonorrhea
Rate per 100,000 by Year of Diagnosis, 1994-2005
260
240
220
200
180
160
140
120
100
80
60
40
20
0
248 per 100,000
115 per 100,000
1995
1996
1997 1998
1999
2000
2001
2002 2003
2004
2005
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates in Minnesota, 1996-2005

Between 1996 and 2004 the rate of Chlamydia infection has doubled
from 115 to 236 per 100,000. In 2005, it increased by 5 percent to
248 per 100,000

The rate has doubled both among men (54 to 138) and women (175
to 355)

Rates have almost tripled among 25-29 year olds (214 to 620) and
among 30-39 year olds (56 to 155)

Among 15-19 year olds rates have increased 1½ times (640 to 989)
and among 20-24 year olds rates have increased 2½ times (567 to
1496)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates in Minnesota, 1996-2005

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 40% and 67%, 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
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
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.
STDs in Minnesota: Annual Review
SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

Between 2004-2005, cases of Chlamydia, Gonorrhea and P&S Syphilis increased
to their highest levels ever

STD rates continue to be highest in Minneapolis and St. Paul. However Chlamydia
rates increased most in the suburbs (9%) and Greater MN (6%).

STD rates are highest among persons of color

Chlamydia (7 in 10) and gonorrhea (5 in 10) rates are highest among adolescents
and young adults; syphilis rates are highest among adults

The number of early syphilis cases more than doubled, with cases among MSM
increasing almost three fold

Prevalence of antibiotic-resistant gonorrhea has increased five fold between 2002
and 2005, specifically among gay and bi-sexual men
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review