Sexually Transmitted Disease (STD)
Surveillance Report, 2007
Minnesota Department of Health
STD Surveillance System
www.health.state.mn.us/std
Introduction

Under Minnesota law, physicians and laboratories must
report all laboratory-confirmed cases of chlamydia,
gonorrhea, syphilis, and chancroid to the Minnesota
Department of Health (MDH) within one working day.

The MDH does not maintain statistics for other, nonreportable STDs (ex: herpes, HPV/genital warts).

This slide set describes trends in reportable STDs in
Minnesota by person, place, and time.

Analyses exclude cases reported from federal and private
prisons.
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 STD
data include:
Level of STD screening by healthcare providers
 Individual test-seeking behavior
 Sensitivity of diagnostic tests
 Compliance with case reporting
 Completeness of 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 above factors.
STDs in Minnesota: Annual Review
Interpreting STD Surveillance Data

The surveillance system only includes cases diagnosed in
conjunction with a positive laboratory test. Cases
diagnosed solely on symptoms are not counted.

Surveillance data represent cases of infection, not
individuals. A person with multiple infections in a given year
will be counted more than once.

Caution is warranted when interpreting changes in STD
numbers that can seem disproportionately large when the
number of cases is small.
STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
United States: State-Specific Chlamydia Rates, 2006
(National Rate = 347.8 per 100,000)
283
283
175
286
263
252
234
365
339
279
348
376
309
206
350
283
285
318
350
420 317
396
Guam 494
406
510
357
363
366
214
160 318
425
297
387
525
331
395
435
191
152
241
292
312
232
429
390
612
Rate per 100,000
population
430
651 503
682
VT
NH
MA
RI
CT
NJ
DE
MD
DC
275
<=150
(n= 1)
150.1-300
(n= 21)
>300
(n= 32)
Puerto Rico 130
Virgin Is. 187
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2006 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific Gonorrhea Rates, 2006
(National Rate = 120.9 per 100,000)
67.3
20.7
10.4
24.0
40.1
64.4
14.4
125.1
47.3
23.6
81.5
115.6
66.3
79.2
92.2
158.2 139.2
36.0
93.4
80.5
89.9
139.5
167.4
52.5 85.6
175.9
78.5
Guam 58.1
100.2
90.7
154.9
199.4
162.6
154.9
242.5
Rate per 100,000
population
216.8
257.1 234.0
133.2
240.6
94.9
VT 11.6
NH 13.7
MA 38.0
RI 47.2
CT 74.4
NJ 63.0
DE 176.0
MD 130.8
DC 342.8
69.4
134.8
<=19.0
(n= 5)
19.1-100.0
(n= 27)
>100
(n= 22)
Puerto Rico 7.7
Virgin Is. 31.3
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2006 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific P&S Syphilis Rates, 2006
(National Rate = 3.3 per 100,000)
2.9
0.1
0.7
0.2
0.8
0.9
0.2
1.2
1.7
0.0
0.6
0.4
5.7
2.1
0.9
5.1
1.5
3.8
1.2
3.4
1.0
1.5
0.6
2.9
2.0
4.1
2.5
3.6
4.2
2.8
1.6
2.9
7.0
Rate per 100,000
population
6.4
4.7
7.6
1.7
0.5
1.0
1.9
1.3
1.8
2.0
2.4
5.4
21.1
1.7
Guam 1.8
3.4
1.6
VT
NH
MA
RI
CT
NJ
DE
MD
DC
1.4
4.0
<=0.2
(n= 4)
0.21-4.0
(n= 40)
>4.0
(n= 10)
Puerto Rico 3.8
Virgin Is. 0.9
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2006 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, 1997-2007†
Gonorrhea
P&S* Syphilis
300
10
275
9
250
8
225
7
200
175
6
150
5
125
4
100
3
75
2
50
25
1
0
0
1997
1998
1999
* P&S = Primary and Secondary.
Data Source: Minnesota STD Surveillance System
2000
2001
2002
2003
2004
2005
2006
2007
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 2007

Total of 17,057 STD cases reported to MDH in 2007:



13,412 Chlamydia cases
3,459 Gonorrhea cases
186 Syphilis cases (all stages)
Note: Chancroid remains extremely rare in Minnesota. There were no cases reported in 2007.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA
STDs in Minnesota: Annual Review
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Mahnomen
Clay
Becker
2007 Minnesota
Chlamydia Rates
by County
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
151 - 300
> 300
Pine
Todd
Grant
Carlton
Morrison
Douglas
Kanabec
Wilkin
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
769
659
213
170
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
(502 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 by Residence at Diagnosis
Minnesota, 2007
Total Number of Cases = 13,412
Unknown
4%
Minneapolis
22%
Greater MN
29%
St. Paul
14%
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, 1997-2007
Males
Overall
400
Females
Rate per 100,000 persons .
350
300
250
200
150
100
50
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 1997-2007
1800
Rate per 100,000 persons .
1600
15-19
20-24
25-29
30-39
1400
1200
1000
800
600
400
200
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender
Minnesota, 2007
Rate per 100,000 persons .
2400
2100
Males
1800
Females
1500
1200
900
600
300
0
10-14
15-19
20-24
25-29
30-39
40-44
45-49
50+
Age in Years
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 1997-2007
2250
2000
White
Black
American Indian
Asian/PI
Hispanic*
Rate per 100,000 persons .
1750
1500
1250
1000
750
500
250
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
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, 1997-2007
800
Rate per 100,000 persons .
700
White
American Indian
Asian/PI
Hispanic*
600
500
400
300
200
100
0
1997
1998
1999
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
2000
2001
2002
2003
2004
2005
2006
2007
Year
STDs in Minnesota: Annual Review
GONORRHEA
STDs in Minnesota: Annual Review
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
2007 Minnesota
Gonorrhea Rates
by County
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
Grant
0 - 10
11 - 29
Pine
Todd
Carver
Renville
Dakota
Scott
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le Sueur Rice
Rock
Nobles
(123 cases missing residence information)
Goodhue
Wabasha
Brown
Murray
Pipestone
325
244
42
25
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, 2007
Total Number of Cases= 3,459
Unknown
4%
Greater MN
16%
Minneapolis
36%
Suburban
24%
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, 1997-2007
Males
Overall
100
90
Females
Rate per 100,000 persons .
80
70
60
50
40
30
20
10
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 1997-2007
400
15-19
20-24
25-29
30-39
Rate per 100,000 persons .
350
300
250
200
150
100
50
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by Gender
Minnesota, 2007
Rate per 100,000 persons
400
350
Males
300
Females
250
200
150
100
50
0
10-14
15-19
20-24
25-29
30-39
40-44
45-49
50+
Age in Years
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 1997-2007
White
American Indian
Hispanic*
1200
Rate per 100,000 persons .
1000
Black
Asian/PI
800
600
400
200
0
1997
1998
1999
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
2000
2001
2002
2003
2004
2005
2006
2007
Year
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1997-2007
160
Rate per 100,000 persons .
140
White
American Indian
Asian/PI
Hispanic*
120
100
80
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SYPHILIS
STDs in Minnesota: Annual Review
Syphilis Rates by Stage of Diagnosis
Minnesota, 1997-2007
5.0
All Stages
4.5
P&S*
Rate per 100,000 persons .
4.0
Early Latent
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1997
1998
1999
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
2000
2001
2002
2003
2004
2005
2006
2007
Year
STDs in Minnesota: Annual Review
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Lake
St. Louis
2007 Minnesota
Primary & Secondary
Syphilis Rates by
County
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
Pipestone Murray
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
Blue Earth Waseca
Faribault
Data Source: Minnesota STD Surveillance System
Steele
Freeborn
Dodge Olmsted
Mower
(35 cases)
(5 cases)
(15 cases)
(3 cases)
(1 case missing residence information)
Wabasha
Brown
9.1
1.7
0.8
0.1
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Infections
in Minnesota by Residence at Diagnosis, 2007
Total Number of Cases = 59
Greater MN
5%
Unknown
2%
Suburban
25%
Minneapolis
60%
St. Paul
8%
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, 1997-2007
Males
4.0
Overall
3.5
Rate per 100,000 persons .
Females
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 1997-2007
5.0
15-19
20-24
4.5
30-39
40-49
25-29
Rate per 100,000 persons .
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis
Rates by Gender, Minnesota, 2007
6
Males
Rate per 100,000 persons
5
Females
4
3
2
1
0
15-19
20-24
25-29
30-39
40-44
45-49
50+
Age in Years
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Cases by Race
Minnesota, 2007
Total Number of Cases = 59
Asian/PI
2%
Other*
2%
Unknown
8%
American Indian
0%
Black
19%
White
69%
*Includes persons reported with more than one race
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 1997-2007
14
Rate per 100,000 persons .
12
White
Black
American Indian
Asian/PI
Hispanic*
10
8
6
4
2
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA AND GONORRHEA AMONG
ADOLESCENTS & YOUNG ADULTS
(15-19 year olds)
(20-24 year olds)
STDs in Minnesota: Annual Review
Chlamydia Disproportionately Impacts Youth
MN Population in 2000
Chlamydia Cases in 2007
(n = 4,919,479)
(n = 13,412)
25-29 yrs
17%
25-34 yrs
14%
35+ yrs
50%
30-44 yrs
12%
15-24 yrs
14%
45+ yrs
2%
15-24 yrs
68%
<15 yrs
1%
<15 yrs
22%
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Disproportionately Impacts Youth
MN Population in 2000
Gonorrhea Cases in 2007
(n = 4,919,479)
(n = 3,459)
25-29 yrs
19%
25-34 yrs
14%
35+ yrs
50%
30-44 yrs
20%
15-24 yrs
14%
45+ yrs
4%
<15 yrs
1%
<15 yrs
22%
Data Source: Minnesota STD Surveillance System
15-24 yrs
56%
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2007
† Adolescents
Cases
% of Total
Male
Female
Transgender
2,484
7,853
3
24%
76%
< 1%
White
Black
Am Indian
Asian/PI
Other/Unknown
TOTAL
4,071
3,328
344
309
2,288
10,340
39%
32%
3%
3%
22%
100%
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
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2007
Cases
% of Total
Hispanic
Non-Hispanic
Unknown
625
6,276
3,439
6%
61%
33%
Minneapolis
St. Paul
Suburban MN
Greater MN
Unknown
TOTAL
2,399
1,555
2,961
3,052
373
10,340
24%
16%
30%
31%
4%
100%
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.
† 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
Chlamydia Rates Among Adolescents & Young Adults†
by Gender in Minnesota, 1997-2007
2400
Males
Females
Rate per 100,000 persons .
2100
1800
1500
1200
900
600
300
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
† 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
Chlamydia — Positivity Rates by Age and Gender
MIPP† Clinics, 2002-2007
20%
Males, 15-19
Females, 15-19
Males, 20-24
Females, 20-24
Percent Positive
(No. positive / No. of tests)
16%
12%
8%
4%
0%
2002
2003
2004
2005
2006
2007
Year
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women
ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Cases Among Adolescents and Young Adults†
by Gender and Race, Minnesota, 2007
Males (n = 2,046)
Females (n = 7,095)
White
32%
Black
41%
Unknown
19%
† Adolescents
White
43%
Black
26%
Amer Indian
4%
Amer Indian
2%
Other
4%
Asian/PI
2%
Unknown
18%
Asian / PI
4%
Other
5%
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
Chlamydia Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2007
Males
Females
Rate per 100,000 persons .
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
White
Black
American
Indian
Asian/PI
Hispanic
Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
† 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
Chlamydia — Positivity Rates Among 15-24 Year-olds by Race
MIPP† Clinics, 2002-2007
White
American Indian
Percent Positive
(No. positive / No. of tests)
20%
Black
Asian/PI
16%
12%
8%
4%
0%
2002
2003
2004
2005
2006
2007
Year
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women
ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates Among Adolescents & Young Adults†
by Gender in Minnesota, 1997-2007
450
Males
Females
Rate per 100,000 persons .
400
350
300
250
200
150
100
50
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
† 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
Gonorrhea — Positivity Rates by Age and Gender
MIPP† Clinics, 2002-2007
6%
Males, 15-19
Females, 15-19
Males, 20-24
Females, 20-24
Percent Positive
(No. positive / No. of tests)
5%
4%
3%
2%
1%
0%
2002
2003
2004
2005
2006
2007
Year
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women
ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Cases Among Adolescents and Young Adults†
by Gender and Race, 2007
Males (n = 647)
Females (n = 1,285)
Black
65%
Black
46%
White
31%
White
14%
Amer Indian
1%
Unknown
16%
Other
3%
† Adolescents
Asian/PI
1%
Unknown
14%
Amer Indian
4%
Other Asian / PI
1%
4%
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
Gonorrhea Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2007
Males
Females
Rate per 100,000 persons .
4500
4000
3500
3000
2500
2000
1500
1000
500
0
White
Black
American
Indian
Asian/PI
Hispanic
Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
† 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
Gonorrhea — Positivity Rates Among 15-24 Year-olds by Race
MIPP† Clinics, 2002-2007
10%
Percent Positive
(No. positive / No. of tests)
8%
White
Black
American Indian
Asian/PI
6%
4%
2%
0%
2002
2003
2004
2005
2006
2007
Year
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women
ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Summary of Chlamydia and Gonorrhea Among
Adolescents and Young Adults†, Minnesota, 2007




Adolescents and young adults accounted for 68% of
chlamydia and 56% of gonorrhea cases diagnosed in
Minnesota.
75% of chlamydia or gonorrhea cases diagnosed among
adolescents and young adults were females.
Whites and Blacks accounted for 40% and 32% of
chlamydia or gonorrhea cases, respectively. Rates
39% of gonorrhea or chlamydia cases were in the Cities of
Minneapolis and Saint Paul.
† 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:
-Fluoroquinolone-Resistant Gonorrhea
-Early Syphilis Among MSM
-Continuing Increase of Chlamydia
STDs in Minnesota: Annual Review
Fluoroquinolone-Resistant Gonorrhea
in Minnesota
STDs in Minnesota: Annual Review
Background: Antibiotic-Resistant Gonorrhea

Gonorrhea has developed resistance to nearly every drug
used since the advent of antimicrobial therapy.



Tetracycline and penicillins abandoned in 1980s.
Only cephalosporins remain recommended by CDC.
Current threat: Quinolone-resistant N. gonorrhoeae (QRNG)



Emerged in Asia in 1990s, spread to U.S. West Coast.
Since 2000, CDC has recommended non-quinolone therapy for
populations where QRNG exceeds 5% (Hawaii, California,
gay/bisexual men).
April 2007: QRNG >5% among heterosexuals; CDC removes
quinolones from gonorrhea treatment recommendations.
STDs in Minnesota: Annual Review
Surveillance of Antibiotic-resistant Gonorrhea
in Minnesota


Two STD clinics in Minneapolis/St. Paul send cultures to
the MDH on a monthly basis.
The MDH lab determines susceptibilities to:
Azithromycin
Ciprofloxacin
Tetracycline


Cefixime
Penicillin
Ceftriaxone
Spectinomycin
Clinics are notified of resistant results.
The MDH Partner Services Program follows up on all
QRNG cases and their sex partners to ensure proper
treatment.
STDs in Minnesota: Annual Review
Antibiotic-resistant Gonorrhea in Minnesota
Number tested
Ciprofloxacin
400
Penicillin
Azithromycin
Tetracycline
25
20
300
250
15
200
10
150
100
Percent resistant
No. isolates tested
350
5
50
0
0
2002
2003
2004
2005
2006
2007
No isolates were resistant to cefixime or ceftriaxone. One isolate (0.3%) was resistant to spectinomycin in 2004. Data for
azithromycin indicate reduced susceptibility rather than resistance.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Prevalence of QRNG in Minnesota†,
1999 - 2007
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%
2006
19
328
5.8%
2007
31
361
8.6%
QRNG=Quinolone-Resistant Neisseria gonorrhoeae
† Surveillance from 1999-2001 includes isolates from males at one STD clinic. A second STD clinic was added in 2002 that submits isolates for both
males and females.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Prevalence of QRNG in Minnesota by
Mode of Transmission, 2002 - 2007 †
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%
2006
17
63
27%
2
258
0.8%
2007
18
64
28%
13
288
4.5%
QRNG=Quinolone-Resistant Neisseria gonorrhoeae
† Surveillance from 1999-2001 includes isolates from males at one STD clinic. A second STD clinic was added in 2002 that submits isolates for both
males and females.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of 2007 QNRG cases
(n = 31)

29 males, 2 females

61% of the cases were White, 10% Asian

37% of cases were 15-24 years old, 16% were 45 or older
(Mean age – 31, Median age – 28)

18 of 31 cases (58%) were among gay/bisexual males
QRNG=Quinolone-Resistant Neisseria gonorrhoeae
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
What’s Being Done in Minnesota?

The MDH continues to monitor gonorrhea isolates for
antibiotic resistance and ensure proper treatment of QRNG
cases and their sex partners.

Clinicians and laboratories are asked to report suspected
treatment failures and resistant gonococcal isolates to the
MDH.

The MDH and CDC recommend against the use of
fluoroquinolones for patients testing positive for gonorrhea.
QRNG=Quinolone-Resistant Neisseria gonorrhoeae
STDs in Minnesota: Annual Review
Early Syphilis Among
Men Who Have Sex With Men
in Minnesota
STDs in Minnesota: Annual Review
Number of Early Syphilis† Cases by Gender
Minnesota, 2001-2007
120
All Male
MSM
Number of Cases
100
80
60
40
20
Women
0
2001
2002
2003
2004
Year
2005
2006
2007
MSM=Men who have sex with men.
Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, and 2007).
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† Cases by Stage at Diagnosis
Minnesota, 2001-2007
Primary
Secondary
Early Latent
Total
120
Number of Cases
100
80
60
40
20
0
2001
2002
2003
2004
2005
2006
2007
Year
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† by Gender and Sexual Behavior
Minnesota, 2001-2007
Year
Early Syphilis Cases
Male 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)
2006
104
90 (88)
80 (89)
2007
114
111 (97)
103 (93)
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† Cases Among MSM by Age
Minnesota, 2007 (n=103)
20
18
Mean Age =
36 years
Number of Cases
16
14
12
10
8
6
4
2
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55+
Age in Years
MSM=Men who have sex with men
† 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 MSM, Minnesota, 2007

Gay and bisexual men account for 93% of cases among men.

74% of cases among MSM are White, but a disproportionate number of
cases (15%) are African American.

71% of cases live in Hennepin County, and 59% in the City of
Minneapolis.

44% of cases are also infected with HIV.

Among cases interviewed by the MDH Partner Services Program:
 Commonly reported risk factors were meeting partners on the internet,
anonymous sex, and no condom use.
MSM=Men who have sex with men
† 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?

The MDH Partner Services Program continues to follow up
on early syphilis cases and their sex partners.

In 2004 the MDH implemented the Syphilis Elimination
Project (SEP). In 2007, SEP:





Developed a clinician toolkit for syphilis testing and treatment;
Created a new outbreak response plan; and
Increased awareness among gay/bisexual men through
advertising in magazines, bars, and websites.
SEP website: www.health.state.mn.us/sep
Physicians are encouraged to screen men who have sex
with men at least annually and to ask about sex partners.
STDs in Minnesota: Annual Review
Continuing Increase of Chlamydia
STDs in Minnesota: Annual Review
Chlamydia in Minnesota
Rate per 100,000 by Year of Diagnosis, 1992-2007
300
Rate of Chlamydia per 100,000 .
275
250
225
200
273 per 100,000
175
150
125
100
75
115 per 100,000
50
25
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates in Minnesota, 1996-2007

From its lowest point in 1996, the incidence rate of chlamydia
infection has more than doubled from 115 to 273 per 100,000
persons. In 2007 the rate increased by 4%.

The rate almost tripled among men (54 to 153) and more than
doubled among women (175 to 390).

Rates more than tripled among 25-29 year-olds and 30-39 year-olds.

Rates among 15-19 year-olds increased by 1.7 times (640 to 1071)
and rates among 20-24 year-olds nearly tripled (567 to 1592).

In this time period, rates more than doubled among Whites,
Hispanics, and Asian/Pacific Islanders.

The chlamydia rates among Blacks and American Indians increased
by 69% and 65%, respectively.
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 combination of
factors including:


Improved diagnostic tools with increased sensitivity
Addition of active surveillance component to MDH STD
surveillance system

Improved case reporting among providers

Improved screening practices by clinicians

Increase of disease in the population
Effects of the first three factors above would have stabilized over time.
Therefore, the sustained upward trend is most likely due to increased
screening by providers and/or an actual increase of disease in the
population.
STDs in Minnesota: Annual Review
STD SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

From 1997-2007, the chlamydia rate more than doubled while the
gonorrhea rate grew slowly but steadily.

Minnesota has seen a resurgence of syphilis since 2002, with men who
have sex with men being especially impacted.

Persons of color continue to be disproportionately affected by STDs.

STD rates are highest in the cities of Minneapolis and Saint Paul. But
from 2006 to 2007 the rates of chlamydia and gonorrhea increased the
most in Greater Minnesota.

Adolescents and young adults (15-24 years) have the highest rates of
chlamydia and gonorrhea, making up 68% of new infections in 2007.

Between 2006 and 2007, rates of chlamydia and gonorrhea increased
by 4% and 5%, respectively. Primary/secondary syphilis cases
increased by 38% among men who have sex with men, who comprised
95% of all male cases in 2007; cases among women remain low.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review