Sexually Transmitted Disease (STD)
Surveillance Report, 2008
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.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
United States: State-Specific Chlamydia Rates, 2007
(National Rate = 370.2 per 100,000)
294
291
192
281
266
260
254
352
335
232
290
290
381
341
224
432
389
362
418
370
296
413
328
174
399
350
484
346
445
354
612
745
547
Rate per 100,000
population
458
365
452
733
440
318
Puerto Rico 201
Virgin Is. 320
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2007 Surveillance Slides.
169
156
251
298
327
247
408
412
1037
209
Guam 481
403
322
VT
NH
MA
RI
CT
NJ
DE
MD
DC
<=300
(n= 20)
300.1-400
(n= 17)
>400
(n= 17)
United States: State-Specific Gonorrhea Rates, 2007
(National Rate = 118.9 per 100,000)
57.1
12.9
8.9
18.2
33.4
66.9
18.3
121.5
33.4
15.7
81.1
94.4
64.7
71.0
102.1
162.2 139.2
32.2
85.8
91.7
153.4
82.6
183.5
51.1 82.0
169.0
82.0
Guam 82.4
82.1
91.9
134.9
188.2
158.4
148.3
239.0
Rate per 100,000
population
190.5
285.7 236.7
136.4
259.7
86.4
VT 10.3
NH 10.5
MA 41.9
RI 37.7
CT 66.4
NJ 69.6
DE 151.5
MD 120.5
DC 408.1
51.3
129.0
<=19.0
(n= 8)
19.1-100.0
(n= 25)
>100
(n= 21)
Puerto Rico 8.2
Virgin Is. 63.5
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2007 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific P&S Syphilis Rates, 2007
(National Rate = 3.8 per 100,000)
2.4
0.8
0.7
0.2
0.5
1.1
0.1
1.2
0.9
0.8
0.7
0.2
4.4
2.1
0.8
5.6
1.2
5.5
1.2
3.6
1.0
1.7
0.9
0.3
4.1
3.0
1.8
2.4
3.6
6.1
4.3
2.1
4.6
8.3
Rate per 100,000
population
7.3
4.9
12.4
1.0
1.6
2.3
2.4
3.4
1.1
2.6
2.1
6.1
30.6
1.3
Guam 4.7
4.8
VT
NH
MA
RI
CT
NJ
DE
MD
DC
0.7
5.0
<=0.2
(n= 4)
0.21-2.2
(n= 24)
>2.2
(n= 26)
Puerto Rico 4.3
Virgin Is. 0.0
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2007 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, 1998-2008
* P&S = Primary and Secondary.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
STDs in Minnesota:
Number of Cases Reported in 2008

Total of 17,650 STD cases reported to MDH in 2008:




14,350 Chlamydia cases
3,036 Gonorrhea cases
263 Syphilis cases (all stages)
0 Chancroid cases
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
2008 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
786
692
231
187
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
(540 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, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Gender
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender
Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
GONORRHEA
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Infections in Minnesota
by Residence at Diagnosis, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Gender
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by Gender
Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Excluding Blacks
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Prevalence of QRNG in Minnesota by
Mode of Transmission, 2002 - 2008 †
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SYPHILIS
STDs in Minnesota: Annual Review
Syphilis Rates by Stage of Diagnosis
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Infections
in Minnesota by Residence at Diagnosis, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Gender
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis
Rates by Gender, Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Cases by Race
Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 1998-2008
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
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Disproportionately Impacts Youth
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2008
Cases
% of Total
Male
2,771
25%
Female
8242
75%
4,286
3,704
338
368
2,317
11,013
39%
33%
3%
4%
21%
100%
White
Black
Am Indian
Asian/PI
Other/Unknown
TOTAL
†
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
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2008
Cases
% of Total
Hispanic
Non-Hispanic
Unknown
692
7,022
3,299
6%
64%
30%
Minneapolis
St. Paul
Suburban MN
Greater MN
Unknown
TOTAL
2,348
1,602
3,291
3,354
418
11,013
21%
15%
30%
30%
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, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia — Positivity Rates by Age and Gender
MIPP† Clinics, 2002-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Cases Among Adolescents and Young Adults†
by Gender and Race, Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2008
Data Source: Minnesota STD Surveillance System
Numbers above bars indicate female to male rate ratio
STDs in Minnesota: Annual Review
Chlamydia — Positivity Rates Among 15-24 Year-olds by Race
MIPP† Clinics, 2003-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates Among Adolescents & Young Adults†
by Gender in Minnesota, 1998-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea — Positivity Rates by Age and Gender
MIPP† Clinics, 2003-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Cases Among Adolescents and Young Adults†
by Gender and Race, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea — Positivity Rates Among 15-24 Year-olds by Race
MIPP† Clinics, 2003-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Summary of Chlamydia and Gonorrhea Among
Adolescents and Young Adults†, Minnesota, 2008




Adolescents and young adults accounted for 69% of
chlamydia and 59% 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 39% and 34% of
chlamydia or gonorrhea cases, respectively.
36% 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
Topics of Interest:
-Early Syphilis Among MSM
-Continuing Increase of Chlamydia
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis Among
Men Who Have Sex With Men
in Minnesota
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Number of Early Syphilis† Cases by Gender
Minnesota, 2001-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† Cases by Stage at Diagnosis
Minnesota, 2001-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† by Gender and Sexual Behavior
Minnesota, 2001-2008
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)
2008
163
158 (97)
140 (89)
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, 2008 (n=140)
30
Mean Age =
35 years
Number of Cases
25
20
15
10
5
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, 2008

Gay and bisexual men account for 89% of cases among men.

81% of cases among MSM are White, but a disproportionate number of
cases (13%) are African American.

70% of cases live in Hennepin County, and 49% in the City of
Minneapolis.

46% 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). SEP activities include:





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.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Continuing Increase of Chlamydia
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia in Minnesota
Rate per 100,000 by Year of Diagnosis, 1992-2008
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates in Minnesota, 1996-2008

From its lowest point in 1996, the incidence rate of chlamydia
infection has more than doubled from 115 to 292 per 100,000
persons. In 2008 the rate increased by 7%.

The rate tripled among men (54 to 168) and more than doubled
among women (175 to 413).

Rates more than tripled among 25-29 year-olds and 30-39 year-olds.

Rates among 15-19 year-olds increased by 1.8 times (640 to 1,164)
and rates among 20-24 year-olds tripled (567 to 1,715).

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 91% and 88%, 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.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

From 1998-2008, the chlamydia rate doubled while the gonorrhea rate
fluctuated but increased slightly.

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
in recent years the rates of chlamydia and gonorrhea increased the
most in the Twin Cities suburbs and Greater Minnesota.

Adolescents and young adults (15-24 years) have the highest rates of
chlamydia and gonorrhea, making up 67% of new infections in 2008.

Between 2007 and 2008, the chlamydia rate increased by 7% while the
gonorrhea rate fell by 12%. Primary/secondary syphilis cases
increased by 87% among men who have sex with men, who comprised
89% of all male cases in 2008; cases among women remain low.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review