Sexually Transmitted Disease (STD)
Surveillance Report, 2009
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, 2008
(National Rate = 401.3 per 100,000)
331
324
198
300
287
276
280
375
371
302
314
314
377
340
228
460
407
395
332
470
409
411
349
183 405
422
287
Guam 396
391
458
446
414
455
499
597
728
535
447
528
466
389
Puerto Rico 174
Virgin Is. 535
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2007 Surveillance Slides.
192
160
271
314
357
258
447
439
1177
Rate per 100,000
population
422
711
VT
NH
MA
RI
CT
NJ
DE
MD
DC
<=300
300.1-400
>400
(n= 13)
(n= 17)
(n= 24)
United States: State-Specific Gonorrhea Rates, 2008
(National Rate = 111.6 per 100,000)
48.3
12.7
7.3
22.4
32.7
58.4
12.5
108.7
47.1
23.7
82.3
84.7
56.9
77.3
89.0
160.9 138.2
18.0
70.5
81.9
71.2
143.3
146.5
41.2 134.0
136.3
107.2
Guam 62.8
54.4
88.7
169.4
176.3
142.6
159.2
214.2
Rate per 100,000
population
170.5
256.8 210.5
134.7
220.2
84.6
47.5
VT
6.0
NH
7.6
MA 33.0
RI 29.0
CT 80.0
NJ 61.0
DE 120.8
MD 118.6
DC 451.5
127.8
<=19.0
19.1-100.0
>100
(n= 7)
(n= 24)
(n= 23)
Puerto Rico 6.9
Virgin Is. 109.3
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2008 Surveillance Slides.
STDs in Minnesota: Annual Review
United States: State-Specific P&S Syphilis Rates, 2008
(National Rate = 4.5 per 100,000)
2.8
0.7
0.8
0.0
0.7
2.2
0.5
1.2
0.1
0.6
0.5
0.8
3.0
2.2
0.9
6.0
2.6
4.3
1.1
2.4
2.2
3.1
2.2
0.7
3.8
3.4
2.2
Guam 3.5
5.0
6.3
2.1
3.2
6.7
7.3
2.2
6.3
9.7
1.8
1.5
3.3
1.7
1.0
2.6
1.9
6.7
24.8
Rate per 100,000
population
9.6
5.9
16.5
0.1
VT
NH
MA
RI
CT
NJ
DE
MD
DC
2.3
5.7
<=0.2
0.21-2.2
>2.2
(n= 4)
(n= 23)
(n= 27)
Puerto Rico 4.2
Virgin Is. 0.0
SOURCE:
Centers for Disease Control & Prevention, Division of STD Prevention. 2008 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, 1999-2009
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
1999
2000
2001
* P&S = Primary and Secondary.
Data Source: Minnesota STD Surveillance System
2002
2003
2004
2005
2006
2007
2008
2009
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 2009

Total of 16,702 STD cases reported to MDH in 2009:




14,186 Chlamydia cases
2,302 Gonorrhea cases
214 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
2009 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
741
687
233
185
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
(581 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, 2009
Total Number of Cases = 14,186
Unknown
4%
Minneapolis
20%
Greater MN
30%
St. Paul
14%
Suburban
32%
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, 1999-2009
450
Males
Overall
Rate per 100,000 persons .
400
Females
350
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 1999-2009
1800
Rate per 100,000 persons .
1600
15-19
20-24
25-29
30-39
1400
1200
1000
800
600
400
200
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender
Minnesota, 2009
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, 1999-2009
2250
White
Black
2000
American Indian
Asian/PI
Hispanic*
Rate per 100,000 persons .
1750
1500
2009 rates compared with Whites:
Black = 16x higher
American Indian = 4x higher
Asian/PI = 3x higher
Hispanic = 5x higher
1250
1000
750
500
250
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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
Minnesota, 1999-2009
White
Asian/PI
800
American Indian
Hispanic*
Rate per 100,000 persons .
700
600
500
400
300
200
100
0
1999
2000
2001
2002
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
2003
2004
2005
2006
2007
2008
2009
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
2009 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
(93 cases missing residence information)
Goodhue
Wabasha
Brown
Murray
Pipestone
188
141
32
20
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, 2009
Total Number of Cases= 2,302
Unknown
4%
Greater MN
19%
Suburban
28%
Minneapolis
31%
St. Paul
18%
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, 1999-2009
Males
Overall
100
90
Females
Rate per 100,000 persons .
80
70
60
50
40
30
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 1999-2009
400
15-19
20-24
25-29
30-39
Rate per 100,000 persons .
350
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by Gender
Minnesota, 2009
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, 1999-2009
White
American Indian
Hispanic*
1200
Rate per 100,000 persons .
1000
Black
Asian/PI
800
2009 rates compared with Whites:
Black = 36x higher
American Indian = 5x higher
Asian/PI = 0x higher
Hispanic = 4x higher
600
400
200
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Rate per 100,000 persons .
Gonorrhea Rates by Race/Ethnicity
Minnesota, 1999-2009
160
White
American Indian
140
Asian/PI
Hispanic*
120
100
80
60
40
20
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Quinolone-Resistant Neisseria gonorrhoeae
in Minnesota



MDH routinely tracked fluoroquinolone resistance in gonorrhea
isolates from 1999 – 2008 through the Gonococcal Isolate
Surveillance Program (GISP) and continues limited resistance
testing.
Resistance to ciprofloxacin increased from 0% of isolates
among MSM in 1999 to a peak of 28% in 2007. The proportion
then decreased in 2008 to 15%. Among heterosexuals,
ciprofloxacin resistance increased from 0% of isolates in 1999 to
5% in 2008.
As of April 12, 2007 fluoroquinolones were no longer
recommended for the treatment of gonorrhea†.
for Disease Control and Prevention.[Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines,
2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections]. MMWR 2007;56:[332-336].
†Centers
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SYPHILIS
STDs in Minnesota: Annual Review
Syphilis Rates by Stage of Diagnosis
Minnesota, 1999-2009
Rate per 100,000 persons .
6.0
5.5
All Stages
5.0
P&S*
4.5
Early Latent
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1999
2000
2001
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
2002
2003
2004
2005
2006
2007
2008
2009
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
2009 Minnesota
Primary & Secondary
Syphilis Rates by
County
Itasca
Mahnomen
Hubbard
Becker
Clay
Cass
Crow Wing
Wadena
Aitkin
Carlton
Wilkin
Otter Tail
Morrison
Douglas
0 – 0.2
Kanabec
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
0.21 – 1.0
> 1.0
Benton
Stevens
Chisago
Grant
Rate per 100,000 persons
Pine
Mille Lacs
Traverse
Todd
Carver
Renville
Scott
Dakota
Sibley
Lincoln Lyon
Redwood
Nicollet
Le Sueur
Rice
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
(38 cases)
(10 cases)
(18 cases)
(5 cases)
Goodhue
Wabasha
Brown
Pipestone Murray
9.9
3.5
0.9
0.2
Blue Earth Waseca
Faribault
Data Source: Minnesota STD Surveillance System
Steele
Freeborn
Dodge Olmsted
Mower
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, 2009
Total Number of Cases = 71
Greater MN
7%
Suburban
25%
Minneapolis
54%
St. Paul
14%
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, 1999-2009
5.0
Males
4.5
Overall
Females
Rate per 100,000 persons .
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 1999-2009
8.0
Rate per 100,000 persons .
7.0
15-19
20-24
30-39
40-49
25-29
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis
Rates by Gender, Minnesota, 2009
Rate per 100,000 persons
8
7
Males
6
Females*
5
4
3
2
1
0
15-19
20-24
25-29
30-39
40-44
45-49
50+
Age in Years
*0 primary/secondary female syphilis cases were reported in 2009.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Cases by Race
Minnesota, 2009
Total Number of Cases = 71
Asian/PI
0%
Other*
8%
American Indian
1%
Black
15%
White
76%
*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, 1999-2009
14
Rate per 100,000 persons .
12
White
Black
American Indian
Asian/PI
Hispanic*
10
8
6
4
2
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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 2009
(n = 4,919,479)
(n = 14,186)
25-29 yrs
16%
25-34 yrs
14%
35+ yrs
50%
30-44 yrs
12%
15-24 yrs
14%
45+ yrs
2%
15-24 yrs
69%
<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 2009
(n = 4,919,479)
(n = 2,302)
25-29 yrs
19%
25-34 yrs
14%
35+ yrs
50%
30-44 yrs
17%
15-24 yrs
14%
45+ yrs
4%
<15 yrs
1%
<15 yrs
22%
Data Source: Minnesota STD Surveillance System
15-24 yrs
59%
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2009
†
Cases
% of Total
Male
2,644
25%
Female
Transgender
8,007
1
75%
--
White
4,164
39%
Black
Am Indian
Asian/PI
3,483
323
267
33%
3%
3%
Other/Unknown
TOTAL
2,415
10,652
23%
100%
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 2009
Cases
% of Total
Hispanic
Non-Hispanic
Unknown
594
6,516
3,542
6%
61%
33%
Minneapolis
St. Paul
Suburban MN
Greater MN
Unknown
TOTAL
2,052
1,560
3,253
3,357
430
10,652
19%
15%
31%
32%
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, 1999-2009
2400
Males
Females
Rate per 100,000 persons .
2100
1800
1500
1200
900
600
300
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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, 2002-2009
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
2008
2009
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, 2009
Males (n = 2,314)
White
33%
Females (n = 7,490)
Black
40%
Unknown
20%
† Adolescents
White
45%
Amer
Indian
1%
Other
4%
Asian/PI
2%
Black
29%
Unknown
14%
Other
5%
Amer Indian
4%
Asian / PI
3%
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, 2009
Males
Females
Rate per 100,000 persons .
16,000
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, 2002-2009
Percent Positive
(No. positive / No. of tests)
20%
White
Black
American Indian
Asian/PI
16%
12%
8%
4%
0%
2002
2003
2004
2005
2006
2007
2008
2009
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, 1999-2009
Males
450
Females
Rate per 100,000 persons .
400
350
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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,1999-2009
6%
Males, 15-19
Females, 15-19
Males, 20-24
Females, 20-24
2004
2006
Percent Positive
(No. positive / No. of tests)
5%
4%
3%
2%
1%
0%
2002
2003
2005
2007
2008
2009
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, 2009
Males (n = 496)
Females (n = 877)
Black
50%
Black
59%
White
19%
White
27%
Unknown
15%
Other
4%
† Adolescents
Asian/PI
2%
Amer
Indian
1%
Unknown
13%
Amer Indian
4%
Other
5%
Asian / PI
1%
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, 2009
Males
Females
Rate per 100,000 persons .
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, 2002-2009
Percent Positive
(No. positive / No. of tests)
10%
8%
White
Black
American Indian
Asian/PI
6%
4%
2%
0%
2002
2003
2004
2005
2006
2007
2008
2009
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, 2009




Adolescents and young adults accounted for 69% of
chlamydia and 60% 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 33% of
chlamydia or gonorrhea cases, respectively.
34% 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
Topic of Interest:
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, 2001-2009
160
All Male
140
MSM
Number of Cases
120
100
80
60
40
20
Women
0
2001
2002
2003
2004
2005
Year
2006
2007
2008
2009
MSM=Men who have sex with men.
Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, 2007, and 2009).
† 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, 2001-2009
Primary
Secondary
Early Latent
Total
160
Number of Cases
140
120
100
80
60
40
20
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
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, 2001-2009
Year
Early Syphilis Cases
Male Cases (%)
MSM Cases
(% of males)
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)
2009
117
106 (91)
96 (91)
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, 2009 (n=96)
20
18
Mean Age = 36 years
Range: 17 to 66 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, 2009

Gay and bisexual men account for 91% of cases among men.

76% of cases among MSM are White, but a disproportionate number of
cases (13%) are African American.

68% of cases live in Hennepin County, and 53% in the City of
Minneapolis.

53% 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
Effort (SEE). SEE 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
SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

From 1999-2009, the chlamydia rate increased by 88% while gonorrhea decreased to
the lowest reported rate for the past decade. Rates of reported chlamydia, gonorrhea
and syphilis decreased in 2009 compared to 2008.

Minnesota has seen a resurgence of syphilis over the past decade, 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. However, chlamydia
and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for
63% of the reported cases in 2009.

Adolescents and young adults (15-24 years) have the highest rates of chlamydia and
gonorrhea, making up 67% of new infections in 2009.

Between 2008 and 2009, the chlamydia rate decreased by 2% while the gonorrhea
rate fell by 24%. Primary/secondary syphilis cases decreased by 37% among men
who have sex with men, who comprised 91% of all male cases in 2009; cases among
women remain low.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review