Sexually Transmitted Disease (STD)
Surveillance Report, 2011
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
Changes in Rate Calculations for 2011

This 2011 data release includes rates calculated using
revised population estimates for the calendar years
between 2000 and 2010 U.S. Censuses

Previously published rates dating back to 2001 have been
updated in this release

Data from the 2010 U.S. Census, released in 2011
reflected substantial growth among populations of color and
American Indians in MN. Populations with the greatest
increase were Black or African American, Asian/Pacific
Islander, and Hispanic/Latino.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
Chlamydia—Rates by State, United States and Outlying Areas, 2010
National Rate = 422.6 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
Gonorrhea—Rates by State, United States and Outlying Areas, 2010
National Rate = 99.6 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
Primary and Secondary Syphilis—Rates by State
United States and Outlying Areas, 2010
National Rate = 4.5 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
Overview of STDs in Minnesota
STDs in Minnesota: Annual Review
STDs in Minnesota
Rate per 100,000 by Year of Diagnosis, 2001-2011
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
STDs in Minnesota:
Number of Cases Reported in 2011

Total of 19,547 STD cases reported to MDH in 2011:




16,898 Chlamydia cases
2,283 Gonorrhea cases
366 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
2011 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
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
848
795
271
198
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
(728 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, 2011
Total Number of Cases = 16,898
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, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender
Minnesota, 2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 2001-2011
2011 rates compared with Whites:
Black = 11x higher
American Indian = 4x higher
Asian/PI = 2x higher
Hispanic = 3x higher
* 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, 2001-2011
* 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
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
2011 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
Todd
Grant
0 - 10
11 - 29
Pine
Carver
Renville
Dakota
Scott
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le Sueur Rice
Rock
Nobles
(91 cases missing residence information)
Goodhue
Wabasha
Brown
Murray
Pipestone
211
132
30
14
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, 2011
Total Number of Cases= 2,283
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, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by Gender
Minnesota, 2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 2001-2011
2011 rates compared with Whites:
Black = 26x higher
American Indian = 6x higher
Asian/PI = 0x higher
Hispanic = 2x higher
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 2001-2011
* 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, 2001-2011
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Lake of the Woods
Kittson
Roseau
Marshall
Koochiching
Pennington
Beltrami
Cook
Clearwater
Red Lake
Polk
Norman
Lake
St. Louis
2011 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
Wabasha
Brown
Pipestone Murray
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
15.2 (58 cases)
4.9 (14 cases)
2.4 (52 cases)
0.5 (13 cases)
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, 2011
Total Number of Cases = 139
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, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 2001-2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis
Rates by Gender, Minnesota, 2011
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Cases by Race
Minnesota, 2011
Total Number of Cases = 139
*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, 2001-2011
* 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 2010
Chlamydia Cases in 2011
(n = 5,303,925)
(n = 16,898)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Disproportionately Impacts Youth
MN Population in 2010
Gonorrhea Cases in 2011
(n = 5,303,925)
(n = 2,283)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2011
† Adolescents defined
*
as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Total includes 5 cases diagnosed in transgendered persons
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2011
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, 2001-2011
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, 2002-2011
† 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, 2011
Males (n = 2,998)
† Adolescents
Females (n = 8,876)
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, 2011
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, 2002-2011
† 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, 2001-2011
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, 2002-2011
† 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, 2011
Males (n = 476)
† Adolescents
Females (n = 914)
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, 2011
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, 2002-2011
† 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, 2011




Adolescents and young adults accounted for 69% of
chlamydia and 65% of gonorrhea cases diagnosed in
Minnesota.
74% of chlamydia or gonorrhea cases diagnosed among
adolescents and young adults were females.
Whites and Blacks accounted for 43% and 31% of
chlamydia or gonorrhea cases, respectively.
32% 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, 2001-2011
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, 2001-2011
† 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, 2001-2011
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, 2011 (n=218)
Mean Age = 35.8 years
Range: 15 to 64 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
Early Syphilis† (ES) Cases
Co-infected with HIV, 2006-2011
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, 2011

Gay and bisexual men account for 88% of cases among men.

71% of cases among MSM are White, but a disproportionate number of
cases (15%) are African American.

52% in the City of Minneapolis and 30% live in the suburbs

57% 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 - includes several archived provider
presentations and links to current awareness campaign materials
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 2001-2011, the chlamydia rate increased by 90%. Gonorrhea increased for the
first time since 2007. Rates of reported syphilis increased slightly in 2011 compared to
2010.

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
64% of the reported cases in 2011.

Adolescents and young adults (15-24 years) have the highest rates of chlamydia and
gonorrhea, making up 69% of new infections in 2011.

Between 2010 and 2011, the chlamydia rate increased by 9% and the gonorrhea rate
increased by 5%. Primary/secondary syphilis cases decreased by 8%. Men who
have sex with men comprised 88% of all male cases in 2011; cases among women
remain low.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review