Sexually Transmitted Diseases
What Me Worry ?
STD Trends and Prevention Strategies
A State Perspective
August 8, 2007 Springfield, Illinois
Illinois Department of Public Health
Office of Health Protection, Division of Infectious Diseases,
STD Section
Why You Should Care About STDs




Very Common in US
Often Asymptomatic
STDs Facilitate Increased HIV Transmission
Cause Significant Medical & Psychological Complications




Infertility
Cancer
Adverse Pregnancy Outcomes
Newborn Illness and Death
 Some are Incurable
 High Health Care Cost - $16.6 Billion per year in US
 Teens-Young Adults, Women & Economically
Disadvantaged Are Disproportionately Affected
 Social Stigma & Mixed Messages Hamper Prevention
Source: Tracking the Hidden Epidemics, 2000; CDC
Estimated Annual New Cases of STDs in US
Total Incidence 15 Million
HIV
20,000
Trichomoniasis
5 million
Hepatitis B
102,000
HPV
5.5 million
Herpes
1 million
70,000
Syphilis
Gonorrhea
650,000
Chlamydia
3 million
0
1
Source: Tracking the Hidden Epidemics 2000, CDC
2
3
4
5
6
Millions
Estimated Prevalence of Leading STDs
HIV
(560,000)
Hepatitis B
(750,000)
Chlamydia (3 million)
HPV (20 million)
Herpes (45 million)
Kaiser Family Foundation and American Social Health Association. 1998.
STDs are Sexist

Transmission efficiency greater male to
female than the reverse
 More women asymptomatic or with
atypical, nonspecific Sx; delayed care
 Diagnosis more difficult in women
 Complications more frequent in women,
often severe or permanent
High Rates In Teenagers
 Sex at Early Age
 25% of Females Had Sex by 15 Yrs
 80% of Females Had Sex by 19 Yrs
 Drug and Alcohol Usage
 Average Antibiotic Compliance Rate 54%
 Biologic Factors
 Lack of Cervical Mucus Protection
 Denial, Risk Taking and Multiple Partners
 STD Education: Abstinence-Only, Biology vs.
Behaviors
 Environmental - Media Messages, Clubs, etc.
Source: Journal of Adolescent Health 1991; 12; 91
STD/HIV Interactions

Enhanced HIV transmission
 Genital ulcer disease: HSV, chancroid, syphilis
 Inflammatory STDs: gonorrhea, chlamydia, trich
 Other: ? bacterial vaginosis, ? candidiasis, ? HPV

Adverse effects of STD on HIV progression
 HSV (?)

Adverse effects of HIV on natural Hx or Rx of STD
 HSV
 HPV
 Molluscum contagiosum
– Chancroid
– Neurosyphilis
– PID
Chlamydia – Why Should We
Care?

High Prevalence and Incidence in Adolescents
and Young Adults
 PID
 Infertility
 Ectopic Pregnancy
 Newborn Infection
 Facilitates HIV Transmission
Illinois Reported Chlamydia Cases by Year, 1990-2006
No. Cases
60,000
50,000
40,000
30,000
20,000
10,000
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
Reported Chlamydia Cases By Provider Type
Illinois 2006
Hospital
25%
Neighborhood H.C.
4%
Correctional
4%
School-based
1%
Hlth Dept Clinic
1%
Prenatal
0%
University
2%
Other
1% Military
1%
Private MD
37%
Family Plan.
10%
STD Clinic
14%
Illinois Chlamydia Cases By Gender, 1990 - 2006
60,000
Cases
50,000
40,000
30,000
20,000
10,000
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
Females
Males
Total
Chlamydia Case Rates by Race & Ethnicity*
Illinois 1990 - 2006
1,800
1,600
1,400
1,200
1,000
800
600
400
200
African American
*1990-1999 Case Rates (oer 100,000) based on 1990 U.S. Census,2000 –
2001 – 2004 Case Rates based on 2000 U.S. Census.
Racial categories include persons of any or unknown ethnicity:
Hispanic ethnicity includes persons of any race
White
Hispanic
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
0
Reported Chlamydia Cases by Age Group*
Illinois, 2006
25-29
17%
20-24
35%
30-34
7%
35-39
3%
40+
3%
15-19
34%
*Where age is known
(n=53,563)
10-14
1%
0-9
0%
Reported Chlamydia Cases by Selected Counties
and Age Groups, Illinois 2006
County
Adams
No. Cases
% Cases Ages
15-19
% Cases Ages
20-24
162
39
43
1,070
42
35
Coles
157
29
53
DeKalb
462
31
51
Jackson
411
34
48
Jefferson
104
36
40
Kankakee
512
38
35
Knox
211
43
31
Livingston
111
24
35
Macon
646
42
33
Champaign
Reported Chlamydia Cases by Selected Counties
and Age Groups, Illinois 2006
County
No. Cases
% Cases Ages
15-19
% Cases Ages
20-24
Madison
866
40
38
McDonough
118
16
72
McLean
512
37
39
1,577
40
36
708
34
42
Sangamon
1,136
38
34
St. Clair
1,902
40
36
Stephenson
129
44
39
Vermilion
448
37
40
53,586
34
36
Peoria
Rock Island
Total Illinois
2006 Illinois Chlamydia Rates
Jo Daviess
Winnebago
Stephenson
Boone McHenry
Carroll
Lake
Ogle
Kane
DeKalb
Whiteside
DuPage Chicago
Lee
Kendall
Rock Island
Henry
Bureau
Stark
Kankakee
Marshall
Knox
Warren
Peoria
Henderson
McDonough
Livingston
Woodford
Iroquois
McLean
Tazewell
Fulton
Grundy
La Salle
Putnam
Mercer
Hancock
Cook
Will
Ford
Mason
Schuyler
Adams
Morgan
Pike
De Witt
Logan
Menard
Cass
Brown
Macon
Edgar
100 - 199
Clark
20 - 99
Douglas
Christian
Moultrie
Coles
Shelby
Greene
Calhoun
200 - 399
Champaign
Piatt
Sangamon
Scott
>=400
Vermilion
Cumberland
Macoupin Montgomery
Jersey
Effingham
Fayette
Madison
St. Clair
Jasper Crawford
Bond
Clay
Clinton
Washington
Monroe
Marion
Wabash
Wayne Edwards
Hamilton White
Franklin
Jackson Williamson Saline Gallatin
Union
Lawrence
Jefferson
Perry
Randolph
Richland
Johnson
Pope Hardin
Pulaski
Massac
Alexander
Rate per 100,000
Population
Change in Reported Chlamydia Cases for Illinois Counties
January – December 2005 and 2006
Jo Daviess Stephenson
Winnebago
BooneMcHenry
Carroll
Lake
Ogle
DeKalb
Whiteside
Kane
DuPage
Lee
Chicago
Kendall
Cook
Will
Rock Island Henry
Bureau
La Salle Grundy
Putnam
Mercer
Stark
Kankakee
Marshall
Knox
Livingston
Warren
Peoria Woodford
Henderson
Hancock
McLean
Tazewell
McDonough Fulton
Iroquois
Ford
Mason
Schuyler
Adams
Brown
Pike
Morgan
Scott
Sangamon
Vermilion
Champaign
De Witt
Logan
Piatt
Menard
Cass
Macon
Douglas
Christian
Edgar
Moultrie
Coles
Shelby
Greene
Calhoun
Jersey
Effingham
Jasper Crawford
Fayette
Clay
Clinton
St. Clair
>=10% Increase
(32)
>=10% Decrease
(34)
<10% or No Change (37)
Clark
Bond
Madison
10% Change in Chlamydia Cases
2005 and 2006
Cumberland
MacoupinMontgomery
Monroe
Marion
Washington
Jefferson
Randolph
Perry
RichlandLawrence
Wabash
WayneEdwards
Hamilton White
Franklin
Jackson WilliamsonSalineGallatin
Pope Hardin
Union Johnson
Pulaski Massac
Alexander
Gonorrhea – Why Should We
Care?

PID
 Infertility
 Ectopic Pregnancy
 Newborn infection
 Facilitates HIV transmission
 Antibiotic Resistance
 Incidence in Adolescents and Young Adults
Illinois Reported Gonorrhea Cases by Year, 1990-2006
45,000
No. Cases
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
Total
Reported Gonorrhea Cases By Provider Type
Illinois 2006
Hospital
34%
Correctional
4%
School-based
1%
Neighborhood H.C.
3%
Hlth Dept Clinic
1%
Other
1%
University
1%
Private MD
26%
Family Plan.
6%
STD Clinic
23%
Illinois Gonorrhea Cases By Gender, 1990 - 2006
45,000
Cases
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
Females
Males
Total
Gonorrhea Case Rates By Race & Ethnicity*
Illinois 1990 -2006
2,500
2,000
1,500
1,000
500
African American
*Racial categories do not include persons of Hispanic ethnicity:
Hispanic ethnicity includes persons of any race
White
Hispanic
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
0
Illinois Reported STD Case Rates
Disparity Between Racial/Ethnic Groups, 2005
African
Americans
Whites
Hispanics
Disparity:
African
Americans
vs. Whites
Disparity:
Hispanics
vs. Whites
Chlamydia
1,418
104
302
14 X
3X
Gonorrhea
726
28
39
26 X
1.4 X
11
3
4
4X
1.3 X
P/S*
Syphilis
*Primary and Secondary
2006 Illinois Gonorrhea Rates
Jo Daviess
StephensonWinnebago
BooneMcHenry
Carroll
Lake
Ogle
DeKalb
Whiteside
Kane
DuPage Chicago
Lee
Cook
Kendall
Will
Rock Island
Henry
Bureau
La Salle Grundy
Putnam
Mercer
Stark
Kankakee
Marshall
Knox
Livingston
Warren
Peoria
Henderson
Hancock McDonough
Woodford
McLean
Tazewell
Fulton
Iroquois
Ford
Mason
Schuyler
Adams
Brown
Vermilion
Champaign
De Witt
Logan
Menard
Cass
Piatt
Pike
Sangamon
Greene
Calhoun
Douglas
Christian
> 100 - 300
>0 - 100
Macon
Morgan
Scott
>300
Edgar
Moultrie
Coles
0
Shelby
Cumberland
Macoupin Montgomery
Jersey
Clark
Effingham
Jasper Crawford
Fayette
Bond
Madison
Clay
Clinton
Marion
Wabash
Wayne Edwards
St. Clair
Washington
Monroe
Randolph
RichlandLawrence
Jefferson
Perry
Hamilton White
Franklin
Jackson Williamson Saline Gallatin
Union Johnson Pope Hardin
Pulaski Massac
Alexander
Rate per 100,000
Population
Change in Reported Gonorrhea Cases for Illinois Counties
January – December 2005 and 2006
Jo Daviess
Winnebago
Stephenson
BooneMcHenry
Carroll
Lake
Ogle
DeKalb
Whiteside
Kane
DuPageChicago
Lee
Kendall
Rock Island
Henry
Bureau
La Salle Grundy
Putnam
Mercer
Stark
Kankakee
Marshall
Knox
Livingston
Warren
Peoria Woodford
Henderson
Hancock
Mason
Brown
Pike
Morgan
Scott
Sangamon
Macon
Douglas
Christian
Edgar
Moultrie
Coles
Shelby
Cumberland
MacoupinMontgomery
Clark
Effingham
Jasper Crawford
Fayette
Bond
Madison
Clay
Clinton
St. Clair
>=10% Increase
(31)
>=10% Decrease
(46)
<10% or No Change (26)
ChampaignVermilion
Piatt
Jersey
10% Change in Gonorrhea Cases
2005 and 2006
Ford
De Witt
Logan
Menard
Cass
Greene
Calhoun
Iroquois
McLean
Tazewell
McDonough Fulton
Schuyler
Adams
Cook
Will
Monroe
Marion
Washington
Jefferson
Randolph
Perry
RichlandLawrence
Wabash
WayneEdwards
Hamilton White
Franklin
Jackson WilliamsonSaline Gallatin
Union JohnsonPope Hardin
Alexander
Pulaski Massac
Syphilis – Why Should We
Care?

Congenital infection
 Facilitates HIV transmission
 Late complications
 High rate of syphilis-HIV co-infection
among MSM and increasing neurological
involvement
Illinois Reported Early Syphilis By Year, 1990 - 2006
6,000
No. Cases
5,000
4,000
3,000
2,000
1,000
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
Source: IDPH STD Section
Reported Early Syphilis Cases by Provider Type
Illinois 2006
Correctional
Facility
3%
Hospital
26%
STD Clinic
29%
Other
6%
Private MD
36%
Illinois Reported Early Syphilis Cases By Gender, 1990 –
2006
Cases
6,000
5,000
4,000
3,000
2,000
1,000
Females
Males
Total
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
0
Illinois Reported Primary & Secondary Syphilis Cases By Age Group,
2006
45+
15%
15-19
5%
20-24
14%
40-44
19%
25-29
20%
35-39
12%
30-34
15%
Illinois Reported Primary & Secondary Syphilis Cases
By Gender and Sexual Orientation, 2000-2006
400
350
Number of cases
300
250
Females
200
MSM
150
Heterosexual* Males
100
50
0
2000
2001
2002
*heterosexual or sexual orientation not stated
2003
2004
2005
2006
Illinois Reported Primary & Secondary Syphilis Case Rates
By Race/Ethnicity, 1990 - 2006
140
120
100
80
60
40
20
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
19
90
0
African American
White
Hispanic
2006 Illinois Primary and Secondary Syphilis Rates
Jo Daviess
Winnebago
Stephenson
Boone McHenry
Carroll
Lake
Ogle
Kane
DeKalb
Whiteside
DuPage
Lee
Chicago
Cook
Kendall
Will
Rock Island
Henry
Bureau
Grundy
La Salle
Putnam
Mercer
Kankakee
Stark
Marshall
Knox
Warren
Peoria
Livingston
Woodford
Iroquois
Henderson
Hancock
McDonough
McLean
Tazewell
Fulton
Ford
Mason
Schuyler
Adams
Brown
Cass
Vermilion
De Witt
Logan
Pike
Piatt
Menard
>0 - 4
Douglas
Sangamon
Scott
Christian
Macoupin
Coles
Cumberland
Montgomery
Jersey
Clark
Effingham
Jasper Crawford
Fayette
Madison
Bond
Clay
Clinton
St. Clair
Monroe
Randolph
Rate per 100,000 population
Edgar
Moultrie
Shelby
Greene
Calhoun
> 4 - 10
Champaign
Macon
Morgan
>10
Washington
Marion
Richland Lawrence
Wabash
Wayne Edwards
Jefferson
Perry
Hamilton
White
Franklin
Jackson Williamson Saline Gallatin
Union
Johnson
Pope Hardin
Pulaski
Massac
Alexander
0
2006 Illinois Reported Early Syphilis Cases
And Change in Reported Cases Compared to 2005 by County
January - December
Jo Daviess
Winnebago
Stephenson
BooneMcHenry
Carroll
Lake
Ogle
DeKalb
Whiteside
Kane
DuPage Chicago
Lee
Kendall
Rock Island
Henry
Bureau
Stark
Kankakee
Marshall
Knox
Warren
Peoria
Henderson
Hancock
La Salle Grundy
Putnam
Mercer
McDonough Fulton
Woodford
Mason
Adams
Brown
Pike
Morgan
Scott
Sangamon
Douglas
Greene
Calhoun
MacoupinMontgomery
Edgar
Coles
Shelby
Cumberland
Clark
Effingham
Jasper Crawford
Fayette
Clay
Clinton
St. Clair
Monroe
Increase
(21)
No Cases or No Change (65)
Decrease
(17)
Moultrie
Bond
Madison
Early Syphilis 2005 and 2006
Ford
Macon
Christian
Jersey
Iroquois
Vermilion
De Witt
Champaign
Piatt
Logan
Menard
Cass
Livingston
McLean
Tazewell
Schuyler
Cook
Will
Marion
Washington
Jefferson
Randolph
Perry
RichlandLawrence
Wabash
WayneEdwards
Hamilton White
Franklin
Jackson WilliamsonSaline Gallatin
Union JohnsonPope Hardin
Alexander
Pulaski Massac
Illinois Reported Primary and Secondary Syphilis Cases
Male:Female Ratio, 1992-2006
Cases
12.0
10.0
8.0
6.0
4.0
2.0
1.00:1.00
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
0.0
Illinois Primary & Secondary Syphilis
By Gender and Sexual Orientation, 2000-2006
100%
90%
80%
48
81
91
55
47
116
181
70%
120
147
37
130
124
125
60%
50%
40%
30%
20%
10%
362
179
193
251
206
207
2001
2002
2003
2004
264
52
0%
2000
MSM
Heterosexual* Males
*heterosexual or sexual orientation not stated
Females
2005
2006
Illinois Primary and Secondary Syphilis Among MSM
Percent of Reported Cases By Race*/Ethnicity, 2002 - 2006
100%
Percent of Cases
80%
60%
40%
20%
0%
2002
2003
African American
Racial categories are non-Hispanic
2004
2005
White
2006
Hispanic
HIV Status By Gender and Sexual Orientation
Illinois Primary & Secondary Syphilis, 2006
Percent of cases
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
122
237
115
34
282
142
157
15
3
Females
All Males
+ HIV
Non MSM
- HIV or Unknown
MSM
Illinois Primary & Secondary Syphilis Among MSM
by Year and HIV Status, 2000 - 2006
400
Number of cases
350
300
175
250
200
150
129
85
122
282
114
86
100
50
0
187
36
18
2000
108
122
92
121
2001
2002
2003
2004
HIV+
HIV-
2005
142
2006
Questions
For Local Health Departments

What activities and resources currently
provided by the IDPH STD program are
helpful and should continue?

What activities and resources are needed
that are not currently provided by the IDPH
STD Program?
Significant STD Challenges






Degradation of Public Health Infrastructure
Affordable, Accessible and High Quality Public
and Private Diagnostic and Treatment Services
Schizophrenic Public Messages and Attitudes
About Sexuality and STD Prevention
Absence of Social and Political Will for Long
Term, Sustainable and Effective Prevention
Education in Schools and Other Settings Serving
Persons at Increased Risk
Stigma, Discrimination and Marginalization
Difficulty in Engaging Communities and
Fostering Shared Responsibility for Prevention
Significant Opportunities

Renewed Attention for STD Prevention
– IDHS MCH Program Making STI Reduction and Prevention a
Priority
– Targeted LHD Initiatives Developed Using CDC STD Program
Planning Evaluation Process
– Interest From External Partners

Overall High Quality LHD and IDPH Core Program
Services





Reporting and Surveillance
Screening
Accessibility of STD Medications
Counseling and Sex Partner Referral
Technical Assistance and Training
IDPH STD Program
For Questions and Assistance
Contact Us At
217-782-274
firstname.lastname@Illinois.gov
John Creviston
Marilyn Harris
Steve Holmes
Diana McGrath
Charlie Rabins
Becky Rinozzi
Ed Renier
Alice Studzinski
Richard Zimmerman
Valerie Young