Annual Summary: 2013 Minnesota Sexually Transmitted Disease Statistics

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On this page:
Overall Summary
Sources of Data
Limitations of Data
Chlamydia
Gonorrhea
Syphilis
Chancroid
Summary Points
Data Tables

Overall Summary:

The 2013 Sexually Transmitted Disease (STD) Statistics include a summary of surveillance data for Minnesota’s reportable STDs: chlamydia, gonorrhea, syphilis, and chancroid. In Minnesota, STDs are the most commonly reported communicable diseases and account for nearly 70% of all notifiable diseases reported to the Minnesota Department of Health (MDH). In 2013 the number of reported bacterial STDs increased to 23,133 cases, representing an overall increase of 10% from the previous year. The change in incidence rates varied by disease, with chlamydia increasing by 4%, gonorrhea increasing by 26%, and primary/secondary syphilis increasing by 64%.

This report provides a comprehensive review of STD trends and current morbidity in Minnesota; data are also available in a slide presentation (PDF: 1.4MKB/64 slides). If you are interested in using one or more of these slides in a presentation, please contact Dawn Ginzl via e-mail or 651-201-4041.

Data Tables:

List of tables included in this report:
Table 1. Number of Cases and Rates (per 100,000 persons) of Chlamydia, Gonorrhea, Syphilis (All Stages) and Chancroid— Minnesota, 2008-2013
Table 2a. Chlamydia: Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2013
Table 2b. Gonorrhea: Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2013
Table 2c. Primary/Secondary Syphilis:  Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2013
Table 3. Number of Chlamydia and Gonorrhea Cases and Rates (per 100,000 persons) by County—Minnesota, 2013

Sources of Data:

STD Case Reporting
Under state law (Minnesota Rule 4605.7040), both physicians and laboratories must report laboratory-confirmed infections of chlamydia, gonorrhea, syphilis, and chancroid to the MDH within one working day. Other common sexually transmitted conditions such as herpes simplex virus (HSV) and human papillomavirus (HPV) are not reported to the MDH. 

MDH Partner Services Program
All early syphilis cases, and many untreated chlamydia or gonorrhea cases reported to the MDH are referred to the Partner Services Program to ensure treatment of patients and their sexual partners. Additional surveillance data is collected through this process including information on sexual behavior and drug use.

Gonococcal Isolate Surveillance Project (GISP)
As part of the national Gonococcal Isolate Surveillance Project (GISP) funded by the Centers for Disease Control and Prevention (CDC), the MDH monitors antimicrobial susceptibilities of Neisseria gonorrhoeae. A Minneapolis STD clinic submits isolates on a monthly basis to the MDH. Sociodemographic and behavioral data for each case are also submitted. As of 2008, the MDH ceased routine susceptibility testing for GISP isolates, but still collaborates with the CDC to perform susceptibility testing.

Limitations of Data:

Several factors impact the completeness and accuracy of the MDH’s STD surveillance data, including compliance with and completeness of case reporting among healthcare providers and laboratories. Clinically diagnosed cases, presumptively treated cases, and asymptomatic cases with no STD-related illnesses may be under-reported through the STD surveillance system. Furthermore, STD cases reported by laboratories lacking subsequent provider reporting were excluded from the STD surveillance database prior to 2012. The majority of laboratory reports originate from facilities that do not routinely collect demographic and clinical information required for STD surveillance. In 2002, the MDH implemented an active surveillance process whereby providers are reminded to submit demographic and clinical information missing from cases reported solely through laboratories. Additional factors affecting validity of the STD surveillance data include STD screening coverage, individual test-seeking behavior, and accuracy of diagnostic tests. Thus, changes in STD rates may be due to one or more of these factors or due to actual changes in the incidence of STDs in the population.

Population counts used to calculate incidence rates by residence (i.e., state, counties, Minneapolis, and Saint Paul), by age, by gender, and by race/ethnicity were obtained from the U.S. Census Bureau. Incident rates (number of reported cases per 100,000 persons) were calculated using yearly case data and population counts from the decennial census. Population counts for 1991 to 1999 were estimated by interpolation between the 1990 and 2000 census data. Rates for 2013 were calculated using population counts from the 2010 Census, the most recent year for which counts by race, age, gender, and residence were available at the time of calculation and preparation. This 2013 data release includes rates calculated using population estimates for the calendar years between the 2000 and 2010 U.S. Censuses.

Chlamydia:

Chlamydia is the most commonly reported communicable disease in Minnesota. From an all-time low of 115 cases per 100,000 in 1996, the incidence of chlamydia has tripled to 353 per 100,000 in 2013. Over these years, increases were seen across all gender, age and geographical groups. The rates have quadrupled among men (54 to 220 per 100,000) and more than doubled among females (175 to 484 per 100,000). Among 30-39 year-olds, the incidence rate is over five times higher in 2013 compared to 1996. Rates have doubled among American Indians, Blacks, and Hispanics and almost tripled among Whites and Asian/Pacific Islanders. In addition to an increase of disease in the population, other factors may have contributed to the increases seen during these years including increased reporting by providers, use of improved STD diagnostic tools, improved screening practices by clinicians, counting only lab reports as cases and the addition of an active surveillance component to the MDH’s STD surveillance system.

In 2013, the chlamydia rate increased by 4% overall and remained highest among women (484 per 100,000), Blacks (1,517 per 100,000), and 20-24 year-olds (2,142 per 100,000). The rates increased by 7% among males and 3% among females. Adolescents (15-19 year-olds) and young adults (20-24 year-olds) have the highest rates and comprise the majority of cases, rates among males increased the most among those over 50+ years (35%), and rates among females increased the most among those 45-49 years (30%). Across geographic areas, the City of Minneapolis had the highest incidence rate (933 per 100,000). However, Greater Minnesota experienced the greatest increase in chlamydia cases between 2012 and 2013 (7%); followed by St. Paul (5%), Minneapolis (1%), and the Suburban area (seven-county metro excluding the cities of Minneapolis and St. Paul) experienced a decrease of 2%. Racial disparities in chlamydia continue to persist in Minnesota with the incidence rate among Blacks being 10 times that among Whites. Other racial/ethnic groups are disproportionately affected by chlamydia; incidence rates among American Indians, Asian/Pacific Islanders and Hispanics were 4.4, 1.8, and 2.4 times higher than the rate among Whites, respectively.

Gonorrhea:

In 2013, Minnesota experienced another increase (26%) in the rate of reported gonorrhea, after rates increased in 2011 for the first time since 2007. From 2003 to 2013, the incidence of gonorrhea in Minnesota increased from 64 to 73 per 100,000 persons (14%). However, as with chlamydia, the incidence of infection was higher among some segments of the population compared to others. Rates during the past decade have increased by 23% among males and 7% among females. The rates decreased among Hispanics and Blacks (41% and 15%, respectively) while rates among Whites, American Indians, & Asian/Pacific Islanders increased or remained stable. However, during this period Blacks continued to have gonorrhea incidence rates far higher than other race groups.

In 2013 the incidence rate of gonorrhea increased by 26% from 58 to 73 per 100,000 persons. As with chlamydia, gonorrhea rates were highest among females (76 per 100,000), Blacks (611 per 100,000), and 20-24 year-olds (360 per 100,000). Adolescents and young adults continue to account for a disproportionate amount (58%) of all gonorrhea cases. The Cities of Minneapolis and Saint Paul accounted for the highest rates of infection (359 and 230 cases per 100,000 persons, respectively). The greatest increase in cases from 2012 to 2013 (28%) was seen in Minneapolis, whereas, gonorrhea cases in Greater Minnesota increased by 27%, St. Paul increased by 25%, and the Suburban area (seven-county metro excluding the cities of Minneapolis and St. Paul) increased 21%, during this same time. Compared to chlamydia, greater racial disparities in gonorrhea infections continue to persist in Minnesota with an incidence rate among Blacks being 26.5 times that among Whites. These racial disparities are also evident among American Indians and Hispanics, whose rates are 7.0 and 2.3 times those of Whites.

The emergence of quinolone-resistant Neisseria Gonorrhea (QRNG) in recent years has become a particular concern. Due to the high prevalence of QRNG in Minnesota as well as nationwide, quinolones are no longer recommended for the treatment of gonococcal infections. Additionally, the CDC changed the treatment guidelines for gonococcal infections in August of 2012. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in one week for a test-of-cure at the site of infection.

Syphilis:

Incidence rates of primary/secondary syphilis in Minnesota remained stable from 1998 until 2002 when an outbreak was observed among men who have sex with men (MSM) and the overall rate increased from 0.2 to 1.2 per 100,000 persons. Since 2002, primary/secondary syphilis rates have fluctuated but remained elevated. In addition, the number of early syphilis cases (primary, secondary, and early latent stages) increased from 94 in 2003 to 332 in 2013, with MSM accounting for 88% of all cases among males in 2013. The disparity in early syphilis rates between males and females has remained large and reflects the greater burden within the MSM community; however the rates among females continue to increase.

In 2013, the overall incidence rate of primary/secondary syphilis increased from 2.2 to 3.6 cases per 100,000 persons. The number of cases among males increased from 111 in 2012 to 178 in 2013 while among females, the number increased from 7 to 12. Increases in cases were observed across all geographic areas; however the City of Minneapolis remains to account for the majority of cases (52%). The incidence of primary/secondary syphilis infection increased in every age group, except among persons 15-19 years of age. Whites comprised the majority (62%) of cases in 2013, while Asian/Pacific Islanders saw an increase of primary/secondary syphilis rates of 620% from 2012 to 2013. Also, Blacks comprised compromised 27% of all primary/secondary syphilis cases in 2013 and have a rate of primary/secondary syphilis that is over 7 times higher than that among Whites.

The number of early syphilis cases increased in 2013 (332 versus 214 in 2012). The number of cases among women increased from 18 cases in 2012 to 30 cases in 2013. Early syphilis cases among men increased from 196 to 298 (52%). Of all early syphilis cases reported in 2013, 90% were among males and 88% of these were MSM. Of the MSM early syphilis cases 46% were co-infected with HIV.

Chancroid:

Chancroid remains extremely rare in Minnesota. The last case reported in Minnesota was in 1999.

Summary Points:

  • Over the past decade (2003-2013), Minnesota’s chlamydia rates showed an overall increase of 65% while the rate of gonorrhea has fluctuated but has overall shown an increase of 14%. Rates of primary/secondary syphilis have increased 260%.
  • Minnesota has seen a resurgence in syphilis since 2002, with men who have sex with men being especially impacted. The co-infection rate with HIV continues to remain high.
  • Racial disparities in STDs continue to persist in Minnesota with communities of color having the highest rates.
  • Between 2012 and 2013, the chlamydia incidence rate increased by 4%, while the gonorrhea rate increased by 26%. Cases of primary/secondary syphilis increased by 64%. The greatest growth was seen among late latent syphilis cases, which increased by 71%.
  • In 2013, incidence rates of chlamydia increased by 7% among males and 3% among females; gonorrhea increased by 23% among males and 7% among females.
  • STD rates continued to be highest in the City of Minneapolis. However, the Twin Cities suburbs and Greater Minnesota accounted for a large percentage of STD cases.
  • Adolescents and young adults (ages 15-24) accounted for 68% of chlamydia and 58% of gonorrhea cases reported in 2013.
  • In 2013, men who have sex with men account for 88% of all male early syphilis cases, and rates of primary/secondary syphilis increased 620% among Asian/Pacific Islanders.     

Data Tables

Table 1. Number of Cases and Rates (per 100,000 persons) of Chlamydia, Gonorrhea, Syphilis (All Stages)
and Chancroid — Minnesota, 2008-2013

2009 2010 2011 2012 2013
Disease Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate
Chlamydia 14,369 272 15,509 292 16,898 319 18,048 340 18,724 353
Gonorrhea 2,328 44 2,149 41 2,283 43 3,082 58 3,872 73
All Stages of Syphilis 215 4.1 351 6.6 366 6.9 335 6.3 537 10.1
~ Primary/Secondary Syphilis 71 1.3 150 2.8 139 2.6 118 2.2 193 3.6
~ Early Latent Syphilis 46 0.9 74 1.4 121 2.3 96 1.8 139 2.6
~ Late Latent Syphilis 97 1.8 126 2.4 106 2.0 120 2.3 205 3.9
~ Other Syphilis (1) 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
~ Congenital Syphilis (2) 1 1.4 1 1.5 0 0.0 1 1.5 0 0.0
Chancroid 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
NOTE: Data exclude cases diagnosed in federal or private correctional facilities;
U.S. Census Intercensal and U.S. 2010 data is used to calculate rates.
(1) Includes unstaged neurosyphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations.
(2) Congenital syphilis rate per 100,000 live births.

Table 2a. Chlamydia: Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender — Minnesota, 2013
  Chlamydia
Males Females Total (6)(7)
Group Case % Case % Case % Rate
Residence (1)
Minneapolis 1,383 24% 2,186 17% 3,570 19% 933
St. Paul 715 12% 1,662 13% 2,377 13% 834
Suburban (2) 1,588 27% 3,767 29% 5,355 29% 245
Greater Minnesota 1,575 27% 4,425 34% 6,000 32% 244
Age
< 15 yrs 21 0% 120 1% 141 1% 13
15-19 yrs 1,023 18% 4,103 32% 5,126 27% 1,394
20-24 yrs 2,193 38% 5,424 42% 7,617 41% 2,142
25-29 yrs 1,208 21% 1,932 15% 3,141 17% 843
30-34 yrs 623 11% 690 5% 1,313 7% 383
35-39 yrs 283 5% 355 3% 638 3% 194
40-44 yrs 193 3% 168 1% 361 2% 102
45-49 yrs 116 2% 71 1% 187 1% 46
50-54 yrs 70 1% 42 0% 112 1% 28
55+ yrs 61 1% 27 0% 588 3% 45
Race/Ethnicity
White 2,045 35% 5,271 41% 7,317 39% 162
Black 1,583 27% 2,680 21% 4,263 23% 1,554
American Indian 77 1% 396 3% 473 3% 776
Asian/PI 169 3% 469 4% 638 3% 295
Other (3) (4) 93 2% 292 2% 385 2% x
Unknown (4) 1,824 31% 3,824 30% 5,666 30% x
Hispanic (5) 290 5% 663 5% 949 5% 379
TOTAL 5,791   12,932   18,742   353

NOTE: Data exclude cases diagnosed in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.
(1) Residence missing for 1,422 cases of chlamydia.
(2) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul)
(3) Includes persons reported with more than one race.
(4) No comparable population data available to calculate rates.
(5) Persons of Hispanic origin may be of any race..
(6) Total includes 1 case of chlamydia diagnosed in transgendered persons(male to female)


Table 2b. Number of Cases and Rates (per 100,000 persons) of Gonorrhea by Residence, Age, Race/Ethnicity and Gender — Minnesota, 2013
  Gonorrhea
Males Females Total (1)(7)
Group Case % Case % Case % Rate
Residence (2)
Minneapolis 741 40% 632 31% 1,374 35% 359
St. Paul 272 15% 385 19% 657 17% 230
Suburban (3) 504 27% 576 28% 1,080 28% 49
Greater Minnesota 207 11% 360 18% 567 15% 23
Age
< 15 yrs 8 0% 32 2% 40 1% 4
15-19 yrs 287 16% 696 34% 983 25% 267
20-24 yrs 554 30% 725 36% 1,279 33% 360
25-29 yrs 360 20% 298 15% 659 17% 177
30-34 yrs 229 12% 153 8% 382 10% 111
35-39 yrs 131 7% 66 3% 197 5% 60
40-44 yrs 95 5% 37 2% 132 3% 37
45-49 yrs 80 4% 15 1% 95 2% 23
50-54 yrs 47 3% 10 0% 57 1% 14
55+ yrs 44 2% 4 0% 48 1% 4
Race /Ethnicity
White 569 31% 496 24% 1,065 28% 24
Black 807 44% 910 45% 1,718 44% 626
American Indian 32 2% 79 4% 111 3% 182
Asian/PI 32 2% 38 2% 70 2% 32
Other (4)(5) 8 0% 14 1% 22 1% x
Unknown (5) 387 21% 499 25% 886 23% x
Hispanic (6) 56 3% 76 4% 132 3% 53
TOTAL 1,835   2,036   3,872   73
NOTE: Data exclude cases diagnosed in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.
(1) Total includes 1 case of gonorrhea diagnosed in transgendered persons (male to female).
(2) Residence missing for 194 cases of gonorrhea.
(3) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul).
(4) Includes persons reported with more than one race.
(5) No comparable population data available to calculate rates.
(6) Persons of Hispanic origin may be of any race.

Table 2c. Number of Cases and Rates (per 100,000 persons) of Primary/Secondary Syphilis by Residence, Age, Race/Ethnicity and Gender -- Minnesota, 2013
  Primary & Secondary (P&S) Syphilis
  Males Females Total
Group Case % Case % Case % Rate
Residence
Minneapolis 91 51% 6 0% 100 52% 26.1
St. Paul 18 10% 2 0% 20 10% 7.0
Suburban (1) 54 30% 1 0% 55 28% 2.5
Greater Minnesota 15 8% 3 0% 18 9% 0.7
Age
< 15 yrs 0 0% 0 0% 0 0% 0.0
15-19 yrs 2 1% 0 0% 2 1% 0.5
20-24 yrs 30 17% 3 0% 33 17% 9.3
25-29 yrs 35 20% 4 0% 42 22% 11.3
30-34 yrs 26 15% 1 0% 27 14% 7.9
35-39 yrs 22 12% 1 0% 23 12% 7.0
40-44 yrs 16 9% 2 0% 18 9% 5.1
45-49 yrs 19 11% 0 0% 19 10% 4.7
50-54 yrs 16 9% 1 0% 17 9% 4.2
55+ yrs 12 7% 0 0% 12 6% 0.9
Race/Ethnicity
White 107 60% 3 0% 111 58% 2.5
Black 40 22% 6 0% 48 25% 17.5
American Indian 2 1% 0 0% 2 1% 3.3
Asian/PI 7 4% 1 0% 8 4% 3.7
Other (2)(3) 4 2% 0 0% 4 2% x
Unknown 18 10% 2 0% 20 10% x
Hispanic (4) 9 5% 0 0% 9 5% 3.6
TOTAL 178   12   193   3.6

NOTE: Data exclude cases diagnosed in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.
(1) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul).
(2) Includes persons reported with more than one race.
(3) No comparable population data available to calculate rates.
(4) Persons of Hispanic origin may be of any race.
(5) Total includes 3 cases of primary/secondary syphilis diagnosed in transgendered persons (male to female).


Table 3. Number of Chlamydia and Gonorrhea Cases and Rates (1) (per 100,000 persons) by County of Residence -- Minnesota, 2013
 
Chlamydia
Gonorrhea
 
Chlamydia
Gonorrhea
County
Cases
Rate Cases
Rate
County
Cases
Rate
Cases
Rate
Aitkin 17 105 2 - Marshall 12 127 0 -
Anoka 884 267 157 47 Martin 50 240 2 -
Becker 74 228 4 - Meeker 28 120 4 -
Beltrami 210 473 23 52 Mille Lacs 70 268 2 -
Benton 101 263 21 55 Morrison 69 208 9 27
Big Stone 11 209 1 - Mower 140 357 21 54
Blue Earth 303 473 16 25 Murray 5 57 0 -
Brown 22 85 1 - Nicollet 51 156 2 -
Carlton 102 288 8 23 Nobles 50 234 3 -
Carver 130 143 10 11 Norman 12 175 1 -
Cass 83 291 10 35 Olmsted 501 347 44 31
Chippewa 13 104 1 - Otter Tail 78 136 8 14
Chisago 87 161 3 - Pennington 30 215 4 -
Clay 177 300 37 63 Pine 74 249 7 24
Clearwater 20 230 2 - Pipestone 11 115 1 -
Cook 7 135 0 - Polk 58 184 22 70
Cottonwood 12 103 1 - Pope 16 146 2 -
Crow Wing 137 219 8 13 Ramsey 2786 548 732 144
Dakota 1005 252 144 36 Red Lake 19 465 3 -
Dodge 55 274 4 - Redwood 25 156 0 -
Douglas 46 128 0 - Renville 24 153 1 -
Faribault 25 172 4 - Rice 130 203 10 16
Fillmore 38 182 3 - Rock 16 165 2 -
Freeborn 113 362 10 32 Roseau 37 237 2 -
Goodhue 136 294 10 22 St. Louis 729 364 88 44
Grant 10 166 1 - Scott 269 207 25 19
Hennepin 5765 500 1983 172 Sherburne 213 241 26 29
Houston 24 126 1 - Sibley 16 105 1 -
Hubbard 22 108 0 - Stearns 448 297 38 25
Isanti 63 167 7 19 Steele 94 257 7 19
Itasca 100 222 12 27 Stevens 5 51 1 -
Jackson 20 195 1 - Swift 5 51 1 -
Kanabec 25 154 1 - Todd 36 145 1 -
Kandiyohi 136 322 6 14 Traverse 3 - 1 -
Kittson 8 176 0 - Wabasha 39 180 0 -
Koochiching 21 158 0 - Wadena 19 137 0 -
Lac qui Parle 5 69 0 - Waseca 45 235 4 -
Lake 16 147 0 - Washington 456 191 56 24
Lake of the Woods 8 198 0 - Watonwan 30 268 2 -
Le Sueur 47 170 5 18 Wilkin 7 106 0 -
Lincoln 6 102 3 - Winona 185 359 7 14
Lyon 51 197 2 - Wright 197 158 25 20
McLeod 60 164 4 - Yellow Medicine 9 86 2 -
Mahnomen 15 277 2 -        
NOTE: Data exclude cases diagnosed in federal or private correctional facilities.
County data missing for 1425 chlamydia cases and 197 gonorrhea cases.
(1) Rates not calculated for counties with fewer than 5 cases.
U.S. Census 2010 data is used to calculate rates.


Data Archive

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Updated Monday, 28-Apr-2014 13:06:39 CDT