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Overview of Statistics and Highlights:
The number of cases and rates (per 100,000 persons) for all reportable bacterial sexually transmitted diseases (STDs) for the years 1998 through 2002 are presented in Table 1 by year of diagnosis. Table 2 displays chlamydia, gonorrhea and primary/secondary syphilis case numbers and rates by residence, age, gender, and race/ethnicity for 2002. Chlamydia and gonorrhea case numbers and rates by county for 2002 are shown in Table 3.

Between 2001 and 2002 in Minnesota, the chlamydia rate increased by 21% and the gonorrhea rate increased by 13%. Portions of the increases were reporting artifacts caused by the addition of an active component to the previously passive surveillance system. Although both laboratories and physicians are required to report STDs to the Minnesota Department of Health (MDH), laboratory reports alone do not provide adequate information to include cases in the surveillance statistics. Thus, in January 2002 the MDH began cross-checking reports of laboratory test results against clinician case reports. For instances in which a positive laboratory result was reported but a corresponding clinician case report was not received within 45 days, MDH mailed a reminder letter and report form to the appropriate clinical facility. Through this process, 631 chlamydia case reports and 146 gonorrhea case reports were completed and returned to MDH. These account for a 7% and 5% increase in chlamydia and gonorrhea cases, respectively, between 2001 and 2002. The process likely accounts for even larger portions of the increases because as clinicians were made aware or reminded of the reporting requirements, more cases were reported while fewer letters and forms had to be mailed out. The number of additional case reports received due to the educational effect of the process cannot be quantified.

Between 2001 and 2002 in Minnesota, the primary/secondary syphilis rate increased by 71%. The rate increase was driven by an increase in syphilis cases among white men who have sex with men (MSM). Eighty-two cases of early syphilis (which includes primary, secondary, and early latent stages) were reported in Minnesota in 2002 compared to 49 cases in 2001. Of the 82 early syphilis cases in 2002, 70 (85%) occurred among men. Fifty-six (80%) of the men reported having sex with other men. Almost half (45%) of the MSM diagnosed with early syphilis were co-infected with HIV. Similar trends have been observed in other parts of the country. MDH is collaborating with local physicians, clinics, and community-based organizations to stem the increase.

STD rates continue to be highest in the seven-county metropolitan area, particularly in the cities of Minneapolis and St. Paul. Adolescents and young adults aged 15-24 years have the highest rates of chlamydia and gonorrhea, whereas the highest rates of primary/secondary syphilis are among persons in older age groups. Gonorrhea rates are comparable for men and women. However, due to more frequent screening among women, the rate of chlamydia infection among women is more than twice the rate among men. Rates of STDs remain elevated among communities of color. Blacks, American Indians, Asians and Hispanics typically have rates that are much higher (2 to 40 times higher) than rates for Whites, depending on the STD and racial/ethnic group.

Sources and Limitations of Data:
In Minnesota, laboratory-confirmed infections of chlamydia, gonorrhea, syphilis, and chancroid are monitored by the MDH through a combined physician and laboratory-based surveillance system. State law (Minnesota Rule 4605.7040) requires both physicians and laboratories to report all cases of these four bacterial STDs directly to the MDH. Other common sexually transmitted conditions caused by viral pathogens, such as herpes simplex virus (HSV) and human papillomavirus (HPV), are not reported to the MDH. Factors that impact the completeness and accuracy of the available data on STDs include: level of screening, accuracy of diagnostic tests, and compliance with case reporting. Thus, any changes in STD rates may be due to one of these factors, or due to actual changes in STD occurrence.

Population counts used to calculate rates by residence, by gender, and by race/ethnicity were obtained from the U.S. Census Bureau. Population counts for 1998 and 1999 were estimated by interpolation between the 1990 and 2000 Census data. Rates for 2000, 2001, and 2002 were calculated using each year’s case data and 2000 population counts. The 2000 Census data on race include the number of persons by race alone or in combination with one or more races. Thus, persons who identified themselves by more than one race are “over counted”.

(1) Late latent syphilis includes neurosyphilis
(2) Congenital syphilis rate per 100,000 live births

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Table 2. Number of Cases and Rates (per 100,000 persons) of Chlamydia, Gonorrhea, and Primary/Secondary Syphilis by Residence, Age, Gender, and Race/Ethnicity — Minnesota, 2001

(1) Suburban is defined as the seven county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington Counties), excluding cities of Minneapolis and St. Paul
(2) Race categories include persons by race alone, or in combination with one or more races
(3) No comparable population data available to calculate rates
(4) Persons of Hispanic origin may be of any race

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Data Archive: Previous STD Annual Reports

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