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

Overall Summary:

The 2008 Sexually Transmitted Disease (STD) Statistics includes 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 over 60% of all notifiable diseases reported to the Minnesota Department of Health (MDH). In 2008 the number of reported bacterial STDs reached their highest level ever with 17,650 cases reported. This represents an overall increase of 3.5% from the previous year and is part of a continued trend observed over the past ten years. The change in incidence rates varied by disease, with chlamydia increasing by 7%, primary/secondary syphilis doubling, and gonorrhea decreasing by 12%.

This report provides a comprehensive review of STD trends and current morbidity in Minnesota; data are also available in a slide presentation (PPT: 927KB/68 slides).

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, 2004-2008
Table 2a. Chlamydia: Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2008
Table 2b. Gonorrhea: Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2008
Table 2c. Primary/Secondary Syphilis:  Number of Cases and Rates (per 100,000 persons) by Residence, Age, Race/Ethnicity and Gender— Minnesota, 2008
Table 3. Number of Chlamydia and Gonorrhea Cases and Rates (per 100,000 persons) by County—Minnesota, 2008

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. 

Partner Services Program
All early syphilis 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, who performs the susceptibility testing. Sociodemographic and behavioral data for each case are also submitted. The MDH also conducts testing on additional isolates collected outside of the GISP project from a St. Paul STD clinic.

Minnesota Infertility Prevention Project (MIPP)
Minnesota participates in the national Infertility Prevention Project funded by the CDC. Through MIPP, the MDH funds clinics across the state – including STD, family planning, adolescent, and community clinics – to provide testing and treatment for chlamydia and gonorrhea to men and women ages 15-24. Participating clinics submit to MDH demographic and clinical data on every test performed. With information on positive as well as negative tests, prevalence (or positivity) rates for chlamydia and gonorrhea can be calculated and monitored.

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 may be excluded from the STD surveillance database. 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. Subsequent (2000-2008) rates were calculated using population counts from the 2000 Census, the most recent year for which counts by race, age, gender, and residence were available. Essentially, the denominator in rate calculations for 2000-2008 has remained stable while cases have increased. As a result, rates for these years – especially the most recent ones – may be inflated. Furthermore, 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 overrepresented in the denominators.

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 more than doubled to 292 per 100,000 in 2008. Over these years, increases were seen across all gender, age, race and geographical groups. The rates tripled among men (54 to 168 per 100,000) and more than doubled among females (175 to 413 per 100,000). Among 25-39 year-olds, the incidence rate more than tripled. Rates doubled among Whites, Blacks, Hispanics and American Indians and almost tripled among 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 and the addition of an active surveillance component to the MDH’s STD surveillance system.

In 2008, the chlamydia rate increased by 7% overall and was highest among women (413 per 100,000), Blacks (2,111 per 100,000), and 20-24 year-olds (1,715 per 100,000).  The rates increased by 10% among males and 6% among females. Although adolescents (15-19 year-olds) and young adults (20-24 year-olds) have the highest rates and comprise the majority of cases, rates increased the most among 35-39 year-olds (12%). Across geographic areas, the City of Minneapolis had the highest incidence rate (786 per 100,000), but the greatest increase in 2008 was seen in Greater Minnesota (10%). Communities of color had double-digit increases in chlamydia rates (range, 13-15%), while Whites saw a more modest 3% increase. Racial disparities in chlamydia continue to persist in Minnesota with the incidence rate among Blacks being 16 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, 2.7, and 5.6 times higher than the rate among Whites, respectively.

Gonorrhea:

From 1998 to 2008, the incidence of gonorrhea in Minnesota increased from 56 to 62 per 100,000 persons. As with chlamydia, the incidence of infection was higher among some segments of the population compared to others. The rates increased by 6% among males and 12% among females. Across age groups, the rates increased the most among 20 to 24 year-olds (27%) and 25 to 29 year- olds (23%). The rates increased among all racial/ethnic groups except Blacks; however, during this period Blacks continued to have gonorrhea incidence rates far higher than other race groups.

In 2008 the incidence rate of gonorrhea decreased by 12% from 71 to 62 per 100,000 persons. As with chlamydia, gonorrhea rates were highest among females (67 per 100,000), Blacks (766 per 100,000), and 20-24 year-olds (306 per 100,000). The rates decreased by 14% among females and 10% among males. Adolescents and young adults (ages 15-24) had the smallest decrease (7-8%), but continue to account for a disproportionate amount (59%) of all gonorrhea cases. The Cities of Minneapolis and Saint Paul accounted for the highest rates of infection, but Greater Minnesota was the only geographic region to see an increase in gonorrhea (14% overall; 43% among men and 3% among women). Compared to chlamydia, greater racial disparities in gonorrhea infections continue to persist in Minnesota with an incidence rate among Blacks being 40 times that among Whites. These racial disparities are also evident among American Indians and Hispanics, whose rates are 4 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.

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 83 in 2002 to 163 in 2008, with MSM accounting for 89% of all cases among males. Meanwhile, early syphilis among women has been declining; there were only 5 female cases in 2008. Therefore, the disparity in early syphilis rates between males and females has grown larger and reflects the increasing burden within the MSM community.  

In 2008, the overall incidence rate of primary/secondary syphilis doubled from 1.2 to 2.4 per 100,000. The number of cases among males increased from 58 in 2007 to 111 in 2008 while among females, the number increased from 1 to 5. Primary/secondary syphilis cases among MSM, who comprised 89% of male cases in 2008, increased by 87%. Increases in cases were observed across all geographic areas; however the City of Minneapolis remains to account for majority of cases (44%). The incidence of primary/secondary syphilis infection increased in every age group, especially among persons 20-24 years old (5 cases in 2007 and 24 cases in 2008). Whites comprised the majority (77%) of cases in 2008, but African Americans still have a rate of primary/secondary syphilis that is almost 5 times higher than that among Whites.

The number of early syphilis cases also increased in 2008 (163 versus 114 in 2007). The number of cases among women increased slightly (from 2 to 5), while cases among men increased from 111 to 158 (42%). Of all cases reported, 97% were among males and 89% of these were MSM. Most (81%) of the MSM cases were White, but a disproportionate number (12%) were Black. Almost half were residents of Minneapolis. Among all early syphilis cases, the largest increase in a single age group was among persons 20-24 years old (14 cases in 2007; 33 cases in 2008).  

Chancroid:

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

Summary Points:

• Over the past decade (1998-2008), Minnesota’s chlamydia rate doubled while the gonorrhea rate fluctuated but increased slightly.
• Minnesota has seen a resurgence in syphilis since 2002, with men who have sex with men being especially impacted.
• Racial disparities in STD’s continue to persist in Minnesota with communities of color having the highest rates.
• Between 2007 and 2008, the chlamydia incidence rate increased by 7% while the gonorrhea rate decreased by 12%. Cases of primary/secondary syphilis nearly doubled among males (89% of whom were men who have sex with men), while cases among women remained low.
• In 2008, incidence rates of chlamydia increased by 10% among males and 6% among females; gonorrhea decreased by 10% among males and 14% among females.
• Although STD rates continue to be highest in the City of Minneapolis, rates have been growing the fastest in the Twin Cities suburbs and greater Minnesota.
• Adolescents and young adults (ages 15-24) accounted for 69% of chlamydia and 59% of gonorrhea cases reported in 2008.
• In 2008, primary/secondary syphilis cases increased by 87% among men who have sex with men, who comprised 85% of all cases.

Data Tables

Data Archive

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