Sexually Transmitted Diseases, 2009
Active surveillance for gonorrhea and chlamydia involves cross-checking laboratory-reported cases against cases reported by clinicians. Although both laboratories and clinical facilities are required to report STDs independently of each other, an episode of STD is not considered a case for surveillance purposes until a corresponding case report is submitted by a clinical facility. Case reports contain demographic and clinical information that is not available from laboratory reports. When a laboratory report is received but no corresponding case report is received within 45 days, MDH mails a reminder letter and case report form to the corresponding clinical facility. Active surveillance for syphilis involves immediate follow-up with the clinician upon receipt of a positive laboratory report. Cases of chancroid are monitored through a mostly passive surveillance system. Herpes simplex virus and human papillomavirus infections are not reportable.
Although overall incidence rates for STDs in Minnesota are lower than those in many other areas of the United States, certain population subgroups in Minnesota have very high STD rates. Specifically, STDs disproportionately affect adolescents, young adults, and persons of color.
Chlamydia trachomatis infection is the most commonly reported infectious disease in Minnesota. In 2009, 14,186 chlamydia cases (288 per 100,000 population) were reported, representing a 1% decrease from 2008 (Table 3).
Adolescents and young adults are at highest risk for acquiring chlamydial infection (Table 4). The chlamydia rate is highest among 20 to 24-year-olds (1,652 per 100,000), with the next highest rate among 15 to 19-year-olds (1,196 per 100,000). The incidence of chlamydia among adults 25 to 29 years of age (731 per 100,000) is considerably lower but has increased in recent years. The chlamydia rate among females (410 per 100,000) is more than twice the rate among males (164 per 100,000), a difference most likely due to more frequent screening among women.
The incidence of chlamydia infection is highest in communities of color (Table 4). The rate among blacks (2,038 per 100,000) is over 15 times higher than the rate among whites (132 per 100,000). Although blacks comprise approximately 4% of Minnesota’s population, they account for 29% of reported chlamydia cases. Rates among Asian/Pacific Islanders (324 per 100,000), American Indians (511 per 100,000), and Hispanics (633 per 100,000) are over two to six times higher than the rate among whites.
Chlamydia infections occur throughout the state, with the highest reported rates in Minneapolis (741 per 100,000) and St. Paul (687 per 100,000). While there was an overall decrease of 1% across the state in 2009 the greatest decrease for chlamydia was seen in the Minneapolis with a decrease of 6% compared to only 1% in each of the remaining geographic regions shown in Table 4.
Gonorrhea, caused by Neisseria gonorrhoeae, is the second most commonly reported STD in Minnesota. In 2009, 2,302 cases (42 per 100,000 population) were reported, representing a 24% decrease from 2008 (Table 3).
Adolescents and young adults are at greatest risk for gonorrhea (Table 4), with incidence rates of 163 per 100,000 among 15 to 19-year-olds, 237 per 100,000 among 20 to 24-year olds, and 134 per 100,000 among 25 to 29-year-olds. Gonorrhea rates for males (42 per 100,000) and females (51 per 100,000) are comparable. Communities of color are disproportionately affected by gonorrhea, with nearly one half of cases reported among blacks. The incidence of gonorrhea among blacks (546 per 100,000) is 36 times higher than the rate among whites (15 per 100,000). Rates among Asian/Pacific Islanders (15 per 100,000), American Indians (80 per 100,000), and Hispanics (58 per 100,000) are up to five times higher than among whites.
Gonorrhea rates are highest in the cities of Minneapolis and St. Paul (Table 4). The incidence in Minneapolis (188 per 100,000) is 33% higher than the rate in St. Paul (141 per 100,000), nearly six times higher than the rate in the suburban metropolitan area (32 per 100,000), and over nine times higher than the rate in Greater Minnesota (20 per 100,000). Geographically in 2009, Minneapolis and Greater Minnesota saw the greatest drop in cases with 32% and 31% respectively, with St. Paul and the suburban area posting decreases of 17% and 13% respectively.
The prevalence of quinolone-resistant N. gonorrhoeae (QRNG) continues to be an issue in Minnesota as well as nationally. In 2007, the MDH recommended that fluoroquinolones (eg, ciprofloxacin) no longer be used for the treatment of gonorrhea in Minnesota.
The incidence of primary/secondary syphilis in Minnesota is lower than that of chlamydia or gonorrhea (Table 3), but has remained elevated since an outbreak was observed in 2002 among men who have sex with men (MSM). In 2009, there were 71 cases of primary/secondary syphilis in Minnesota (1.4 cases per 100,000 persons). This represents a decrease of 39% compared to the 116 cases (2.4 per 100,000 population) reported in 2008.
Primary and Secondary Syphilis
The incidence of primary/secondary syphilis in Minnesota is lower than that of chlamydia or gonorrhea (Table 3), but has remained elevated since an outbreak was observed in 2002 among men who have sex with men (MSM). This sustained outbreak reached a new level in 2008, with 116 cases of primary/secondary syphilis (2.4 per 100,000 population) being reported compared to 59 (1.2 per 100,000) cases in 2007.
In 2009, the number of early syphilis cases decreased by 28%, with 117 cases occurring compared to 163 cases in 2008. The incidence remains highly concentrated among MSM. Of the early syphilis cases in 2009, 106 (91%) occurred among men; 96 (91%) of these men reported having sex with other men; 53% of the MSM diagnosed with early syphilis were co-infected with HIV.
No cases were reported in 2009. The last case was reported in 1999.
- For up to date information see>> Sexually Transmitted Diseases (STDs)
- Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2009