Sexually Transmitted Diseases, 2014
Surveillance for gonorrhea and chlamydia in Minnesota are monitored through a mostly passive surveillance system. The process involves collecting both case reports and laboratory reports to document a case of gonorrhea and/or chlamydia. Syphilis is monitored through active surveillance, which 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 2014, 19,897 chlamydia cases (375 per 100,000 population) were reported, representing a 6% increase from 2013 (Table 3).
Adolescents and young adults are at highest risk for acquiring chlamydia infection (Table 4). The chlamydia rate is highest among 20 to 24-year-olds (2,244 per 100,000), followed by the 15 to 19-year-old age group (1,402 per 100,000). The incidence of chlamydia among adults 25 to 29 years of age (932 per 100,000) is considerably lower but has continued to increase in recent years. The chlamydia rate among females (504 per 100,000) is more than twice the rate among males (244 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 (1,625 per 100,000) is nine times higher than the rate among whites (182 per 100,000). Rates among Asian/Pacific Islanders (318 per 100,000), Hispanics (440 per 100,000), and American Indians (862 per 100,000) are over two to four times higher than the rate among whites.
Chlamydia infections occur throughout the state, with the highest reported rates in Minneapolis (999 per 100,000) and St. Paul (818 per 100,000). While there was an overall increase of 6% across the state in 2014 the greatest increase for chlamydia was seen in the suburban metropolitan area of the Twin Cities. This area displayed an increase of 19%, as shown in Table 4. Every county in Minnesota had at least 2 chlamydia cases in 2014.
Gonorrhea, caused by Neisseria gonorrhoeae, is the second most commonly reported STD in Minnesota. In 2014, 4,073 cases (77 per 100,000 population) were reported, representing a 5% increase from 2013. This is the highest reported rate of gonorrhea in the last decade (Table 3).
Adolescents and young adults are at greatest risk for gonorrhea (Table 4), with incidence rates of 218 per 100,000 among 15 to 19-year-olds, 362 per 100,000 among 20 to 24-year olds, and 218 per 100,000 among 25 to 29-year-olds. Gonorrhea rates for males (86 per 100,000) were higher than females (67 per 100,000) for the first time since 1993. Communities of color are disproportionately affected by gonorrhea. The incidence of gonorrhea among blacks (556 per 100,000) is 18 times higher than the rate among whites (31 per 100,000). Rates among Asian/Pacific Islanders (40 per 100,000), Hispanics (75 per 100,000), and American Indians (240 per 100,000) are up to seven times higher than among whites.
Gonorrhea rates are highest in the cities of Minneapolis and St. Paul (Table 4). The incidence in Minneapolis (377 per 100,000) is over 1.5 times higher than the rate in St. Paul (238 per 100,000), seven times higher than the rate in the suburban metropolitan area (51 per 100,000), and 13 times higher than the rate in Greater Minnesota (28 per 100,000). In 2014, Greater Minnesota saw the largest increase in cases at 21%.
The emergence of quinolone-resistant N. gonorrhoeae (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 1 week for a test-of-cure at the site of infection.
Surveillance data for primary and secondary syphilis are used to monitor morbidity trends because they represent recently acquired infections. Data for early syphilis (which includes primary, secondary, and early latent stages of disease) are used in outbreak investigations because they represent infections acquired within the past 12 months and signify opportunities for disease prevention.
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 began in 2002 among men who have sex with men (MSM). In 2014, there were 257 cases of primary/secondary syphilis in Minnesota (4.8 cases per 100,000 persons). This represents an increase of 33% compared to the 193 cases (3.6 per 100,000) reported in 2013.
In 2014, the number of early syphilis cases increased by 25%, with 416 cases, compared to 332 cases in 2013. The incidence remains highly concentrated among MSM. Of the early syphilis cases in 2014, 374 (90%) occurred among men; 283 (76%) of these men reported having sex with other men; 50% of the MSM diagnosed with early syphilis were co-infected with HIV.
Chancroid continues to be very rare in Minnesota. No cases were reported in 2014. 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, 2014