Annual Summary of Disease Activity:
Disease Control Newsletter (DCN)
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Sexually Transmitted Diseases, 2015
Surveillance for gonorrhea and chlamydia in Minnesota are monitored through a mostly passive surveillance system involving collecting both case reports and laboratory reports. Syphilis is monitored through active surveillance, which involves immediate follow-up with the clinician upon receipt of a positive laboratory report. 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 2015, 21,238 chlamydia cases (400 per 100,000 population) were reported, representing a 7% increase from 2014 (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 (2,336 per 100,000), followed by the 15 to 19-year-old age group (1,403 per 100,000). The incidence of chlamydia among adults 25 to 29 years of age (1,061 per 100,000) is considerably lower but has continued to increase in recent years. The chlamydia rate among females (528 per 100,000) is more than twice the rate among males (271 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 (1,701 per 100,000) is nine times higher than the rate among whites (192 per 100,000). Although blacks comprise approximately 5% of Minnesota’s population, they account for 22% of reported chlamydia cases. Rates among Asian/Pacific Islanders (341 per 100,000), Hispanics (507 per 100,000), and American Indians (918 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 (1,124 per 100,000) and St. Paul (868 per 100,000). While there was an overall increase of 7% across the state in 2015, the greatest increase for chlamydia was seen in Minneapolis. This area displayed an increase of 13%, as shown in Table 4. Every county in Minnesota had at least 2 cases in 2014.
Gonorrhea, caused by Neisseria gonorrhoeae, is the second most commonly reported STD in Minnesota. In 2015, 4,097 cases (77 per 100,000 population) were reported. 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 rates of 174 per 100,000 among 15 to 19-year-olds, 352 per 100,000 among 20 to 24-year olds, and 238 per 100,000 among 25 to 29-year-olds. Gonorrhea rates for males (92 per 100,000) were higher than females (63 per 100,000). Communities of color are disproportionately affected by gonorrhea. The incidence of gonorrhea among blacks (531 per 100,000) is 15 times higher than the rate among whites (34 per 100,000). Rates among Asian/ Pacific Islanders (45 per 100,000), Hispanics (81 per 100,000), and American Indians (241 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 (376 per 100,000) is over 1.5 times higher than the rate in St. Paul (230 per 100,000), seven times higher than the rate in the suburban metropolitan area (49 per 100,000), and 12 times higher than the rate in greater Minnesota (32 per 100,000). In 2015, Greater Minnesota saw the largest increase in cases at 15%.
The emergence of quinolone-resistant N. gonorrhoeae in recent years has become a 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, CDC changed the treatment guidelines for gonococcal infections in August 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. New CDC STD Treatment Guidelines were released in 2015.
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 2015, there were 246 cases of primary/ secondary syphilis in Minnesota (4.6 cases per 100,000 persons). This represents a small decrease compared to the 257 cases (4.8 per 100,000) reported in 2014.
In 2015, the number of early syphilis cases increased by 4%, with 431 cases, compared to 416 cases in 2014. The incidence remains highly concentrated among MSM. Of the early syphilis cases in 2015, 341 (80%) occurred among men; 222 (65%) of these were MSM; 56% of the MSM diagnosed with early syphilis were co-infected with HIV. However, the number of women reported has continued to increase from 2012.
Three congenital syphilis cases were reported in 2015. Congenital syphilis can be prevented by screening and treatment during pregnancy. Because of an increase in syphilis in Minnesota among women of childbearing age, MDH issued a health advisory in January 2016 that all pregnant women be tested at their first prenatal visit, at 28 weeks gestation, and at delivery.
Chancroid continues to be very rare in Minnesota. 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, 2015