Sexually Transmitted Diseases, 2018
Gonorrhea and chlamydia in Minnesota are monitored through a mostly passive surveillance system involving review of submitted 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 2018, 23,564 chlamydia cases (444 per 100,000 population) were reported. This is the same rate as in 2017 (Table 3).
Adolescents and young adults are at highest risk for acquiring a chlamydia infection (Table 4). The chlamydia rate is highest among 20 to 24-year-olds (2,385 per 100,000), followed by the 15 to 19-year-old age group (1,624 per 100,000). The incidence of chlamydia among adults 25 to 29 years of age (1,155 per 100,000) is considerably lower but has increased in recent years. The chlamydia rate among females (562 per 100,000) is nearly twice the rate among males (324 per 100,000), most likely due to more frequent screening among females.
Chlamydia infection incidence is highest in communities of color (Table 4). The rate among black non-Hispanics (2,025 per 100,000) is 9.7 times higher than the rate among white non-Hispanics (209 per 100,000). Although black, non-Hispanic persons comprise approximately 5% of Minnesota’s population, they account for 24% of reported chlamydia cases. Rates among Asian/Pacific Islanders (419 per 100,000), Hispanic, any race (751 per 100,000), and American Indian/ Alaska Natives (1,148 per 100,000) are over 2 to 6 times higher than the rate among white, non-Hispanic persons.
Chlamydia infections occur throughout the state, with the highest reported rates in Minneapolis (1,255 per 100,000) and St. Paul (982 per 100,000). Greater Minnesota had the greatest increase in rates between 2017 and 2018 at 5%. Every county in Minnesota had at least 4 cases in 2018.
Gonorrhea is the second most commonly reported STD in Minnesota. In 2018, 7,542 cases (142 per 100,000 population) were reported. This is the highest reported rate of gonorrhea in the last decade with a 15% rate increase compared to 2017 (Table 3).
Adolescents and young adults are at greatest risk for gonorrhea (Table 4), with rates of 339 per 100,000 among 15 to 19- year-olds, 543 per 100,000 among 20 to 24-year olds, and 434 per 100,000 among 25 to 29-yearolds. Gonorrhea rates for males (159 per 100,000) were higher than females (125 per 100,000).
Communities of color are disproportionately affected by gonorrhea. The incidence of gonorrhea among black, non- Hispanics (926 per 100,000) is 16 times higher than the rate among white, non-Hispanics (57 per 100,000). Rates among Asian/Pacific Islanders (85 per 100,000), Hispanic, any race (184 per 100,000), and American Indian/Alaska Natives (658 per 100,000) are up to 12 times higher than among white, non- Hispanic persons.
Gonorrhea rates are highest in the cities of Minneapolis and St. Paul (Table 4). The incidence in Minneapolis (617 per 100,000) is over 1.5 times higher than the rate in St. Paul (393 per 100,000), 6 times higher than the rate in the suburban metropolitan area (99 per 100,000), and 8 times higher than the rate in Greater Minnesota (73 per 100,000). In 2018, the city of Minneapolis saw the largest increase in cases at 35%.
Surveillance data for primary and secondary syphilis are used to monitor morbidity trends because these represent recently acquired infections. Data for early syphilis (which includes primary, secondary, and early latent stages of disease) are used in outbreak investigations because these 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 2018, there were 292 cases of primary/secondary syphilis in Minnesota (5.5 cases per 100,000 persons), which is the same number of cases and rate as in 2017.
In 2018, the number of early syphilis cases decreased by 4%, with 578 cases, compared to 605 cases in 2017. The incidence remains highly concentrated among MSM. Of the early syphilis cases in 2018, 484 (84%) occurred among men; 363 (62%) of these were MSM; with 39% of the MSM diagnosed with early syphilis that were co-infected with HIV. However, the number of women reported has continued to increase over the past 10 years from 5 early syphilis cases in 2008 to the highest number of cases reported in 2018 at 94.
Ten congenital syphilis cases were reported in 2018, which is the highest number of cases reported for Minnesota in more than 50 years. Syphilis may be passed from a pregnant person to the unborn baby through the placenta.The infection can cause miscarriages and stillbirths, and infants born with congenital syphilis can suffer a variety of serious health problems, including deformities, seizures, anemia, and jaundice. The CDC reported that the number of infants born with syphilis has more than doubled in the past 4 years and last year reached a 20-year high. In Minnesota, the number and rate of congenital syphilis cases among infants has increased over the past 5 years from 0 in 2014 to 15.1 per 100,000 live births in 2018.
- For up to date information see>> Sexually Transmitted Diseases (STDs)
- Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2018