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Laboratory Surveillance of Sexually Transmitted Disease
LA County Dept. of Health ServicesSexually Transmitted Disease Program
Laboratory Surveillance Unit
Chandra Higgins, [email protected]
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Reportable STDs in LA County
• Reporting requirements
• Dual reporting system
• Forms
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Legal STD Reporting Requirements in California
Laboratory• Syphilis• Chlamydia• Gonorrhea
Health Provider• Syphilis• Chlamydia• Gonorrhea• Chancroid• PID (Pelvic
Inflammatory Disease)• NGU (Non-Gonococcal
Urethritis)
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Reporting Responsibilities
Laboratory• All positives
• Report within one working day of identification
Health Provider• Known or suspect
• Report syphilis within one working day of identification. All others within 7 calendar days.
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Reporting Responsibilities
Laboratory• Patient name &
limited demographics
• Provider name, address, phone
• Specimen accession, dates, test type & results
Health Provider• Patient name & full
demographics• Diagnosis, date of
diagnosis & onset• Name, address, &
phone of reporter
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Medical Provider’s STD Reporting Form (p.1)
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Medical Provider’s STD Reporting Form(p.1, continued)
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Medical Provider’s STD Reporting Form (p.2)
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Medical Provider’s STD Reporting Form(p.2, continued)
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ProviderOnlyESy 0.3%CT 3.5%GC 4.8%
BothESy 51%CT 70%GC 66%
LaboratoryOnlyESy 49%CT 27%GC 29%
Reports to LA County STD ProgramChlamydia, Gonorrhea, and Syphilis 2004
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Reporting Issues
• Improved enforcement of reporting laws• State investigations; non-compliance can
result in loss of lab license
• Identification of non-reporters is difficult• Dual reporting requirement facilitates
identification• Annual laboratory survey identifies
laboratories with deficient reporting practices
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Reporting Issues(continued)
• Heaviest burden on laboratories• Often sole reporting source• Rely on providers for patient information• Referring laboratories withhold patient /
provider information from testing facilities
• Increased interstate testing has accompanied growth of managed care & core laboratories• Reporting requirements vary by state
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Annual Laboratory Survey
• Monitor compliance with reporting guidelines
• Monitor trends in test utilization & laboratory practice
• Provide information on STD testing trends and recommendations
• Inform laboratories about STD Program function
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Private Lab44%
Physician Office
7%
Private Hospital
33%
Other10%
PH/County6%
2004 STD Testing Laboratories
N=163
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PH/County Hospital7%
Physician Office1%
Private Hospital6%
Other14%
Free Standing Private72%
Test Volume by Lab-Type 2004
Syphilis, Chlamydia, Gonorrhea
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0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1995 1997 1999 2001 2003 2004
Tes
ts I
n M
illi
on
s
Syphilis Chlamydia Gonorrhea
L.A. County STD Testing 1995 – 2004
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Nontreponemal90%
Treponemal10%
N=1,629,500
Syphilis Testing, 2004
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0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1995 1997 1999 2001 2003 2004
Test
s In
Mill
ions
Amplified DNA Probe EIA
Growth In Amplified Tests
Chlamydia, 1995 - 2004
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SDA52%
TMA24%
PCR23%
LCR1%
Amplified Methods
2003 & 2004 Chlamydia Tests
PCR10%
LCR0%
SDA64%
TMA26%
2003 2004
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0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1995 1997 1999 2001 2003 2004
Test
s in
Mill
ions
Amplified DNA Probe Culture
Growth in Amplified Testing
Gonorrhea, 1995 - 2004
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Gonorrhea19%
Syphilis18%
Hepatitis B13%
HPV/HVS16%
HIV13%
Chlamydia21%
L.A. County STD Testing
All 2004 Testing