Gonorrhea in New York City Epidemiology, Disease Control Activities, and

Challenges

Presented by: Julia A. Schillinger, MD, MScCAPT USPHS

Bureau of STD ControlNew York City Department of Health and Mental Hygiene

jschilli@health.nyc.gov

Gonorrhea rates, by sex New York City, 1995-2009*

0

50

100

150

200

250

Year

Cas

e R

ate

per

100,

000

male female overall

Data based on cases reported to the NYC DOHMH;

* Annualized based on half-year 2009 data

April 2007:

CDC alert: Discontinue FQ use

September 2006:

NYC joins GISP

2004: NYC STD clinic QRNG prevalence exceeds 5%

April 2004: NYC DOHMH QRNG health alert

January 2008:

NYC makes AST for GC reportable

Gonorrhea reported to the NYC DOHMH. Case rates (per 100,000 population) by age and sex*, full year 2008

-800 -600 -400 -200 0 200 400 600 800

Ag

e (y

ears

)

Case rate per 100,000 population

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

N=80

N=1724

N=1508

N=685

N=328

N=176

N=92

N=54

N=32

N=16

N=2

N=5

N=24

N=950

N=1607

N=1199

N=717

N=476

N=379

N=212

N=89

N=34

N=15

N=14

400 200 600 800

*excludes persons for whom sex or age were not reported

Male GC reported to the NYC DOHMH, 2000-2008, case rates, by age

0

100

200

300

400

500

600

700

2000 2001 2002 2003 2004 2005 2006 2007 2008

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

Female GC reported to the NYC DOHMH, 2000-2008, case rates, by age

0

100

200

300

400

500

600

700

800

900

1000

2000 2001 2002 2003 2004 2005 2006 2007 2008

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

0

50

100

150

200

250

Cas

e ra

te p

er 1

00,0

00

Black NH AmInd/AN

Hispanic White NH API

Race/ethnicity

Male Female

GC reported to the NYC DOHMH (n=10,483); case rates by race/ethnicity and sex, 2008

5

13

2844

1,665

2,186

378560

58

347

Other = 187Unknown race/eth = 5,011

Male GC reported to the NYC DOHMH, 2000-2008, case rates, by race

0

100

200

300

400

500

600

2000 2001 2002 2003 2004 2005 2006 2007 2008

Black NH

White NH

Hispanic

Asian NH

Am Ind/Al Nat

Female GC reported to the NYC DOHMH, 2000-2008, case rates, by race

0

50

100

150

200

250

2000 2001 2002 2003 2004 2005 2006 2007 2008

Black NH

White NH

Hispanic

Asian NH

Am Ind/Al Nat

Male GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race

0

50

100

150

200

250

300

350

400

450

500

2000 2001 2002 2003 2004 2005 2006 2007 2008

Black NH

White NH

Hispanic

Asian NH

Am Ind/Al Nat

Female GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race

0

100

200

300

400

500

600

700

800

900

1000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Black NH

White NH

Hispanic

Asian NH

Am Ind/Al Nat

14 13 10 13 10 10 12 12 14

43 43 40 4135

30 31 32 32

010

2030

4050

6070

8090

100

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

% G

C c

ases

rep

orte

d fr

om N

YC

ST

D c

linic

s

0

50

100

150

200 GC

case rate per 100,000

Females% males% Malesrate Femalerate

Case rate (per 100,000 population) of Neisseria gonorrhea reported to the New York City DOHMH, with percent reported from Bureau of STD clinics,

2000-2008, by sex

New York City United Hospital Fund (UHF) Neighborhoods

Percent fluoroquinolone resistance among gonorrhea isolates detected among BSTDC clinic patients,

2001-2008

0.1 0.3 3 8 9 17 17 150%

20%

40%

60%

80%

100%

2001 2002 2003 2004 2005 2006 2007 2008

Year

% Q

RN

G (

of

GC

iso

late

s)

QRNG

NYC Bureau of STD ControlCurrent GC Activities I

• GC (& CT) screening in NYC high schools

• Partner notification– GC cases dx’d in NYC school screening program– HIV-GC coinfected at select NYC facilities– InSPOT

• EZ Pass/VIP Program for core transmitters– HIV-GC co-infected, or 2 GC/12 mos eligible

NYC Bureau of STD ControlCurrent GC Activities II

• Sentinel surveillance for antimicrobial resistance– Culture at Fort Greene clinic– Gonococcal Isolate Surveillance Project (GISP)

• Routine surveillance for antimicrobial resistance

• Sentinel surveillance network– Extract behavioral and clinical information on GC

cases diagnosed in BSTDC clinics– Interview sample of non-BSTDC dx’d cases (SSuN

project)

Challenges in GC control

• Large number of infections– Universal interventions unsustainable– Focused interventions staff-intensive

• Syphilis & HIV interview and PN consume staff resources

• NAATs commonly used test– Provide no information on resistance– Not approved for anorectal specimens

• Antibiotic resistance– Opted not to pursue EPT legislation for GC