# Presentation: 746843

## Increasing Incidence of Gonorrhea in California(the talk formerly known as: “Gonorrhea Drips on in California”)

- Michael C Samuel1, Virginia Loo1, Denise Gilson1, Duli Kodagoda2,
- Stewart Coulter1, Gail Bolan1
- 1-California Department of Health Services, Sexually Transmitted Disease Control Branch, Berkeley, California
- 2-Los Angeles Department of Health Services, Sexually Transmitted Disease Program

## Background / Purpose

- Increases in GC noted in several California counties since 1999
- Similar increases noted elsewhere in US and internationally
- Analyze trends by demographic characteristics to better understand reasons for GC increases
- Is the increase “real”

## GonorrheaCalifornia vs. United States Rates, 1970–2000

**Gonorrhea****California vs. United States Rates, 1970–2000**

## GC Case-based surveillance in California - hybrid system

- some counties: “AVSS” vital statistics system
- some counties: California specific STD-MIS-like system
- LA and SF each have unique systems (and separate cooperative agreements)
- some counties have additional local data, especially from STD clinic
- Statewide common denominator is “NETSS-like” selection of demographic and few other variables (Gender of partners NOT collected)

## Additional Data

- Prevalence Monitoring
- Gonococcal Isolate Surveillance Project (GISP)

## Gonorrhea RATES by Gender and YearCalifornia 1998-2001

**Data for 2001 are provisional and will increase slightly**

## Gonorrhea Male:Female Ratio by YearCalifornia 1998-2001

## Female Gonorrhea PositivityCA Prevalence Monitoring (IPP) Data

**Family Planning**

**STD Clinics**

## Female Gonorrhea PositivityCA Prevalence Monitoring (IPP) Data(“consistent series” clinics)

**Family Planning**

**STD Clinics**

## Percent MSM among GISP* Isolates by California Clinic, 1990-2000 *Gonococcal Isolate Surveillance Project

**Percent MSM among GISP* Isolates by California Clinic, 1990-2000 *Gonococcal Isolate Surveillance Project**

- Source: STD Control Branch, DCDC, CA DHS  - Provisional 11/2001

## Santa Cruz County Data

## Counties with Increase in Male GC Cases 1999 to 2000

- (<10 cases)

**72% w/ ******

## Counties with Increase in Female GC Cases 1999 to 2000

- (<10 cases)

**79% w/ ******

## California Regions

**NORTH**

**SOUTH**

**CENTRAL**

**BAY**

**L.A.**

## Female Gonorrhea RATES by RegionCalifornia 1998-2001

## Male Gonorrhea RATES by RegionCalifornia 1998-2001

## Female Gonorrhea RATE by Age GroupCalifornia 1998-2001

## Male Gonorrhea RATE by Age GroupCalifornia 1998-2001

**51%******

**47%******

## Male Gonorrhea RATE by Race/Ethnic GroupCalifornia 2001

## Female Gonorrhea RATE by Race/Ethnic GroupCalifornia 2001

## Female Gonorrhea Cases by Race/Ethnic GroupCalifornia 1998-2001

## Male Gonorrhea Cases by Race/Ethnic GroupCalifornia 1998-2001

## Explanation for Increases

- True increases in incidence
- increases in MSM cases
- Increased CT screening
- mostly in women
- CT/GC dual test
- Slightly decreased specificity of amplified tests --> increased false positives
- Change in reporting (no evidence)

## Conclusion

- Increases in reported male and female GC cases 1999-2001 in almost all areas in California
- Increases higher in males, particularly in older age groups; GISP and other data support increase in MSM
- Race data incomplete, but very high rates among African Americans and noteworthy increase in white males
- IPP data does not support observed increase
- Enhanced GC Surveillance to be conducted in 2002 in sample of counties

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