Presented By:

Steve Kutz, RN, MPHPublic Health Nurse Supervisor,STD & Immunization ProgramsWashoe County Health District

Overview of Gonorrhea (GC) Epidemiology and Program Prevention Efforts

Developed By:

Sandi Noffsinger, MPHSTD Program Coordinator

Nevada State Health Division

Reported Cases of Gonorrhea: Nevada 2000- 2008

Year

Nu

mb

er

of

Ca

ses

* Data extracted from STD*MIS

1602

20862212

2134

3080

28882789

2363

2165

0

500

1000

1500

2000

2500

3000

3500

Rate of Gonorrhea Cases per 100,000 Population: Nevada, 2000 - 2008

Rates for 2006-2008 are calculated based on interim population estimates from the Nevada State Demographer.

Year

Ra

te p

er

100

,00

0 p

op

ula

tio

n

79.4

98.1 100.593.2

128.1

115.1106.3

86.979.1

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

Rates of Gonorrhea Cases per 100,000 Population,by Sex: Nevada, 2000 – 2008

Year

Ra

te p

er

100

,00

0 p

op

ula

tio

n

Rates for 2006-2008 are calculated based on interim population estimates from the Nevada State Demographer.

94.3

107.6

90.998.9

135.6

120.6115.0

93.7

83.2

64.0

88.0 89.194.0

120.1

109.4

97.4

80.074.8

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

Male Female

Sex of Gonorrhea Cases by Age at Diagnosis:Nevada, 2008

Number of Cases

Ag

e o

f C

as

es

30

104

81

98

130

186

313

213

3

1

7

22

23

43

60

140

322

370

17

0

-400 -300 -200 -100 0 100 200 300 400

55+

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

<10

Females

Males

Sex of Gonorrhea Cases by Race/Ethnicity:Nevada, 2008

N=1,159

Female Gonorrhea Cases

N=1,004

Male Gonorrhea Cases

* “API” category includes Asian / Pacific Islander / Native Hawaiian groups. • “American Indian” category includes American Indian and Alaska Native groups.

White, non-Hispanic

22%

Black, non-Hispanic

30%

American Indian1%

Asian/Pacific Islander

2%

Hispanic11%

Other/Unknown34%

White18%

Black45%

American Indian0%API

1%

Hispanic11%

Other/Unknown25%

Rates and Rank of Gonorrhea Cases in Nevada by County, 2008

Rank County n Rate*1 Clark 1,918 982 Washoe 209 503 Carson City 11 194 Nye 11 245 Douglas 8 156 Lyon 5 97 Churchill 2 78 Elko 1 29 Esmeralda 0 -10 Eureka 0 -11 Humboldt 0 -12 Lander 0 -13 Lincoln 0 -14 Mineral 0 -15 Pershing 0 -16 Storey 0 -17 White Pine 0 -

Total 2,165 80*Rate per 100,000

Rank and Rate of Gonnorhea Cases in Nevada by County, 2008

Las Vegas

Reno

592.2618.8

477.0443.8

570.9

530.2 535.4

470.6436.6

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

White Black Hispanic Nevada Total

Rate of Gonorrhea per 100,000 Population, by Race/Ethnicity: Nevada, 2000 - 2008

Year 2010 Objective for

Blacks(425 per 100,000)

Rates for 2006-2008 are calculated based on interim population estimates from the Nevada State Demographer. Year

Ra

te p

er

100

,00

0 p

op

ula

tio

n

Target Population: Black/African Americans,Demographics

Males63%

Females37%

GC Cases Among Blacks in Nevada, by Sex: 2008

Ag

e o

f C

as

es

Number of Cases

Sex of GC Cases Among Blacks, by Age: Nevada, 2008

7

45

34

36

59

83

142

114

2

1

0

6

6

4

16

36

100

131

5

0

-150 -100 -50 0 50 100 150

55+

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

<10

Females

Males

Geographic Distribution of Rate of GC Among Blacks by sex, in Nevada, 2008

538

906

317

463

Rate of Male GC Cases per 100,000

Rate of Female GC Cases per 100,000

All Other Counties*: 168

All Other Counties*: 166

Las Vegas

Reno

Male Female Total

Clark 538 317 427

Washoe 906 463 700

All Other Counties* 168 166 167

Rates per 100,000 of GC Cases Among Blacks in Nevada by County, 2008

* All other Frontier and Rural (Far) Counties include: Churchill, Carson City, Douglas, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Pershing, Storey, and White Pine.

Percent of GC Morbidity by Provider Type (Among Positive Cases), in Nevada, 2008

Provider Type # Cases % Morbidity

STD Clinic 700 81%Family Planning 76 9%Teen 41 5%Other 15 2%Juvenile Detention Center 34 4%TOTAL 866 100%

Data is based on statewide IPP data from IPP funded sites only.

Nevada’s Gonorrhea Isolate Surveillance Project (GISP)

The Sentinel Site for GISP has been located at Southern Nevada Health District in Las Vegas, Nevada since 2002. 

In 2009: Obtained 655 cultures from symptomatic people

at the SNHD STD Clinic 318 (49%) of the cultures collected were

positive 287 samples were sent to the regional

laboratory for evaluation of antimicrobial resistance▪ Nevada has met or exceeded the goal of 25 positive

male isolates per month in 2009 in all months except March (18 samples were sent)

Interventions for Prevention and Control

Targeted STD Screening in non-traditional settings.

Working with faith based organizations to reach minority populations

Provider education (i.e. Grand Rounds)

Individual provider educational visits/trainings

Correctional outreach

SNHD- In 2007-2009 focusing on pregnant women and teens (in corrections)

Challenges for GC Prevention and Control

Funding cuts

Reaching hidden high risk populations (internet, minority populations)

Reaching un-insured high risk populations

Challenges getting comprehensive sexual education to all youth in Nevada

Offering internal capacity for STD testing (oral and rectal

Thank you!