Contribution of Repeat Infections to the Gonorrhea Burden in the STD Surveillance Network (SSuN)

Barton, Jerusha

Thursday, September 22, 2016

Galleria Exhibit Hall

Jerusha Barton, MPH¹, Robbie Therese Madera, MPH², Heidi Bauer, MD, MS, MPH³, Trang Q. Nguyen, PhD, MPH⁴, Robert P. Kohn, MPH⁵, Rebecca Hawrusik, MS⁶, Ellen Klingler, MPH⁷, Emily Han, MPH³, Teal Bell, MPH⁸, Christina Schumacher, PhD⁹ and Mark Stenger, MA¹⁰, 1Division of STD Prevention, CDC/NCHHSTP/DSTDP, Atlanta, GA, 2Division of Disease Control, Philadelphia Departement of Public Health, Philadelphia, PA, 3STD Control Branch, California Department of Public Health, Richmond, CA, 4Applied Research, Community Health, Epidemiology, and Surveillance Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, 5Applied Research, Community Health, Epidemiology, and Surveillance (ARCHES) Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, 6Division of STD Prevention, Massachusetts Dept of Public Health, Jamaica Plain, MA, 7Bureau of Sexually Transmitted Disease Control, New York City Department of Health & Mental Hygiene, Long Island City, NY, 8Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA, 9Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 10DSTDP/Surveillance and Data Management Branch, CDC, Atlanta, GA

Background: More than 350,000 gonorrhea cases were reported nationally in 2014. National data reflect cases diagnosed, not the number of persons diagnosed. The contribution of repeat infections to overall case incidence has not been previously examined because national reporting data lack patient identifiers. We examined data from the STD Surveillance Network (SSuN), which allows individuals to be linked if diagnosed more than once, to describe characteristics of persons with repeat infections and assess their contributions to overall case incidence.

Methods: Enhanced surveillance data were analyzed to identify individuals diagnosed with gonorrhea more than once in nine SSuN jurisdictions during 2015. Diagnoses were classified as repeat infections if diagnosed >30 days apart for the same individual. We assessed the contribution of repeat diagnoses to case incidence and used generalized estimating equations to estimate the association between repeat diagnosis and selected patient demographics.

Results: During January–December 2015, 73,826 patients were diagnosed and reported with 78,211 cases of gonorrhea. Overall, 5.4% (3,997) of individuals had more than one diagnosis and these individuals contributed 10.7% (8,382) of all diagnoses reported in SSuN jurisdictions. Among those with repeat diagnoses, 8.7% had three or more episodes of gonorrhea identified during the study period (range: 2–6). After controlling for jurisdiction, males (adjusted odds ratio [aOR] 1.6, 95% CI: 1.5, 1.7), persons 25-29 years old (aOR 1.7, 95% CI: 1.5, 2.0), and non-Hispanic-whites (aOR 1.2, 95% CI: 1.0, 1.4) were more likely than females, other age groups, or other race/ethnicities to be reported with repeat infections.

Conclusions: Repeat diagnoses account for a substantial proportion of reported cases in SSuN jurisdictions. Targeting persons at increased risk for repeat infection with interventions, such as partner services, may reduce overall case burden and may identify persons with treatment failures. Persons with repeat infections may also be candidates for individual-level STD/HIV interventions, including PrEP.

THP 94 Contribution of Repeat Infections to the Gonorrhea Burden in the STD Surveillance Network (SSuN)