Std's in new jersey and gay or bisexual men - 2016

Std's in new jersey and gay or bisexual men - 2016

NEW JERSEY STD UPDATE 2017 STEVE DUNAGAN, B.S. SPECIAL PROJECTS COORDINATOR NJ DOH DIVISION OF HIV, STD, AND TB SERVICES GOOD MORNING! UPDATES - DIVISION OF HIV, STD, AND TB SERVICES The field staffs of the STD and HIV programs have been fully integrated and cross-trained and are now known as the Partner Services (PS) unit. Carolyn Tunstall is the PS manager. This merge provides efficiency in managing investigations and ensures that patients are notified by only one field services representative. All Partner Services staff will investigate and interview STD patients, HIV patients, and STD-HIV coinfected patients. Since the last update, our division has acquired seven new field staff and three have retired. Two new staff will start in October 2017.

DISEASE UPDATES CONGENITAL SYPHILIS In 2016, there was a marked increase in the number of congenital syphilis cases in US. NJ did not have any reportable cases before 2016. Per state protocol, we cannot discuss 2016 cases at this point. In addition to Confirmed cases (Cases diagnosed based on clinical diagnosis), CDC is also concerned with Probable cases (mainly, women who delivered before receiving adequate treatment at least 30 days before delivery). It is imperative that women have complete prenatal care throughout the pregnancy. Congenital cases increase when syphilis rates increase among the general population, which they have over the last 5 years This issue is a priority at CDC and has been reflected in their communication to the states and will be reflected in our grant requirements Pregnant women have always been the first priority of the NJ STD program (Positive tests, sex partners, and suspects) DISEASE UPDATES CONGENITAL SYPHILIS (CONT.) DIV. OF HIV, STD, AND TB SERVICES INITIATIVES The STD surveillance unit will follow up on all disease reports of women in child-bearing years submitted without pregnancy status to confirm pregnancy status and provide appropriate

counseling The STD program plans to reach out to OB/Gyn clinics and ERs in high-morbidity cities to alert them of CDC recommendations and advise them to refer pregnant women to prenatal care The STD program will be training community health workers (CHW) to educate their client base on STD awareness and prevention. They will focus on the prevention of congenital syphilis and make referrals to prenatal care as needed. The STD Program has a solid collaboration with Family Planning/Planned Parenthood clinics in place STATISTICS!!! NJ STD TOTALS FOR 2016 Chlamydi a Gonorrhea Primary & Secondary

Syphilis Early Latent Syphilis Total Morbidity 34,314 8,103 472 755 Males 10,348

4,763 448 * 661* Females 23,906 ** 3,327 24 94 Black

8,333 ** 3,299 ** 171 307 Hispanic 4,549 745 138 232 White

6,573 1,513 256* 376* Asian 332 56 16 44

Unknown 19,305 *** 3,309 *** 31 44 RACE/ETHNICITY PRIMARY SYPHILIS Clinical Manifestations 12 SECONDARY SYPHILIS PALMAR/PLANTAR RASH Source: CDC/NCHSTP/Division of STD

Prevention, STD Clinical Slides 2016 TOP TEN CITIES WITH PRIMARY/SECONDARY (P/ S) SYPHILIS (* = LESS OR EQUAL 10) Jersey City Newark 56 55 East Orange Paterson 14 Union 13

Elizabeth * Hamilton * Irvington * 18 West New York * Camden *

2016 STATISTICS FOR EARLY LATENT SYPHILIS TOP 10 CITIES AND TOP 7 COUNTIES Newark 128 (60% of Essex Co) Jersey City 116 (71% of Hudson Co) Essex 214 Paterson 34 Hudson East Orange 30

Union West NY 24 Irvington 18 Union 18 Orange 13 63 Middlesex Elizabeth 23

North Bergen 163 15 57 Passaic 49 Bergen 45 Camden 32

(CONT.) 2016 STATISTICS FOR SYPHILIS (CONT.) 29% increase in male P & S cases from 2015 (346 to 448 cases) 5% increase in male Early Latent cases from 2015 ( 630 to 661 cases) 8% decrease in female P & S cases from 2015 (26 to 24 cases) 12% increase in female Early Latent cases from 2015 ( 84 to 94 cases) The common factor among most congenital cases is inconsistent prenatal care throughout the pregnancy. Mothers must be treated no later than 30 days prior to delivery to ensure adequate treatment of the fetus. CDC recommendations and NJ health standards require a syphilis test in the 1st trimester. Another syphilis test in the 3rd trimester is highly recommended but not required. A test of the babys cord blood IS required at delivery. NJ SYPHILIS 5-YEAR TREND

Early Syphilis All Genders 800 700 600 500 400 300 200 100 0 2012 2013 Primary 2014 Secondary

2015 Early Latent 2016 2016 STATISTICS FOR SYPHILIS - MSM 2016: Approximately 70% of early syphilis male cases were MSM. The percentage has been approximately steady for the last six years. 2016: 92% of the MSM cases were HIV positive Age 15 19 3.3% 15-19: 3.3% Race/Ethnicity 20 24 25 34

35 44 45 - 64 17% 17% 20-24: 39% *** 20% 20% Asian Black 3.2%

37% *** Asian 3.2% Black 37% Hispanic Hispanic 31% 31% ** White White 25% 25% CDC RECOMMENDATIONS FOR TESTING OF GAY/BISEXUAL MEN The following screening tests should be performed at LEAST annually for sexually active MSM, including those with HIV infection:

HIV serology, if HIV status is unknown or negative and the patient himself or his sex partner(s) has had more than one sex partner since most recent HIV test. Syphilis serology to establish whether persons with reactive tests have untreated syphilis A test for urethral infection for gonorrhea and chlamydia in men who have had insertive intercourse during the preceding year (testing of the urine using NAAT is the preferred approach). A test for rectal infection for gonorrhea and chlamydia in men who have had receptive anal intercourse during the preceding year A test for pharyngeal (throat) infection for gonorrhea in men who have had receptive oral intercourse during the preceding year. Testing for chlamydia pharyngeal (throat) infection is not recommended. CDC RECOMMENDATIONS FOR TESTING OF GAY/BISEXUAL MEN To follow up their recommendations for testing of gay/bisexual men, CDC requests yearly data on syphilis and rectal GC testing at HIV care sites in high morbidity counties DAYAM, NJCRI, and Infectious Disease Practice are currently collaborating with the STD program to provide data Increased syphilis rates COULD be attributed to increased testing for PrEP prescription protocols


65% 69% GONORRHEA 2016 SEX RACE/ETHNICITY Males 4763 Black 2,760 ** Females

3327 White 868 Unknown 13 Hispanic 745 Total 8103 ( 12% increase from

2015) Asian 38 Other/Unknown 3,313**** GONORRHEA 2016 TOP TEN CITIES Newark Camden Paterson Jersey City East Orange Trenton

Atlantic City Irvington Elizabeth Hamilton Township (CONT.) CHLAMYDIA - 2016 SEX RACE/ETHNICITY Males 10,348 Black

8,333 Females 23,906 *** White 6,573 Unknown 63 Hispanic 4,549 Total

34,317 (10% increase from 2015) Asian 332 Other/Unknown 19,305**** CHLAMYDIA 2016 TOP TEN CITIES Newark Paterson Jersey City

Camden Trenton East Orange Elizabeth Irvington New Brunswick Passaic City (CONT.) QUESTIONS SO FAR? NJ STD/HIV PROGRAM ACTION STEPS The STD Program provides medications and test kits for state-approved non-profit medical providers We provide technical assistance and training to city/county STD clinics, medical providers, and CBOs/ASOs as needed The Rapid Syphilis Pilot Project Excellent tool for community outreach projects w/mobile vans

A post in June 2017 went out on (NJ Local Information Network and Communications System) regarding CDC rectal and pharyngeal GC testing recommendations for MSMs. This is a great way to send out health alerts to medical providers! NJ STD/HIV PROGRAM ACTION STEPS (CONT.) Development of an internet partner notification program (Take that Jackd, A4A, Grinder! ) Developing policy for expedited partner therapy in NJ, allowing for non-traditional ways of testing and treating sex partners of GC or CT Promotion of the online program that alerts STD patients partners anonymously. (See next slide) Development of a NJ Division of HIV, STD, and TB Services information packet to be distributed by end of 2017 to NJ medical providers with details of the services provided by each unit and specific information such as: rising MSM STD rates, increases in congenital syphilis, and CDC recommendations.

ANONYMOUS REFERRAL You may have been exposed to Gonorrhea. Please get checked soon. RAPID SYPHILIS PILOT PROJECT Currently active at NJCRI and Visiting Nurses Association (VNA) Asbury Park Finger prick, 20 minutes, tests for syphilis antibodies Previously infected patients should NOT take this test If the test is positive, whole blood must be drawn and tested for an RPR and a confirmatory test (RPR, TPPA, EIA) as soon as possible. Patients are usually tested for HIV at the same time Approximately 172 tested and 20 newly identified cases since the beginning of the pilot. Over 11% positivity. RAPID SYPHILIS PILOT PROJECT (CONT.)

Five sites are scheduled to start testing soon: AAOGC, Camden AHEC, Hyacinth Trenton and JC, and Oasis Drop-In Center (SJAA). COUNTY AND CITY CLINICS The STD program does not have jurisdiction over these clinics. They are governed by the Office of Local Health and we can only advise and provide information on best practices for disease prevention. We are aware that many clinics do not offer accommodating hours but that issue should be taken up by the county or citys constituents and brought to the health officers and other local officials attention. The STD Program provides technical assistance, medications, and test kits (or funding in high-morbidity cities). CLOSING THOUGHTS Promote regular STD testing of your MSM and pregnant clients by referral to appropriate clinics, if your site does not provide testing People infected with STDs are more likely to acquire HIV or transmit HIV (if they are positive) Remind clients taking PrEP that they still HAVE to use condoms

Familiarize yourself with symptoms of STDs so that you can provide effective counseling to high-risk clients. (Diagnosis in Color: Sexually Transmitted Diseases Wisdom and Hawkins) Ensure that your medical staff have training in how to effectively counsel and make recommendations to priority populations ( MSM, pregnant females, sex workers, high-risk individuals, IV-drug use) Encourage MSM clients to notify their sex partners! Inform clients of NJ DOH field staffs confidential partner elicitation process. We simply need to get to the source of the infection! QUESTIONS? STEVE DUNAGAN SPECIAL PROJECTS COORDINATOR, DIV OF STD, HIV, TB SERVICES (609) 826-4741 Contact me for: condoms, technical assistance, STD education sessions [email protected] THANK YOU!

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