Large decreases in gonorrhea and chlamydia infections reported

Cleveland Department of Public Health reports preliminary Chlamydia, gonorrhea (2008) and syphilis (2009) surveillance data to Cleveland City Council. Incidence of gonorrhea and Chlamydia reported to public health officials decreased about 9% and 30%, repectively for local area.

Reported Chlamydia and gonorrhea cases for Cleveland

Rates of sexually transmitted infections Chlamydia and gonorrhea reported to public health officials dropped 9.2% and 32% for Cleveland cases and 7.0% and 30.9% for all Cuyahoga County cases.

As seen on the chart to the left, the 4,530 Chlamydia cases attributed to Cleveland for 2008 was the lowest level since 2000. The graphic and data can be seen in the report at this link.

Gonorrhea cases have dropped for two consecutive years since 2006 and are the lowest level in the past three decades. In 1990, over 10,800 gonorrhea cases were reported to the Cleveland Department of Public Health - CDPH. In 2008, about 1,700 gonorrhea cases were reported. 

Updated data

The STD report was presented to the Community & Economic Development Committee of Cleveland City Council by CDPH on February 11, 2010 to support community development block grant funding.

Original data were obtained from the STD Surveillance Unit of the Ohio Department of Health. Data were processed by a method called geocoding that allowed public health analysts to more correctly attribute cases to municipalities.

Chlamydia and gonorrhea levels by municipality

The report includes two tables not originally presented to Cleveland City Council. These tables show the Chlamydia and gonorrhea case counts by municipalities in Cuyahoga County, by sex and age group. 

In past reports, data for the county were provided zip code. According to Katie Burnett of the Cuyahoga County Board of Health, these data by municipality "will go a long way" to provide better direct prevention messages across the cities and school districts.

Syphilis update

Syphilis rates reported in 2009 for Cleveland and Cuyahoga County were provided.

Rates continue to increase for 2009, but at a slower rate than for 2008.

Rates for Cleveland increased to 16.83 per 100,000 in 2008, a 263% increase over 2007 when a recent outbreak began. The rates for 2008 reflect 73 cases of primary, secondary and early latent syphilis in Cleveland. For 2009, 102 cases were reported for a rate of 23.52 per 100,000, up 140%, nearly half of the rate increase seen in the previous year.

Twice as many cases are being diagnosed earlier in the infection, while cases have only primary syphilis. Fourteen percent of cases in 2009 were diagnosed with primary syphilis compared to seven percent in 2008. Officials believe that media campaigns and greater awareness among the medical community may be reasons for the earlier diagnoses.

Also, rates for Cleveland are less than that for other major Ohio cities. In 2008, Akron had the highest rate per 100,000 population (34 cases per 100,000, per Ohio Department of Health data.)

Success in prevention

No cases of congenital syphilis have occurred in Cuyahoga County since the oubtreak began in 2007. Congenital syphilis occurs when an mother infected with syphilis passed the infection to the newborn. Infants born with syphilis can suffer from severe developmental delays, blindness, neurological deficits, and death. Stillborn births may occur with undiagnosed & untreated syphilis. These cases are entirely preventable.

Populations at risk

Males who have sex with males (MSM) reflected the largest share of syphilis cases reported in 2009.

Heterosexual males and females, mostly African American, where the second population that carried the heaviest burden of cases.

In 2009 data, 44% of cases were among youth and young adults age 13 to 24 when diagnosed.

Syphilis and HIV - evidence of serosorting and reckless behavior

Of the 125 new cases of early syphilis reported in 2009, 42 males and one female were HIV-positive, 42% of males and 4.0% of females diagnosed that year.  For these males with both syphilis and HIV, race did not differ. That is, 40.6% of the 64 black males and 45.4% of the 33 white males diagnosed with syphilis in 2009 were HIV-positive.

79% of the HIV/syphilis infected males reported risk behavior involving other males, 12% bisexual, 7% high risk heterosexual behavior and 2% did not respond. Nearly 1 in 4 of these males could potentially transmit HIV to a female partner.

Another concern among public health officials was that 26% of these dually-infected individuals knew that their partner was also HIV-positive, 30% did not know their partners HIV-status and 44% said that their partner was HIV negative.  The potential transmission risk of HIV is increased when a person is infected with an open syphilis sore. Also, those HIV-positive men seeking HIV-positive partners may decide not to use safe sex methods, including barrier methods like condoms, increasing the risk of STD transmission. However, public health officials noted that 42% of these HIV/syphilis positive males stated that they always used condoms for anal intercourse, 44% sometimes, 7% never and 7% felt that the question was not applicable and only had oral sex. 26% never used condoms for oral sex.

This information is intended for funded agencies involved in HIV prevention through the Office of HIV services of the Cleveland Department of Public Health.

Action plans promoted

Members of the Cleveland Department of Public Health provided a multi-point action plan to continue to combat the spread of syphilis in the population. Investigators that work directly with cases and their potential contacts are the front line workers to notify those that may have had contact with an infected person and refer them for testing and treatment.