Sexually Transmitted Disease (STD)
Surveillance Report, 2013
Minnesota Department of Health
STD Surveillance System
www.health.state.mn.us/std
Introduction

Under Minnesota law, physicians and laboratories must
report all laboratory-confirmed cases of chlamydia,
gonorrhea, syphilis, and chancroid to the Minnesota
Department of Health (MDH) within one working day.

The MDH does not maintain statistics for other, nonreportable STDs (ex: herpes, HPV/genital warts).

This slide set describes trends in reportable STDs in
Minnesota by person, place, and time.

Analyses exclude cases reported from federal and private
prisons.
STDs in Minnesota: Annual Review
Introduction

STD surveillance is the systematic collection of data
from cases for the purpose of monitoring the frequency
and distribution of STDs in a given population.

STD surveillance data are used to detect problems,
prioritize resources, develop and target interventions,
and evaluate the effectiveness of interventions.
STDs in Minnesota: Annual Review
Interpreting STD Surveillance Data

Factors that impact the completeness and accuracy of STD
data include:
Level of STD screening by healthcare providers
 Individual test-seeking behavior
 Sensitivity of diagnostic tests
 Compliance with case reporting
 Completeness of case reporting
 Timeliness of case reporting


Increases and decreases in STD rates can be due to actual
changes in disease occurrence and/or changes in one or more
of the above factors.
STDs in Minnesota: Annual Review
Interpreting STD Surveillance Data

The surveillance system only includes cases with a positive laboratory
test. Cases diagnosed solely on symptoms are not counted.

This year’s data like 2012 includes cases that had only a lab report and
no corresponding case report form. This has increased the number of
unknowns in some variables.

Surveillance data represent cases of infection, not individuals. A person
with multiple infections in a given year will be counted more than once.

Caution is warranted when interpreting changes in STD numbers that
can seem disproportionately large when the number of cases is small.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
Chlamydia—Rates by State, United States and Outlying Areas, 2012
National Rate = 453.5 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2012 Surveillance Slides.
Gonorrhea—Rates by State, United States and Outlying Areas, 2012
National Rate = 106.3 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2012 Surveillance Slides.
Primary and Secondary Syphilis—Rates by State
United States and Outlying Areas, 2012
National Rate = 5.1 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2012 Surveillance Slides.
Overview of STDs in Minnesota
STDs in Minnesota: Annual Review
STDs in Minnesota
Rate per 100,000 by Year of Diagnosis, 2003-2013
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
STDs in Minnesota:
Number of Cases Reported in 2013

Total of 23,133 STD cases reported to MDH in 2013:




18,724 Chlamydia cases
3,872 Gonorrhea cases
537 Syphilis cases (all stages)
0 Chancroid cases
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA
STDs in Minnesota: Annual Review
Kittson
Roseau
Lake of
the Woods
Marshall
Koochiching
Pennington
Beltrami
Red Lake
Cook
Polk
2013 Minnesota
Chlamydia Rates
by County
Lake
Clearwater
Norman
St.
Louis
Itasca
Mahnomen
Hubbard
Cass
Becker
Clay
Crow
Wing
Otter
Tail
Todd
Grant
Douglas
Stevens
Pope
Mille
Lacs Kanabec
Morrison
0 - 75
76 - 150
Pine
151 - 300
> 300
Benton
Traverse
Big Stone
Rate per 100,000 persons
Carlton
Aitkin
Wadena
Wilkin
Isanti
Stearns
Sherburne
Anoka
Washington
Swift
Lac qui
Parle
Kandiyohi Meeker
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Wright
Ramsey
Hennepin
Chippewa
Yellow
Medicine
Chisago
McLeod
Carver
Renville
Scott
Dakota
933
834
245
244
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le
Sueur
Pipestone Murray
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
Blue
Earth
(1,425 cases missing residence information)
Goodhue
Rice
Wabasha
Brown
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Waseca Steele Dodge Olmsted
Faribault
Data Source: Minnesota STD Surveillance System
Freeborn
Mower
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Chlamydia Infections by Residence at Diagnosis
Minnesota, 2013
Total Number of Cases = 18,724
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Gender
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Age
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender
Minnesota, 2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 2003-2013
2013 rates compared with Whites:
Black = 10x higher
American Indian = 4.5x higher
Asian/PI = 2x higher
Hispanic = 2.5x higher
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity
Minnesota, 2003-2013
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
GONORRHEA
STDs in Minnesota: Annual Review
Kittson
Roseau
Lake of
the Woods
Marshall
Koochiching
Pennington
Beltrami
Red Lake
Cook
Polk
Lake
Clearwater
Norman
2013 Minnesota
Gonorrhea Rates
by County
St.
Louis
Itasca
Mahnomen
Hubbard
Cass
Becker
Clay
Crow
Wing
Otter
Tail
Todd
Grant
Douglas
Stevens
Pope
Rate per 100,000 persons
Mille
Lacs Kanabec
Morrison
0 - 10
11 - 29
Pine
30 - 100
> 100
Benton
Traverse
Big Stone
Carlton
Aitkin
Wadena
Wilkin
Isanti
Stearns
Sherburne
Swift
Lac qui
Parle
Kandiyohi Meeker
Wright
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Washington
Ramsey
Hennepin
Chippewa
Yellow
Medicine
Chisago
Anoka
McLeod
Carver
Renville
Scott
Dakota
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le
Sueur
Goodhue
Rice
Pipestone Murray
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
Blue
Earth
Waseca Steele Dodge Olmsted
Faribault
Data Source: Minnesota STD Surveillance System
Freeborn
(194 cases missing residence information)
Wabasha
Brown
Mower
359
230
49
23
Winona
Fillmore
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Houston
STDs in Minnesota: Annual Review
Gonorrhea Infections in Minnesota
by Residence at Diagnosis, 2013
Total Number of Cases= 3,873
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Gender
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Age
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by Gender
Minnesota, 2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 2003-2013
2013 rates compared with Whites:
Black = 26.5x higher
American Indian = 7x higher
Asian/PI = 0x higher
Hispanic = 2x higher
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity
Minnesota, 2003-2013
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SYPHILIS
STDs in Minnesota: Annual Review
Syphilis Rates by Stage of Diagnosis
Minnesota, 2003-2013
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Kittson
Roseau
Lake of
the Woods
Marshall
Koochiching
Pennington
Beltrami
Cook
Red Lake
Polk
Lake
Clearwater
Norman
2013 Minnesota
Primary & Secondary
Syphilis Rates by
County
St.
Louis
Itasca
Mahnomen
Cass
Hubbard
Clay
Becker
Carlton
Aitkin
Wilkin
Crow
Wing
Wadena
Otter
Tail
Rate per 100,000 persons
Pine
Todd
Grant
Douglas
Stevens
Pope
Traverse
0 – 0.2
0.21 – 1.0
> 1.0
Mille Kanabec
Lacs
Morrison
Benton
Isanti
Stearns
Big
Stone
Chisago
Sherburne
Anoka
Swift
Kandiyohi
Lac qui
Parle
Meeker
Wright
Chippewa
Yellow
Medicine
McLeod
Renville
Carver
Scott
Sibley
Lincoln
Lyon
Nicollet
Murray
Rock
Nobles
Cottonwood Watonwan
Jackson
Dakota
26.1 (100 cases)
7.0 (20 cases)
2.5 (55 cases)
0.7 (18 cases)
Goodhue
Redwood
Brown
Pipestone
City of Minneapolis
City of St. Paul
Suburban#
Greater Minnesota
Washington
Ramsey
Hennepin
Martin
Blue
Earth
Le Sueur
Rice
Wabasha
7-county metro area, excluding the
cities of Minneapolis and St. Paul
#
Waseca Steele Dodge
Faribault
Data Source: Minnesota STD Surveillance System
Freeborn
Mower
Olmsted
Winona
Fillmore
Houston
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Infections
in Minnesota by Residence at Diagnosis, 2013
Total Number of Cases = 193
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul),
Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Gender
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Age
Minnesota, 2003-2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis
Rates by Gender, Minnesota, 2013
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Cases by Race
Minnesota, 2013
Total Number of Cases = 193
*Includes persons reported with more than one race
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/Ethnicity
Minnesota, 2003-2013
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
CHLAMYDIA AND GONORRHEA
AMONG
ADOLESCENTS & YOUNG ADULTS
(15-19 year olds)
(20-24 year olds)
STDs in Minnesota: Annual Review
Chlamydia Disproportionately Impacts Youth
MN Population in 2010
Chlamydia Cases in 2013
(n = 5,303,925)
(n = 18,724)
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Disproportionately Impacts Youth
MN Population in 2010
Gonorrhea Cases in 2013
(n = 5,303,925)
(n = 3,872)
Data Source: Minnesota STD Surveillance System (due to rounding % does not = 100)
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2013
† Adolescents defined
as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults†
Diagnosed With Chlamydia or Gonorrhea in 2013
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and
Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rates Among Adolescents & Young Adults†
by Gender in Minnesota, 2003-2013
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Cases Among Adolescents and Young Adults†
by Gender and Race, Minnesota, 2013
Males (n = 3,216)
† Adolescents
Females (n = 9,527)
defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Chlamydia Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2013
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rates Among Adolescents & Young Adults†
by Gender in Minnesota, 2003-2013
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Cases Among Adolescents and Young Adults†
by Gender and Race, 2013
Males (n = 841)
† Adolescents
Females (n = 1421)
defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Gonorrhea Rate Among Adolescents and
Young Adults† by Race, Minnesota, 2013
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Summary of Chlamydia and Gonorrhea Among
Adolescents and Young Adults†, Minnesota, 2013




Adolescents and young adults accounted for 68% of
chlamydia and 58% of gonorrhea cases diagnosed in
Minnesota.
73% of chlamydia or gonorrhea cases diagnosed among
adolescents and young adults were females.
Whites and Blacks accounted for 36% and 28% of
chlamydia or gonorrhea cases, respectively.
33% of gonorrhea or chlamydia cases were in the Cities of
Minneapolis and Saint Paul.
† Adolescents
defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Topic of Interest:
Early Syphilis Among
Men Who Have Sex With Men
in Minnesota
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Number of Early Syphilis† Cases by Gender
Minnesota, 2003-2013
MSM=Men who have sex with men.
Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, 2007, 2009 and 4 in 2013).
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† Cases by Stage at Diagnosis
Minnesota, 2003-2013
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† by Gender and Sexual Behavior
Minnesota, 2003-2013
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† Cases Among MSM by Age
Minnesota, 2013 (n=261)
Mean Age = 36 years
Range: 18 to 69 years
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Early Syphilis† (ES) Cases
Co-infected with HIV, 2006-2013
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Characteristics of Early Syphilis† Cases
Among MSM, Minnesota, 2013

Gay and bisexual men account for 88% of cases among men.

68% of cases among MSM are White, but a disproportionate number of
cases (16%) are African American.

51% in the City of Minneapolis and 31% live in the suburbs

46% of cases are also infected with HIV.

Among cases interviewed by the MDH Partner Services Program:
 Commonly reported risk factors were meeting partners on the internet,
anonymous sex, and no condom use.
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
What’s Being Done in Minnesota?

The MDH Partner Services Program continues to follow up on early
syphilis cases and their sex partners.

All HIV/Syphilis co-infected cases are assigned to Partner Services
for follow-up

Physicians are encouraged to screen men who have sex with men at
least annually and to ask about sex partners.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
SURVEILLANCE SUMMARY
Summary of STD Trends in Minnesota

From 2003-2013, the chlamydia rate increased by 65%. The rate of gonorrhea
increased by 26% between 2012 and 2013. Rates of reported syphilis increased in
2013 compared to 2012 by 60%.

Minnesota has seen a resurgence of syphilis over the past decade, with men who
have sex with men and those co-infected with HIV being especially impacted.

Persons of color continue to be disproportionately affected by STDs.

STD rates are highest in the cities of Minneapolis and Saint Paul. However, chlamydia
and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for
58% of the reported cases in 2013.

Adolescents and young adults (15-24 years) have the highest rates of chlamydia and
gonorrhea, making up 66% of new infections in 2013.

Between 2012 and 2013, the chlamydia rate increased by 4% and the gonorrhea rate
increased by 26%. Primary/secondary syphilis cases increased by 64%. Men who
have sex with men comprised 88% of all male cases in 2013; cases among women
remain low but are continuing to increase.
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review
Future Updates to STD Reporting

New case report form to accommodate changes in gonorrhea treatment guidelines
is now available on our website

Case report form is be able to be filled out on a computer and printed to be mailed
or faxed in

Link is up on MDH website to indicate interest in future online “provider portal” for
direct online reporting

All cases co-infected with HIV/Gonorrhea will be assigned to MDH Partner Services
for follow-up

Starting in 2015 all Gonorrhea cases have the potential for being contacted by
MDH for additional follow-up
Data Source: Minnesota STD Surveillance System
STDs in Minnesota: Annual Review