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					               Sexually Transmitted
                Disease in Maine
               2008 Data from the Maine CDC
            HIV, STD and Viral Hepatitis Program
                    Resource Contact: Robert G. Funa
                            (207) 287-5193
                        robert.funa@maine.gov




Maine CDC                                              1
 05/2009
                                   Overview
        • The Maine Center for Disease Control and Prevention (formerly
          the Bureau of Health) collects data for approximately 74
          diseases of public health importance, including certain sexually
          transmitted diseases (STD’s).

        • The following slides highlight gonorrhea, chlamydia and syphilis
          data received through December 31, 2008. Each data slide is
          followed by a “comments” slide that provides interpretation and
          analysis.

        • Maine physicians and clinical laboratories are required to report
          diagnoses of the above STD’s to Maine CDC.* Disease reports
          provide critical public health information; this slide set is one
          example of how these data are used.

            *For more information about reporting requirements, contact Robert Funa at
            (207) 287-5193 or robert.funa@maine.gov

Maine CDC                                                                                2
 05/2009
                Figure 1: Maine Chlamydia Diagnoses, 1996-2008.

         3000



         2500



         2000
Number




         1500

                                                                                             2543   2594
                                                                               2253   2304
                                                                 2040   2120
         1000
                                                          1801
                                            1474
                                                   1346
                                     1213
          500          1067   1073
                965




            0
                1996   1997   1998   1999   2000   2001   2002   2003   2004   2005   2006   2007   2008



Maine CDC                                                                                             3
 05/2009
                  Comments, Figure 1
       • Figure 1 shows chlamydia diagnoses reported to
         Maine CDC from 1996 to 2008.

       • Chlamydia is the most frequently reported infectious
         disease in the State. During 2008, 2,594 cases
         were reported.

       • Apart from a slight decline in 2001, the number of
         diagnoses increased each year between 1996 and
         2008.

       • The number of 2008 chlamydia reports represents an
         increase of 2% over the 2007 total. This is the lowest
         annual percentage increases observed since 1998.

Maine CDC                                                         4
 05/2009
                            Figure 2: 2008 Chlamydia Diagnoses
                                by Age Group (total=2,594).


          1200


                                                                           Males (n=756)
          1000
                                                                           Females (n=1,838)

           800
 Number




           600




           400




           200




             0
                 Under 15           15 - 19       20 - 24        25 - 29        30 and over

                                               Age Group




Maine CDC                                                                                      5
 05/2009
                    Comments, Figure 2
       • Figure 2 shows 2008 chlamydia diagnoses by age group.

       • People 15-24 years were disproportionately affected by this
         disease, accounting for about three-quarters of all 2008 cases.

       • Females are diagnosed with chlamydia much more often than
         males, comprising 70% of all reports. This does not necessarily
         mean that greater numbers of women are infected with the
         disease; women are tested for the disease more frequently than
         men, and may be more likely to exhibit symptoms.




Maine CDC                                                                  6
 05/2009
            Table 1: 2008 Chlamydia Rates per 100,000 Population*, by County
                    (Counties are listed in rank order by rate per 100,000 population).
            County                                      Rate, per 100,000   Number of Cases
            Androscoggin                                          306.9          328
            Cumberland                                            234.0          646
            Somerset                                              219.9           113
            Penobscot                                             219.3          326
            Sagadahoc                                             217.4           79
            Kennebec                                              198.4          240
            State of Maine                                        197.0          2,594
            Knox                                                  194.2           79
            Hancock                                               169.4           90
            Franklin                                              160.8           48
            Oxford                                                155.1           88
            Waldo                                                 148.7           57
            York                                                  137.3          277
            Washington                                            110.8           36
            Lincoln                                               104.0           36
            Piscataquis                                           100.2           17
            Aroostook                                             89.3            64
Maine CDC                                                                                     7
                *= rates are based on 2008 population estimates
 05/2009
                 Comments, Table 1
    • Table 1 lists the number of 2008 chlamydia diagnoses
      and rate per 100,000 population by county, with counties
      listed in rank order by rate. The statewide rate is
      included in the rank order.

    • Androscoggin, Cumberland, Somerset, Penobscot,
      Sagadahoc, and Kennebec Counties had chlamydia
      rates that are higher than the statewide rate.




Maine CDC                                                    8
 05/2009
                                            Figure 3: U.S. and Maine Chlamydia Incidence
                                            Among Persons Aged 15-19 Years, 1996-2007.


                              2000

                              1800

                              1600
Rate Per 100,000 Population




                              1400

                              1200

                              1000

                              800

                              600
                                                                                                      Maine Incidence
                              400                                                                     U.S. Incidence
                              200

                                0
                                     1996    1997   1998   1999   2000   2001   2002   2003   2004   2005      2006         2007




Maine CDC                                                                                                               9
 05/2009
              Comments, Figure 3
    • Figure 3 compares Maine rates and U.S. rates of
      chlamydia among 15-19 year-olds from 1996 to 2007.

    • Rates among Maine 15-19 year-olds increased during
      the past decade, rising from 480 per 100,000 population
      in 1996 to a high of 863.8 per 100,000 population in
      2007.

    • Despite increases among 15-19 year-olds, Maine rates
      are low compared to U.S. rates. In 2007, the Maine rate
      was approximately half the U.S. rate.


Maine CDC                                                   10
 05/2009
                             Figure 4: Maine Gonorrhea Diagnoses,
                                            1996 to 2008.



         250




         200




         150
Number




                                                                    231
                                                                           214
         100


                                                     141    142                   142    135
                                                                                                118
          50                                   90                                                            96
                                        83
                       66        67
                56


           0
               1996   1997      1998   1999   2000   2001   2002    2003   2004   2005   2006   2007        2008




Maine CDC                                                                                              11
 05/2009
                Comments, Figure 4
    • Figure 4 shows gonorrhea diagnoses reported to Maine
      CDC from 1996 to 2008.

    • There have been consecutive decreases in the annual
      number of gonorrhea cases reported during the last five
      years after peaking in 2003.

    • Ninety-six (96) cases were diagnosed in 2008,
      representing a 19% decrease over the total number of
      2007 cases. This was the second largest percentage
      decrease in annual cases reported since 2003.
Maine CDC                                                    12
 05/2009
                         Figure 5: 2008 Gonorrhea Diagnoses
                               by Age Group (total=96).



         45


         40
                                                                               Males (n=53)

         35
                                                                               Females (n=43)


         30
Number




         25


         20


         15


         10


          5


          0
              Under 15        15 - 19      20-29               30-39   40-49             50+

                                                   Age Group



Maine CDC                                                                                     13
 05/2009
                  Comments, Figure 5
      • Figure 5 shows 2008 gonorrhea diagnoses by age group and
        sex.

      • Gonorrhea affects a slightly older age range than chlamydia.
        Almost half of 2008 diagnoses occurred in the 20-29 age range.

      • Males comprised approximately 55% all gonorrhea diagnoses.
        This proportion is less than observations made in 2007 during
        which 62% of reported gonorrhea cases were males.

      • The decrease in the proportion of males diagnosed with
        gonorrhea in 2008 may most likely be due to a decrease in the
        number of male gonorrhea cases that were most likely infected
        through sexual contact with other males (8% in 2008 vs. 33% in
        2007).


Maine CDC                                                                14
 05/2009
        Table 2: 2008 Gonorrhea Rates per 100,000 Population, by County
                   (Counties are listed in rank order by rate per 100,000 population)
            County                           Rate per 100,000           Number of cases
            Cumberland                              14.5                         40
            Oxford                                  10.6                         6
            Hancock                                  9.4                         5
            Androscoggin                             9.4                         10
            Aroostook                                8.4                         6
            Sagadahoc                                8.3                         3
            State of Maine                           7.3                         96
            Franklin                                 6.7                         2
            Washington                               6.2                         2
            York                                     5.9                         12
            Kennebec                                 4.1                         5
            Penobscot                                2.7                         4
            Somerset                                 1.9                         1
            Lincoln                                  0.0                         0
            Piscataquis                              0.0                         0
            Waldo                                    0.0                         0
Maine CDC                                                                                 15
 05/2009    Knox                                     0.0                         0
                 Comments, Table 2

    • Table 2 lists the number of 2008 gonorrhea diagnoses
      and rate per 100,000 population by county, with counties
      listed in rank order by rate. The statewide rate is
      included in the rank order.

    • Six counties, Androscoggin, Cumberland, Sagadahoc,
      Oxford, Aroostook, and Hancock, have gonorrhea rates
      that are higher than the statewide rate.




Maine CDC                                                    16
 05/2009
                                           Figure 6: U.S. and Maine Gonorrhea Incidence Among Persons Aged 15 to 19 Years,
                                                                               1996-2007



                              600




                              500
Rate per 100,000 Population




                              400




                              300

                                                                                                                Maine Incidence

                                                                                                                U.S. Incidence
                              200




                              100




                               0
                                    1996     1997    1998   1999    2000   2001    2002   2003    2004   2005         2006        2007




Maine CDC                                                                                                                    17
 05/2009
              Comments, Figure 6
    • Figure 3 compares Maine rates and US rates of
      gonorrhea among 15-19 year-olds from 1996 to 2007.

    • Gonorrhea rates among 15-19 year-olds in Maine have
      decreased markedly in recent years, with a decline from
      57 cases/100,000 population in 2004 to 15
      cases/100,000 population in 2007.

    • Like chlamydia, Maine gonorrhea rates are much lower
      than U.S. rates. In 2007, the Maine rate among 15-19
      year-olds was approximately 1/30 of the national rate.


Maine CDC                                                      18
 05/2009
                             Figure 7: Early Syphilis Diagnosed in Maine,
                                               1984-2008



         60




         50




         40
Number




         30

                        52

                   44
         20



                                       25
                             22   21        22
         10                                                                                                                 20
              18
                                                 15                                                 15           16
                                                                                                                      14
                                                      12
                                                           10   9
                                                                    2   3   4   1   0   1   4   3        2   3
          0




Maine CDC                                                                                                              19
 05/2009
                       Comments, Figure 7

        •   Figure 7 shows “early syphilis” (which includes syphilis infections of
            less than one year’s duration) diagnosed in Maine since 1984.

        •   After peaking in the mid-1980s, syphilis steadily declined until 1999,
            when there were no diagnoses reported in the state.

        •   Over the past five years, annual syphilis counts in Maine have been
            steadily increasing from 3 cases reported in 2005 to 20 cases in 2008.
            These recent local syphilis trends are similar to those reported
            nationally.

        •   The recent local syphilis outbreaks could be due to several reasons
            such as: an increase in syphilis rates observed nationally particularly
            within the MSM community, the increased use of internet technology to
            meet sexual partners and have anonymous sexual encounters, and
            out-of-state infections of Maine residents who traveled to urban areas,
            where syphilis incidence is higher.

Maine CDC                                                                             20
 05/2009

				
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