Laboratory Surveillance of Sexually Transmitted Disease LA County Dept. of Health Services Sexually Transmitted Disease Program Laboratory Surveillance.

Laboratory Surveillance of Sexually Transmitted Disease

LA County Dept. of Health ServicesSexually Transmitted Disease Program

Laboratory Surveillance Unit

Chandra Higgins, [email protected]

Reportable STDs in LA County

• Reporting requirements

• Dual reporting system

• Forms

Legal STD Reporting Requirements in California

Laboratory• Syphilis• Chlamydia• Gonorrhea

Health Provider• Syphilis• Chlamydia• Gonorrhea• Chancroid• PID (Pelvic

Inflammatory Disease)• NGU (Non-Gonococcal

Urethritis)

Reporting Responsibilities

Laboratory• All positives

• Report within one working day of identification

Health Provider• Known or suspect

• Report syphilis within one working day of identification. All others within 7 calendar days.

Reporting Responsibilities

Laboratory• Patient name &

limited demographics

• Provider name, address, phone

• Specimen accession, dates, test type & results

Health Provider• Patient name & full

demographics• Diagnosis, date of

diagnosis & onset• Name, address, &

phone of reporter

Medical Provider’s STD Reporting Form (p.1)

Medical Provider’s STD Reporting Form(p.1, continued)

Medical Provider’s STD Reporting Form (p.2)

Medical Provider’s STD Reporting Form(p.2, continued)

ProviderOnlyESy 0.3%CT 3.5%GC 4.8%

BothESy 51%CT 70%GC 66%

LaboratoryOnlyESy 49%CT 27%GC 29%

Reports to LA County STD ProgramChlamydia, Gonorrhea, and Syphilis 2004

Reporting Issues

• Improved enforcement of reporting laws• State investigations; non-compliance can

result in loss of lab license

• Identification of non-reporters is difficult• Dual reporting requirement facilitates

identification• Annual laboratory survey identifies

laboratories with deficient reporting practices

Reporting Issues(continued)

• Heaviest burden on laboratories• Often sole reporting source• Rely on providers for patient information• Referring laboratories withhold patient /

provider information from testing facilities

• Increased interstate testing has accompanied growth of managed care & core laboratories• Reporting requirements vary by state

Annual Laboratory Survey

• Monitor compliance with reporting guidelines

• Monitor trends in test utilization & laboratory practice

• Provide information on STD testing trends and recommendations

• Inform laboratories about STD Program function

Private Lab44%

Physician Office

7%

Private Hospital

33%

Other10%

PH/County6%

2004 STD Testing Laboratories

N=163

PH/County Hospital7%

Physician Office1%

Private Hospital6%

Other14%

Free Standing Private72%

Test Volume by Lab-Type 2004

Syphilis, Chlamydia, Gonorrhea

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

1995 1997 1999 2001 2003 2004

Tes

ts I

n M

illi

on

s

Syphilis Chlamydia Gonorrhea

L.A. County STD Testing 1995 – 2004

Nontreponemal90%

Treponemal10%

N=1,629,500

Syphilis Testing, 2004

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1995 1997 1999 2001 2003 2004

Test

s In

Mill

ions

Amplified DNA Probe EIA

Growth In Amplified Tests

Chlamydia, 1995 - 2004

SDA52%

TMA24%

PCR23%

LCR1%

Amplified Methods

2003 & 2004 Chlamydia Tests

PCR10%

LCR0%

SDA64%

TMA26%

2003 2004

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1995 1997 1999 2001 2003 2004

Test

s in

Mill

ions

Amplified DNA Probe Culture

Growth in Amplified Testing

Gonorrhea, 1995 - 2004

Gonorrhea19%

Syphilis18%

Hepatitis B13%

HPV/HVS16%

HIV13%

Chlamydia21%

L.A. County STD Testing

All 2004 Testing