| 2019| Sexually Transmitted Infections Data Brief|

Key Findings from recent STI Data: A note on data in this report: The processing of STI data Inside this Data Brief records may results in a delay in public data availability. Published STI data may change with further follow-up and investigation. Page

 In 2018, the most commonly-occurring Key Findings 1 sexually-transmitted infection in Guilford County was chlamydia, followed by gonorrhea STI Cases and Rates, 2014-2018 2 with 5,162 and 1,965 new cases respectively. HIV Infection, Characteristics of Cases 3-4  HIV Infection incidence rates declined in 2017

and 2018, but the county still has higher rates HIV Infection, Trends 5 than most peer counties and the state.

 New cases are predominantly African Syphilis, Characteristics of Cases 6 American, non-Hispanic males between the ages of 20 and 29. Syphilis Trends 7  Primary and secondary syphilis incidence rates declined from 23.2 cases per 100,000 in 2015 Chlamydia, Characteristics of Cases 8 to 15.9 in 2018.  Chlamydia incidence rates continued an Gonorrhea, Characteristics of Cases 9 upward trend, reaching a high of 969.2 cases per 100,000 in 2018. Chlamydia and Gonorrhea Trends 10  Gonorrhea rates climbed to 368.5 per 100,000, a level not seen since 2007.

 Increasing rates of chlamydia, gonorrhea and syphilis are consistent with state and national trends.

1 | Division of Public Health | 2019 Communicable Diseases Data Brief| Sexually Transmitted Infections, Cases and Rates per 100,000 Guilford County, 2014-2018

Reportable Disease 2014 2015 2016 2017 2018 Number Rate Number Rate Number Rate Number Rate Number Rate Chlamydia 3,563 694.6 4,138 799.5 4,102 786.8 4,731 897.8 5,162 968.1 Gonorrhea 1,271 248.0 1,656 320.0 1,776 340.7 1,713 325.1 1,965 368.5 HIV Infection (HIV & AIDS) 96 18.7 122 23.6 139 26.7 127 24.1 114 21.4* Syphilis (Primary & Secondary - P&S) 43 8.4 120 23.2 98 18.8 111 21.1 85 15.9 Syphilis (P&S and Early Latent) 90 17.6 199 38.4 176 33.8 178 33.8 148 27.8 Pelvic Inflammatory Disease (PID) 2 0.4 3 0.6 1 0.2 3 0.6 4 0.8 Non-Gonococcal Urethritis (NGU) 133 26.0 247 47.7 190 36.4 146 27.7 276 51.8 Hepatitis A 4 0.8 0 0.0 5 1.0 2 0.4 2 0.4 Hepatitis B (acute) 7 1.4 2 0.4 7 1.3 13 2.5 13 2.4 Hepatitis B (chronic carrier) 71 13.9 47 9.1 120 23.0 77 14.6 29 5.4 Hepatitis C (acute) 7 1.4 4 0.8 4 0.8 7 1.3 7 1.3 Population 512,119 517,600 521,330 526,953 533,213** Source: NC Electronic Disease Surveillance System (NC EDSS). *Preliminary data for HIV Infection cases from the 2018 NC HIV/STD Quarterly Surveillance Report, NCDHHS Communicable Disease Branch. **2018 Population estimate obtained from the NC Office of Budget and Management.

Sexually Transmitted Infections

Chlamydia is the most common sexually transmitted infection. Chlamydia can infect both men and women. It can cause serious, permanent damage to a woman’s reproductive system, which can make future pregnancies impossible. Chlamydia can also cause a potentially fatal ectopic pregnancy, which occurs outside the womb.

Gonorrhea is a common infection transmitted by sexual contact, characterized by inflammation of the mucous membranes of the genital and urinary tracts, an acute discharge containing pus, and painful urination, especially in men. Women often have few or no symptoms, but pregnant women can transmit the infection to their baby during delivery, causing serious health problems for the baby.

Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system, making the person more likely to get other infections or infection-related cancers. If untreated, HIV can lead to Acquired Immunodeficiency Syndrome (AIDS), a potentially fatal condition.

Syphilis is a sexually transmitted infection that can cause serious health problems if not treated. Syphilis is divided into stages—primary, secondary and latent—with different signs and symptoms associated with each stage.

Non-Gonococcal Urethritis (NGU) is inflammation of the urethra not caused by gonorrhea. NGU can result from various infectious and non-infectious conditions.

Pelvic Inflammatory Disease (PID) is an infection of female reproductive organs. It is a complication often caused by some STIs such as chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.

Hepatitis A, Hepatitis B and Hepatitis C are potentially serious liver infections caused by three different viruses. Hepatitis A is usually transmitted by ingestion of contaminated food or water, while Hepatitis B and C are typically transmitted though contact with infectious body fluids.

2 | Division of Public Health | 2019 Communicable Diseases Data Brief| Sexually Transmitted Infections: HIV Infection

Characteristics of Guilford County HIV Infection Cases Percentage of Cases by Race and Ethnicity, 2017 Number of Cases = 127

90 81.9 80

70

60

50

40

Percent 30

20 10.2 10 5.5 1.6 1.0 0 White, non- Black, non- Asian, non- Hispanic Multi-race Hispanic Hispanic Hispanic

Percent of HIV Percent of HIV Infection by Age Infection by Sex, 2017 Group, 2017 100 100 90 90 78 80 80 70 70 60 60 50 47.2 50 40 40 30 30 15.7 22 20 9.4 13.4 20 10 9.4 0.8 3.1 0.8 10 0 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 Male Female Source: Communicable Disease Branch, NC Division of Public Health, NCDHHS.

 Guilford County’s HIV infection rate remains higher than that of North Carolina overall. Rates are highest for African American non-Hispanics, males and young adults between the ages of 20 to 29.  HIV mortality rates declined dramatically between 1995 and 1997 and have remained low since that time. The difference between the new case rate and the mortality rate means that the number of residents living with HIV infection continues to grow.

3 | Division of Public Health | 2019 Communicable Diseases Data Brief|

HIV Infection Mode of Transmission, 2017 Number of Cases = 127

Men having sex with men (MSM) 55.9

No risk factor specified 33.1

Heterosexual contact 7.1

Other (blood products, health exposures) 2.2 Mode Mode Transmissionof

MSM/Intravenous Drug Use (IDU) 1.6

0 10 20 30 40 50 60 70 80 90 100 Percent

Source: North Carolina HIV/STD Quarterly Surveillance Report, Annual Surveillance Report, HIV/STD. Surveillance Unit.

HIV Infection New Case among Adults and Adolescents, by Selected County and NC, 2015-2017 Average Rate Rate per 100,00 100 90 80 70 60 50

40 31.4 26.8 29.1 30 21.6 20 15.8 16.7 10 0 North Carolina Wake County Forsyth County Durham County Guilford County Mecklenburg County

Source: 2017 North Carolina HIV/STD/Hepatitis Surveillance Report, NC DHHS. Note: Includes all newly reported HIV infected individuals, regardless of the stage of infection (HIV or AIDS).

4 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Trends in HIV Infection Incidence Rates Guilford County and NC, 1998-2017 Rate per 100,000

45 38.9 40 35 30 24.5 25 19.6 20 13.2 15 10 5 0

Guilford NC

Source: HIV/STD Prevention & Care Branch, Division of Public Health, NC DHHS. Note: HIV Infection includes all new cases of HIV or AIDS.

Trends in HIV Infection Mortality Rates Guilford County and NC, 1998-2017 Rate per 100,000

8 7 6.4 6 5 5.7 4 3 2.1 2 2.1 1 0

Guilford County North Carolina

Source: NC Center for Health Statistics. Note: HIV Infection includes all new cases of HIV and AIDS.

5 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Trends in Primary and Secondary Syphilis Rates

Guilford County, NC and US, 1998-2017 Rate per 100,000 30 25.3 25 21.1 20 15 10.6 10 9.6 9.5 5 2.5 0

Guilford NC US

Source: NC DHHS Communicable Disease Control Branch; NC Electronic Disease Surveillance System (NCEDSS).

Primary, Secondary and Early Latent Syphilis Rates per 100,000 By Selected Counties and NC, 2013-2017

Geographic Area 2013 2014 2015 2016 2017 Cumberland 14.4 23.0 35.8 27.6 24.0 Durham 16.0 24.8 44.5 36.3 38.8 Forsyth 14.1 13.7 22.0 19.9 20.7 Guilford 11.4 17.6 38.4 33.8 33.8 Mecklenburg 15.0 26.6 39.2 37.6 40.6 Wake 11.3 17.7 24.2 22.1 22.4 North Carolina 7.0 11.2 18.6 16.2 17.9 Source: North Carolina HIV/STD Quarterly Surveillance Report, Annual Surveillance Report; NCDHHS Communicable Disease Branch.

6 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Sexually Transmitted Infections: Syphilis

Characteristics of Guilford County Syphilis Cases, 2018 Percentage of Cases by Race and Ethnicity (Primary, Secondary and Early Latent Syphilis) Number of Cases = 150

Asian 0.7

Native Hawaiian or Pacific Islander 1.3

Hispanic 3.3

Multi-racial 4 White 19.3

African-American 74.7

0 10 20 30 40 50 60 70 80 90 100 Percent

Source: Communicable Disease Branch, NC Division of Public Health, NCDHHS. Notes: Hispanics can be of any race; percentages do not add to 100%.

Percent of Syphilis Cases Percent of Syphilis Cases by

by Sex, 2018 Age Group, 2018

100 100 90 83.3 90 80 80 70 70

60 60 50 50 40 40 30 26 25.3 30 18.7 16.7 20 14 20 10.7 10 4.7 10 0.7 0

0 Ages Ages Ages Ages Ages Ages Ages Male Female 15-19 20-24 25-29 30-39 40-49 50-59 60+

Source: NC DHHS, Communicable Disease Branch, NC Electronic Disease Surveillance System (NCEDSS).

 A large racial disparity exists in syphilis incidence, with African-Americans making up 75% of all cases.  83% of cases are men and half of all cases occur among persons ages 20-29.

7 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Sexually Transmitted Infections: Chlamydia

Characteristics of Guilford County Chlamydia Cases and Rates by Race and Hispanic Status, 2016-2018

2016 2017 2018 Race or Ethnicity Number Percent Number Percent Number Percent Classification of Cases of Cases of Cases of Cases of Cases of Cases American Indian 8 0.2% 3 0.01% 12 0.2% Asian 56 1.4% 48 1.0% 65 1.3% African-American 2,534 61.8% 2,952 62.4% 3,249 62.9.0% Hawaiian/Pacific 4 0.1% 3 0.1% 8 0.2% IslanderWhite 467 11.4% 579 12.2% 696 13.5% Other 105 2.6% 129 2.7% 155 3.0% Unknown 914 22.3% 929 19.6% 946 18.3% Multi-Racial 10 0.24% 11 0.2% 24 0.5% Missing 4 0.10% 77 1.6% 7 0.1 Race Total 4,102 100.0% 4,731 100% 5,162 100% Hispanic* 153 3.7% 181 3.8% 237 4.6% *Hispanics can be of any race. Source: NC Electronic Disease Surveillance System (NCEDSS).

• The highest chlamydia incidence rates are among African-American residents, with large disparities compared to Whites and other race/ethnic groups. • The age groups with the highest rates of chlamydia are ages 20-24, followed by ages 15-19 and ages 25-29. • Two-thirds of chlamydia cases are among females. Chlamydia cases are diagnosed largely as a result of screening, and women are more likely to have screening tests.

Percent of Chlamydia Percent of Chlamydia by Age Cases by Sex, 2018 Group, 2018 100 100 90 90 80 80 65.4 70 70 60 60 50 50 40 34.6 40 30.7 40 30 30 20 16.7 20 10 9 0.7 2 0.8 0.1 10 0 0 10-14 15-19 20-24 25-29 30-39 40-49 50-59 60 and Male Female Over

Source: NC Electronic Disease Surveillance System (NCEDSS).

8 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Sexually Transmitted Infections: Gonorrhea

Characteristics of Guilford County Gonorrhea Cases and Percentages by Race and Hispanic Status, 2016-2018

2016 2017 2018 Race or Number Percent Number Percent Number Percent Ethnicity of Cases of Cases of Cases of Cases of Cases of Cases ClassificationAmerican Indian 4 0.2% 1 0.1% 6 0.3% Asian 4 0.2% 12 0.7% 9 0.5% African-American 1,207 73.5% 1,258 73.4% 1,475 75.1 % White 156 9.5% 2 0.1% 170 8.7% Other 16 1.0% 164 9.6% 24 1.2% Unknown 243 14.8% 222 13.0% 271 13.8% Multi-Racial 6 0.4% 4 0.2% 7 0.4% Race Total 1,642 100.0% 1,713 100.0% 1,965 100% Hispanic* 31 1.9% 44 2.6% 33 1.7% *Hispanics can be of any race. Source: NC Electronic Disese Surveillance System (NCEDSS).

 The highest gonorrhea incidence rates are among African-American residents, with large disparities compared to Whites and other race/ethnic groups.  The age groups with the highest rates of gonorrhea are ages 20-24, followed by ages 25-29 and ages 15-19.

Percent of Gonorrhea Cases Percent of Gonorrhea Cases by by Sex, 2018 Age Group, 2018 100 100 90 90 80 80 70 70 60 60 54.4 45.6 50 50 40 35.2 40 30 19.9 30 19.6 20 15.3 20 10 5.2 0.4 3.4 1.1 10 0 0 10-14 15-19 20-24 25-29 30-39 40-49 50-59 60 and Male Female Over

Source: NC Electronic Disease Surveillance System (NCEDSS).

9 | Division of Public Health | 2019 Communicable Diseases Data Brief|

Trends in Chlamydia Incidence Rates

Guilford County, NC and US, 1998-2017 Rate per 100,000

1200 1000 968.2

800 612.2 600 454.3 400 294.2 528.8 200 237 0

Guilford NC US

Source: General Communicable Disease Control Branch; Division of Public Health, NC DHHS.

Trends in Gonorrhea Incidence Rates Guilford County, NC and US, 1998-2017 Rate per 100,000 400 346 325.1 300 255 220.9 200 129.2 171.9 100

0

Guilford NC US

Source: North Carolina Electronic Disease Surveillance System (NCEDSS); NC DHHS, Communicable Disease Control Branch.

This report was prepared by Health Surveillance & Analysis Unit of the Division of Public Health: Mark H. Smith, Ph.D., Epidemiologist Laura Mrosla, MPH, MSW, Community Health Educator

For more information about Guilford County health statistics, visit https://www.guilfordcountync.gov/our-county/human-services/health-department/health-statistics

10 | Division of Public Health | 2019 Communicable Diseases Data Brief|