STI Annual Report

Notifiable Sexually Transmitted Infections
2010 Annual Report
2011 Government of Alberta December 2011 ISSN 1927-4149 Alberta Health and Wellness, Surveillance and Assessment Send inquiries to: Health.Surveillance@gov.ab.ca
Alberta Health and Wellness Notifiable Sexually Transmitted Infections 2010 Annual Report
December 2011
Overview There are over 100 communicable diseases in Alberta which are notifiable to public health officials. While only seven of the notifiable diseases are sexually transmitted infections (STI), they are by far the most commonly reported notifiable diseases in Alberta. In 2010, STI made up 69 per cent of all notifiable disease cases reported (Figure 1). Figure 1
Number of Notifiable STI and Other ND Cases in Alberta
25000 20000 15000 10000 5000 0
The seven reportable STI are: chlamydia, chancroid, gonorrhea, nongonococcal urethritis (NGU), lymphogranuloma venereum (LGV), mucopurulent cervicitis (MPC) and syphilis. In 2010, there were no cases reported of chancroid or LGV. Chlamydia and gonorrhea were the two most commonly reported STI.
Cases
2003 n=19,914 8,364 42% 11,550 58%
2004 n=18,239 7,113 39% 11,126 61%
2005 n=18,825 6,965 37% 11,860 63%
2006 n=20,867 6,677 32% 14,190 68%
2007 n=22,365 7,157 32% 15,208 68%
2008 n=23,354 7,421 32% 16,091 68%
2009 n=23,999 6,782 28% 17,217 72%
2010 n=23,690 7,392 31% 16,298 69%
Other ND Other ND STI STI
Although the greatest number of STI cases occurred in Calgary and Edmonton zones in 2010, the highest STI rate was in the North zone with 553 cases per 100,000 persons and the lowest rates of diseases in the South with 294 cases per 100,000 persons (Table 1). Table 1: STI Cases by Alberta Health Zone, 2010
STI Chlamydia Gonorrhea Infectious Syphilis NGU MPC Total Cases Rate/100,000 South 731 30 19 47 14 841 294.4 Calgary 4,214 282 78 626 125 5,325 386.2 Central 1,652 107 13 111 28 1,911 427.2 Edmonton 4,588 488 43 404 69 5,592 479.9 North 1,947 281 15 136 46 2,425 552.9 ALBERTA 13,132 1,188 168 1,324 282 16,094 433.1
2011 Government of Alberta
December 2011
Chlamydia Chlamydia is the most commonly reported notifiable disease in Alberta. In 2010, over 13,000 cases were reported to the province with the largest proportion being young Caucasian females. Gonorrhea For the second year in a row, there was a decline in gonorrhea cases in 2010. The largest drop in cases has been among females. Overall, the rates for females and males were similar (30 and 34 cases per 100,000, respectively). Syphilis In March 2007, a syphilis outbreak was declared in Alberta by the acting Chief Medical Officer of Health. The infectious syphilis rate was lower in 2010 than in the previous three years. Cases of congenital syphilis continue to be identified in the province despite changes to the provincial prenatal screening program. Two cases were identified in 2010 bringing the total number of congenital syphilis cases to 28 since 2000. Non-Gonococcal Urethritis (NGU) and Mucopurulent Cervicitis (MPC) Rates for NGU have been steady for the last seven years, fluctuating between 34 and 40 cases per 100,000 males. In 2010, MPC cases and rates decreased (282 cases in 2010 vs 354 cases in 2009). Alberta has released the Alberta Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan, 2011-2016 in 2011, as well as undertaken a comprehensive multi-media syphilis campaign. The Notifiable Sexually Transmitted Infections 2010 Annual Report predates both the strategy and campaign.
TE
Data Note
Data for this report was pulled July 13, 2011. Information received after this date is not reflected in this report.
December 2011
Chlamydia Chlamydia is the most commonly reported notifiable disease in Alberta. This is a bacterial infection, transmitted through sexual contact or from mother to child during delivery. Chlamydia is easily treatable with antibiotics, but because it is often asymptomatic it may be left untreated allowing complications to become severe. The risk of pelvic inflammatory disease, ectopic pregnancy, infertility, pelvic pain and reactive arthritis are the associated complications for females. For males, risk of infertility, reactive arthritis and infection of the epididymis and testes may occur if chlamydia is untreated. Figure 1.1
Number and Crude Rate (per 100,000) of Chlamydia Cases in Alberta, 2000 - 2010 (n=103,791)
16,000 14,000 12,000 Cases 10,000 8,000 6,000 4,000 2,000 0
Cases Rate 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
400 350 300 250 200 150 100 50 0 Rates (per 100,000)
Cases and rates of chlamydia have steadily increased in Alberta between 2000 and 2009 (from 196 cases per 100,000 to 373 cases per 100,000 persons respectively) and then slowly decreased in 2010 with the rate of 353 cases per 100,000 persons. Within 10 years, chlamydia cases increased from 5,822 cases in 2000 to 13,132 cases in 2010, or more than double the cases.
5,822 6,290 7,166 7,709 8,185 8,738 10,275 11,013 11,958 13,503 13,132 196.2 208.1 232.2 246.0 257.5 271.2 311.5 323.2 342.1 373.3 353.4
Figure 1.2
Number and Crude Rate (per 100,000) of Chlamydia Cases in Alberta by Gender, 2000 - 2010
8,000 Cases 6,000 4,000 2,000 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
10,000
600 Rates (per 100,000) 500 400 300 200 100 0
Females have historically had higher reported rates of chlamydia than males. In 2010, female rates were almost twice as high as male rates, but had decreased since 2009. The 2010 number and rate of male cases is similar to what was seen in 2009.
Female Cases 4,218 4,410 5,014 5,309 5,506 5,818 6,780 7,230 7,863 8,994 8,575 Male Cases Female Rates Male Rates 1,604 1,880 2,152 2,400 2,679 2,920 3,495 3,783 4,095 4,509 4,557 283.9 291.5 324.6 338.5 346.2 360.4 409.9 423.5 449.4 497.7 462.5 108.2 124.5 139.6 153.3 168.6 181.6 212.6 222.4 234.6 249.1 244.7
December 2011
Figure 1.3
Number and Crude Rate (per 100,000) Chlamydia Cases by Alberta Health Zone (n=13,132)
(January 1st - December 31st, 2010) 5,000 4,000 Cases 3,000 2,000 1,000 0 Cases Rate 500 Rates (per 100,000) 400 300 200 100 0
Chlamydia rates differ within the province by health zone, and appear to increase from north to south. In 2010, the highest rate of chlamydia was in North zone and the lowest rate of disease was in South zone (444 cases vs. 256 cases per 100,000 persons, respectively). Edmonton had the second highest rate, with Calgary having the second lowest rate (394 cases and 306 cases per 100,000, respectively).
South 731 255.9
Calgary 4,214 305.6
Central 1,652 369.3
Edmonton 4,588 393.8
North 1,947 443.9
Figure 1.4
Number and Crude Rate (per 100,000) Chlamydia Cases by Alberta Health Zone and Gender (n=13,132)
(January 1st - December 31st, 2010)
4,000 3,500 3,000
Cases
800 600 400 200 0 Rates (per 100,000)
2,500 2,000 1,500 1,000 500 0

Female Cases Male Cases Female Rates Male Rates South 486 245 339.6 171.9 Calgary 2,810 1,404 407.2 203.8 Central 1,098 554 490.5 247.9 Edmonton 2,882 1,706 493.8 293.4 North 1,299 648 609.0 287.6
As mentioned, females make up the majority of chlamydia cases, as seen consistently across health zones in 2010. Female rates were 170 per cent to 210 per cent higher than male rates. As can be seen on the graph to the left, there were approximately twice as many female chlamydia cases than male cases in the Central, North and Calgary zones.
December 2011
Figure 1.5
Age-Specific Rate (per 100,000) and Counts of Chlamydia
Cases in Alberta (n=13,132)

(January 1st - December 31st, 2010) 6000 5000 4000 Cases 3000 2000 1000 0
Cases Rate
1,800 1,500 Rates (per 100,000) 1,200 900 600 300 0
In Alberta, 82 per cent of all chlamydia cases were in people between the ages of 15 and 29 years old in 2010. The highest rates of chlamydia occurred among older teens/young adults. The rates for the 20 to 24 year age group were 1,776 cases per 100,000 persons in 2010.
0-9 8 1.7
10-14 84 36.8
15-19 3,279
20-24 4,817
25-29 2,634
30-34 1,196 425.0
35-39 579 214.4
40-44 261 98.6
45-49 148 50.5
50-54 72 25.7
55-59 32 14.1
60+ 22 3.8
1,331.9 1,776.4 875.7
Figure 1.6
Gender-Specific Rate (per 100,000) and Counts of Chlamydia Cases by Age Group in Alberta
3,500 3,000 2,000 2,500 Rates (per 100,000) 2,500
Cases
2,000 1,500 1,000
1,500
1,000
500 500 0
Female Cases Male Cases Female Rates Male Rates 0-9 6 2 2.6 0.8 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 75 9 7.7 2,582 3,131 1,551 697 1,686 1,083 673 523 297 282 137 124 92.6 75 73 51.5 49.6 33 39 24.0 27.3 10 22 9.0 18.9 60+ 5 17 1.6 6.3
In 2010, 65 per cent of all chlamydia cases were female, with 85 per cent of those females between the ages of 15 and 29 years. The rate of chlamydia for 15 to 19 year olds was almost four times higher in females than males (2,150 cases per 100,000 females vs. 553 cases per 100,000 males).
67.5 2,149. 2,308. 1,024. 479.8 223.7 104.7 552.7 1,243. 724.7 370.5 205.4
December 2011
Figure 1.7
Chlamydia Cases in Alberta by Known Ethnicity 2000 to 2010
12,000 10,000
2,303
Cases
8,000
1,659 1,543 1,206 1,231 1,322 1,352
2,279
Over the past 10 years, the proportion of chlamydia cases by known ethnicity has remained consistent. Between 65 and 71 per cent of chlamydia cases were Caucasian, with the next largest identified ethnic group being Aboriginal.
1,957
6,000 4,000 2,000 0

2000 n=4,821 2001 n=5,163 2002 n=5,908 2003 n=6,379
1,013
1,114 4,742 5,313 6,132 6,349 6,990 6,762
3,382
3,585
4,125
4,531
4,310
2004 n=6,717
2005 n=6,346
2006 n=7,829
2007 n=8,797
2008 2009 2010 n=9,583 n=10,647 n=10,320
Caucasian
Black
Aboriginal
Asian
Other
Figure 1.8
Chlamydia Cases in Alberta by Ethnicity and Gender, 2010
(n=13,132 Includes Unknown: F=8,575, M=4,557)
Unknown 904
1,908
Male Female
Other
97
Asian
224
In 2010, the majority of chlamydia cases were Caucasian (51.5 per cent or 6,762/13,132 cases). The next largest group was Aboriginal (17 per cent or 2,279 cases). There were more female cases than male in all ethnic groups except for Black (170 female cases vs 260 male cases).
82
446
586
Aboriginal 260
1,693
Black
170
2,501
Caucasian
4,261
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Cases
The majority of chlamydia cases with known sexual preference were heterosexual.
December 2011
Gonorrhea Gonorrhea is the second most commonly reported sexually transmitted infection in Alberta, and is caused by the bacterium Neisseria gonorrheae. Many gonorrheal infections are asymptomatic, particularly in women. Common symptom in males is painful urination and urethral discharge; in women they are cervicitis and sometimes urethritis. Untreated gonorrhea can spread through the body affecting joints and even heart valves. Evidence of resistance to antibiotics traditionally used to treat gonorrheal infections has been increasing, thus prevention is key. Figure 2.1
Number and Crude Rate (per 100,000) of Gonorrhea Cases in Alberta, 2000 - 2010 (n=15,203)
2,500 2,000 1,500 1,000 500 0
Cases Rate
75 60 45 30 15 0
Cases and rates of gonorrhea increased until 2006. After remaining steady for a few years, both cases and rates then dropped significantly since 2009. In 2010, the rate of gonorrhea was 32 cases per 100,000 persons, or half the rate from 2007.
2000 558 18.8
2001 755 25.0
2002 942 30.5
2003 1,016 32.4
2004 1,358 42.7
2005 1,506 46.7
2006 2,107 63.9
2007 2,154 63.2
2008 2,081 59.5
2009 1,538 42.5
2010 1,188 32.0
Figure 2.2
Number and Crude Rate (per 100,000) of Gonorrhea Cases in Alberta by Gender, 2000 - 2010
1,600 1,400 1,200 80 70 60 50 40 30 20 10
2000 238 320 16.0 21.6 2001 309 446 20.4 29.5 2002 402 540 26.0 35.0 2003 430 586 27.4 37.4 2004 503 854 31.6 53.8 2005 574 931 35.6 57.9 2006 835 50.5 77.3 2007 854 50.0 76.4 2008 885 50.6 68.5 2009 754 784 41.7 43.3 2010 557 631 30.0 33.9
Rates (per 100,000)
Cases
Cases
1,000 800 600 400 200 0

Female Cases Male Cases Female Rates Male Rates
Since 2000, males have had predominately higher rates of gonorrhea than female. In 2009, as can be seen in the graph to the left, there was a marked decrease in cases and rates of gonorrhea among males. The rates of disease for males and females have almost converged, something that has not occurred within the last ten years. In 2010, both male and female rates have continued to decline (10 cases less per 100,000 compared to 2009)
1,271 1,300 1,196
Rates (per 100,000)
December 2011
Figure 2.3
Number and Crude Rate (per 100,000) Gonorrhea Cases by Alberta Health Zone (n=1,188)
(January 1st - December 31st, 2010) 600 500 400 Cases 300 200 100 0
Cases Rate South 30 10.5 Calgary 282 20.5 Central 107 23.9 Edmonton 488 41.9 North 281 64.1
90 75 60 45 30 15 0 Rate (per 100,000)
In 2010, the gonorrhea rate in the North zone was six times more than the rate in the South zone (64.1 cases per 100,000 vs. 10.5 cases, respectively). The rate of disease in the Edmonton zone was twice as high as the Calgary zone rate (41.9 cases per 100,000 vs. 20.5 cases, respectively). Central, Calgary, and South zones had lower rates of gonorrhea than the provincial rate of 32.8 cases per 100,000 persons.
Figure 2.4
Number and Crude Rate (per 100,000) Gonorrhea Cases by Alberta Health Zone and Gender (n=1,188)
250 Cases 200 150 100 50 0 125 100 75 50 25 0 Rates (per 100,000) 300 150
Within health zones in 2010, the rate of gonorrhea for males was generally higher than for females, except in Central. The largest difference in cases between the two genders was in Calgary (males had 62 cases more than females).
South 12 18 8.4 12.6
Calgary 110 172 15.9 25.0
Central 60 47 26.8 21.0
Edmonton 240 248 41.1 42.6
North 135 146 63.3 64.8
December 2011
Figure 2.5
Age-Specific Rate (per 100,000) and Counts of Gonorrhea Cases in Alberta (n=1,188)
(January 1st - December 31st, 2010) 400 350 300 Cases 250 200 150 100 50 0 Cases Rate < 15 13 1.8 15-19 268 108.9 20-24 362 133.5 25-29 250 83.1 30-39 186 33.7 40-59 97 9.1 60+ 12 2.1 160 140 120 100 80 60 40 20 0 Rate (per 100,000)
In Alberta, 74 per cent of all 2010 gonorrhea cases were in people between the ages of 15 and 29 years old. The highest rates of gonorrhea occurred among older teens/young adults; the highest rate for the 20 years to 24 years age group was 134 cases per 100,000 persons. The second highest rate of disease was 109 cases per 100,000 persons in those aged 15 to 19 years.
Figure 2.6
Gender-Specific Rate (per 100,000) and Counts of Gonorrhea Cases by Age Group in Alberta (n=1,188)
(January 1st - December 31st, 2010) 200 160 Cases 120 80 40 0 Female Cases Male Cases Female Rates Male Rates < 15 9 4 2.6 1.1 15-19 176 92 146.5 73.0 20-24 191 171 140.8 126.2 25-29 105 145 69.4 97.0 30-39 57 129 20.9 46.3 40-59 19 78 3.6 14.4 60+ 0 12 0.0 4.4 200 160 120 80 40 0 Rates (per 100,000)
The breakdown of gonorrhea cases by sex and age groups show that females had higher rates of disease than males for those under 25 years of age. The highest reported rates were for 15 to 19 year old females (147 cases per 100,000 females). Male rates peaked in the 20 to 24 year age group (126 cases per 100,000 males). Males had significantly higher rates than females in those 30 years and over.
December 2011
Figure 2.7
Gonorrhea Cases in Alberta by Known Ethnicity 2000 to 2010
1,800 1,500 1,200 Cases 900 600
227 297 305 807 367
2002 n=779
603
616
693
402
452
609 521 829 687 462 344
300 0
186 254
2000 n=479
326
2001 n=644
427
538
513
2003 2004 2005 2006 2007 2008 2009 2010 n=844 n=1,127 n=1,181 n=1,666 n=1,657 n=1,635 n=1,234 n=967
The ethnicity of gonorrhea cases has also changed over the years. Aboriginal have been overrepresented through the years as cases, and have the largest proportion as an ethnic group in 2008, 2009, and 2010. The proportion of Caucasian gonorrhea cases has been trending down since 2007 (829 cases in 2007, 344 cases in 2010).
Caucasian
Black
Aboriginal
Asian
Other
Figure 2.8
Gonorrhea Cases in Alberta by Ethnicity and Gender (n=1,188 Includes Unknown: F=557, M=631)
(January 1st - December 31st, 2010) Unknown Other Asian Aboriginal Black Caucasian 0
36 10 217 127 12 4 13 204 317 135 86
Male Female
There were a higher number of male gonorrhea cases than female for all ethnic group except Aboriginal. Sixty seven per cent of the total number of gonorrhea cases among females with known ethnicity were Aboriginal (317/471 cases).
27
100
200
300 Cases
400
500
600
10
December 2011
Syphilis One of the oldest sexually transmitted diseases recorded is syphilis. Syphilis is caused by the bacterium Treponema pallidum. Undiagnosed or untreated syphilis progresses through several stages: primary, secondary, latent and tertiary. Untreated syphilis can lead to destruction of soft tissues, bone, blindness, and heart failure. More importantly, a mother with untreated syphilis may transmit the disease to her unborn child, which can lead to death or lifelong deformity of the child. This section discusses infectious syphilis which covers the primary and secondary stages, as well as early latent. The breakdown of infectious syphilis cases by stage of infection for 2010 is below: Table 3.1 Infectious Syphilis by Stage, Alberta 2010
Stage Early Latent Primary Secondary Symptomatic CNS (Central Nervous System) Symptomatic CNS Ocular Asymptomatic CNS Unknown Total # Cases 83 40 32 4 7 1 1 168
Syphilis regained notoriety in Alberta as cases increased, with a province-wide outbreak declared in March 2007. The last outbreak occurred in the mid-1980s, with a peak of 574 cases (24.5 cases/100,000) in 1984. Between outbreaks, reports of syphilis cases were rare.
Figure 3.1
Number and Crude Rate (per 100,000) of Infectious Syphilis Cases in Alberta, 2000 - 2010 (n=1,471)
300 250 200 Cases 150 100 50 0 Cases Rate 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 15 0.5 21 0.7 16 0.5 43 1.4 77 2.4 146 4.5 217 6.6 246 7.2 243 7.0 279 7.7 168 4.5 12 Rates (per 100,000) 10 8 6 4 2 0
However, starting in 2003 there was an exponential increase in the number of syphilis infectious reported. Alberta declared an outbreak of syphilis in 2007, at which time the number of cases and rates of diagnosed infectious syphilis levelled off. In 2009, there were 279 cases reported in the province. In 2010, the number of cases of syphilis reported in Alberta sharply dropped to 168 cases.
11
December 2011
Figure 3.2
Number and Crude Rate (per 100,000) of Infectious Syphilis Cases in Alberta by Gender, 2000 - 2010
200 12
150 Cases
100
50
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 4 11 0.3 0.7 7 14 0.5 0.9 4 12 0.3 0.8 10 33 0.6 2.1 18 59 1.1 3.7 55 91 3.4 5.7 67 150 4.1 9.1 72 174 4.2 10.2 100 143 5.7 8.2 90 189 5.0 10.4 54 114 2.9 6.1
Compared to other STI in Alberta, infectious syphilis was reported more often among men, ranging from the lowest of 59 per cent (2008) to the highest of 77 per cent (2004) of total annual cases. The chart to the left shows the difference between the genders over the years. In 2010, the male rate was twice as high as the female rate.
Figure 3.3
Number and Crude Rate (per 100,000) Infectious Syphilis Cases by Alberta Health Zone (n=168)
90 80 70 60 Cases 50 40 30 20 10 0 Cases Rate South 19 6.7 Calgary 78 5.7 Central 13 2.9 Edmonton 43 3.7 North 15 3.4 9 8 6 5 4 3 2 1 0 Rate (per 100,000) 7
Rates (per 100,000)
Infectious syphilis rates also differ within the province by health zone. In 2010, the highest rate of disease was in the South zone (6.7 cases per 100,000 persons); the lowest rate was in Central with 2.9 cases per 100,000. The rate for infectious syphilis in the Calgary zone was 1.5 times higher than the rate in the Edmonton zone (5.7 cases per 100,000 persons vs. 3.7 cases per 100,000 persons, respectively).
12
December 2011
Figure 3.4
Number and Crude Rate (per 100,000) Infectious Syphilis Cases by Aberta Health Zone and Gender
75 60
Cases
10 8 6 4 2
South 12 7 8.4 4.9 Calgary 18 60 2.6 8.7 Central 7 6 3.1 2.7 Edmonton 11 32 1.9 5.5 North 6 9 2.8 4.0 Rates (per 100,000)
45 30 15 0
Not only do case counts and rates of infectious syphilis differ by health zone, cases and rates by gender also vary greatly depending on the health zone. In 2010, the majority of male cases occurred in the Calgary zone with the highest rate of 8.7 cases per 100,000 males. The highest rate of disease for females was in the South zone (8.4 cases per 100,000 females).
Figure 3.5
Age-Specific Rate (per 100,000) and Counts of Infectious Syphilis Cases in Alberta (n=168)
(January 1st - December 31st, 2010) 35 30 25 Cases 20 15 10 5 0 Cases Rate < 15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 0 0.0 3 1.2 33 12.2 27 9.0 24 8.5 18 6.7 24 9.1 15 5.1 10 3.6 9 4.0 5 0.9 14 Rate (per 100,000) 12 10 8 6 4 2 0
While cases of chlamydia and gonorrhea are skewed toward young adults, newly reported infectious syphilis cases are more evenly distributed over year groups until 50 years of age where the number of cases decrease. The highest rate of disease was 12.2 cases per 100,000 persons in the 20 to 24 years age group, with the next highest rate in the 40 to 44 year old group (9.1 cases per 100,000).
13
December 2011
Figure 3.6
Gender-Specific Rate (per 100,000) and Counts of Infectious Syphilis Cases by Age Group in Alberta
50 40 Cases 30 20 10 0
Female Cases Male Cases Female Rates Male Rates < 15 0 0 0.0 0.0 15-19 1 2 0.8 1.6 20-24 18 15 13.3 11.1 25-29 10 17 6.6 11.4 30-39 14 28 5.1 10.1 40-59 10 48 1.9 8.9 60+ 1 4 0.3 1.5
15 12 9 6 3 0 Rates (per 100,000)
The highest rate for females was in 20 to 24 years age group at 13 cases per 100,000 females, which is higher than males for this group. Males have the highest rate in the 25 to 29 years age group (11 cases per 100,000 males). In 2010, the males rate of infectious syphilis for age group between 40 to 59 years was 4.7 times higher than rate for females (8.9 cases vs. 1.9 cases per 100,000).
Figure 3.7
Infectious Syphilis Cases in Alberta by Known Ethnicity 2000 to 2010
300 250 200
Cases
77 73 73 56 122 64 143 134 161 78 80
150 100 50 0
11 2000 n=14 16 2001 n=21 10 2002 n=14 11 11 26 2003 n=41 52 2004 n=75 60
For the past eleven years (2000-2010), the majority of infectious syphilis cases with known ethnicity have been Caucasian (55.4 per cent), followed by Aboriginal (30.6 per cent).
2005 2006 2007 2008 2009 2010 n=140 n=214 n=240 n=229 n=267 n=157
Caucasian
Black
Aboriginal
Asian
Other
14
December 2011
Figure 3.8
Infectious Syphilis Cases in Alberta by Ethnicity and Gender (n=168 includes Unknown: F=88, M=79)
(January 1st - December 31st, 2010) Unknown Other Asian Aboriginal Black Caucasian 0 10 20
Male Female
2 21 35
In 2010, the majority of infectious syphilis in each ethnic group were males (more than 81 per cent), except for Aboriginals, where there were more female cases than male cases (35 female cases vs. 21 male cases).
12
64
15
40 Cases 50 60 70 80
30
Figure 3.9
Infectious Syphilis Cases in Alberta by Sexual Preference 2000 - 2010
2010 2009 2008 2007 2006 2005 2004 2003 25 56 15 126 11 105 200 190 158 158 9 47 24 62 46 53
2002 12 2 2001 5 2000
The number of syphilis cases identified by sexual preference as homosexual vary from year to year. The proportion of homosexual identified cases range from no cases in 2001 to 27 per cent (46/168 cases) in 2010. In 2007, when the outbreak of infectious syphilis was declared, the proportion of homosexual and bisexual cases accounted for one-third of all cases (62/246 cases and 19/246 cases, respectfully).
300
50
100
150 Cases
200
250
Bisexual
Heterosexual
Homosexual
Unknown/NA
In 2010, 27 per cent of infectious syphilis cases were homosexual (or 46/168 cases), the largest proportion for the three main sexually transmitted infections. Among Caucasians in 2010, homosexual cases accounted for 41 per cent of cases (32/79 cases).
15
December 2011
Congenital Syphilis Congenital syphilis is the vertical transmission of syphilis from an infected mother to her infant. Congenital syphilis has also increased in Alberta, with the first case in years reported in 2002.
Congenital Syphilis 2000 0 2001 0 2002 1 2003 0 2004 0 2005 5 2006 4 2007 6 2008 3 2009 7 2010 2
Since August 2002, Alberta has had a centralized provincial prenatal screening program in place to screen women early in their pregnancy for five infectious diseases infectious syphilis, HIV, hepatitis B, rubella and varicella. In response to the increase in congenital syphilis cases, Alberta also instituted an universal prenatal syphilis re-screening program in May 2009 to capture women infected with syphilis during pregnancy (mid-pregnancy and delivery). In 2009, three women were identified with infectious syphilis upon re-screening (all three at delivery).
16
December 2011
Non-Gonococcal Urethritis (NGU) Non-gonococcal urethritis is the inflammation of the urethra in males not caused by Neisseria gonorrhea. The Alberta case definition also excludes Chlamydia trachomatis as a cause. NGU may be caused by organisms such as Ureaplasma, Mycoplasma or Trichomonas vaginalis, although a specific pathogen is often not identified. NGU infections may have symptoms such as discharge, itching or burning sensation, or they can be very mild or asymptomatic. The treatment is antibiotics. If NGU is not treated, it may cause epididymitis or infertility. NGU is not reportable at the national level. Figure 4.1
Number and Crude Rate (per 100,000) of NGU Cases in Alberta, 2000 - 2010 (n=16,191)
2,400 2,000 1,600 Cases 1,200 800 400 0
Cases Rates 2000 1,660 55.9 2001 1,737 57.5 2002 1,918 62.1 2003 2,075 66.2 2004 1,273 40.0 2005 1,129 35.0 2006 1,307 39.6 2007 1,270 37.3 2008 1,198 34.3 2009 1,300 35.9 2010 1,324 35.6
75
50
Rates (per 100,000)

Rates (per 100,000)
Rates for NGU have been steady for the last seven years (2004-2010), fluctuating between 34 and 40 cases per 100,000 males. Please note that the case definition for NGU was modified in 2003 and thus comparisons cannot be made between the time periods before and after 2003.
25
Figure 4.2
Number and Crude Rate (per 100,000) NGU Cases by Alberta Health Zone (n=1,324)
(January 1 - December 31, 2010) 1000 800 Cases 600 400 200 0 Cases Rate 100 80 60 40 20 0
South 47 33.0
Calgary 626 90.9
Central 111 49.7
Edmonton 404 69.5
North 136 60.4
In 2010, the rate of disease varied across the province, with the highest rate in Calgary zone (91 cases per 100,000 males) followed by Edmonton and North zones (rate of 70 and 60 cases per 100,000 males, respectively). The lowest NGU rate was in South zone with 33 cases per 100,000 males.
17
December 2011
Figure 4.3
Age-Specific Rate (per 100,000) and Counts of NGU Cases in Alberta (n=1,320 Excludes unknown age)
(January 1 - December 31, 2010) 420 350 280
Cases
300
Rates per (100,000)
250 200 150 100 50 < 15 0 0.0 15-19 132 104.7 20-24 348 256.7 25-29 349 233.6 30-39 291 104.5 40-59 181 33.5 60+ 19 7.0 0
210 140 70 0
In 2010, the majority of NGU cases were diagnosed in males under the age of 30, with the highest rates occurring between the age of 20 and 24 years (257 cases per 100,000 males).
Cases Rate
Figure 4.4
NGU Cases in Alberta by Known Ethnicity 2000 to 2010
2,100 1,800
214
1,500 1,200 900 600 300 0

1,111 1,187 209 248
252
122 108 1,340 1,433 930 716
127
104
115
146
132
In the last seven years (20042010), Caucasians accounted for the majority of NGU infection cases. Aboriginals followed with the proportion ranging from 9 per cent to 12 per cent.
845
855
822
857
896
2000 2001 2002 2003 2004 n=1,492 n=1,602 n=1,770 n=1,891 n=1,188
2005 n=973
2006 2007 2008 2009 2010 n=1,132 n=1,138 n=1,088 n=1,191 n=1,201
Caucasian
Black
Aboriginal
Asian
Other
18
December 2011
Table 4.1: NGU 2010 Cases by Ethnicity and Sexual Preference
Ethnicity Caucasian Black Aboriginal Asian Other Unknown Total
Bisexual
Heterosexual
Homosexual
Unknown
Total 896 102 132 42 29 123 1,324
12 1 3 0 0 0 16
678 91 110 30 27 68 1,004
104 1 3 7 2 4 121
102 9 16 5 0 51 183
In 2010, the majority of NGU cases are heterosexual (75.8 per cent). Among 1,004 cases identified as heterosexual, 67.5 per cent were Caucasian.
19
December 2011
Mucopurulent Cervicitis (MPC) Mucopurulent cervicitis is the clinical syndrome of inflammation of the cervix in females not caused by C. tracomatis or N. gonorrhea. It is associated with higher risk of poor pregnancy outcome, upper genital tract disease, and transmission of HIV. MPC can be treated with antibiotics. If left untreated, it may cause pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy and infertility. As with NGU, MPC is not reportable nationally. Figure 5.1
Number and Crude Rate (per 100,000) of MPC Cases in Alberta, 2000 - 2010 (n=4,706)
900 750 600 Cases 450 300 150 0 Cases Rate 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 635 21.4 609 20.1 717 23.2 729 23.3 216 6.8 238 7.4 273 8.3 294 8.6 359 10.3 354 9.8 282 7.6 30 25 20 15 10 5 0 Rates (per 100,000)
Rate (per 100,000)
The case definition for MPC was modified in 2003 and thus comparisons cannot be made between the two time periods before and after 2003. MPC cases and rates have increased from 2004 to 2008 (6.8 cases vs. 10.3 cases per 100,000 females, respectively). The rate was 7.6 cases per 100,000 females in 2010.
Figure 5.2
Number and Crude Rate (per 100,000) MPC Cases by Alberta Health Region (n=282)
(January 1 - December 31, 2010) 140 120 100 Cases 80 60 40 20 0 Cases Rate South 14 9.8 Calgary 125 18.1 Central 28 12.5 Edmonton 69 11.8 North 46 21.6 35 30 25 20 15 10 5 0
Rates varied among Alberta health zones; the lowest was 9.8 cases per 100,000 females in the South and the highest was 21.6 cases in the North. Forty-four per cent of MPC cases were in the Calgary zone. The other health zones had MPC rates under the provincial rate (15.2 cases per 100,000 females).
20
December 2011
Figure 5.3
Age-Specific Rate (per 100,000) and Counts of MPC Cases in Alberta (n=282)
(January 1 - December 31, 2010) 120 100 Cases 80 60 40 20 0 Cases Rate < 15 3 0.9 15-19 54 45.0 20-24 104 76.7 25-29 43 28.4 30-39 57 20.9 40-59 20 3.8 60+ 0 0.0 90 Rate (per 100,000) 75 60 45 30 15 0
More than half of MPC cases in 2010 were between 15 and 24 years of age (56 per cent). The highest rate of MPC was 77 cases per 100,000 females among 20 to 24 year olds. Young females aged 15 to 19 years had MPC rate with 45 cases per 100,000.
Figure 5.4
MPC Cases in Alberta by Known Ethnicity 2000 to 2010
800 700 600
118 93 107 114
Cases
500 400 300 200 100 0
Overall from 2004 to 2010, the majority of females infected with MPC were Caucasian (65 per cent of cases over those seven years).
431
412
454
516 56 132 50 124 2005 n=186 54 158 2006 n=226 75 159 2007 n=261
91 204
84 205
72 170 2010 n=265
2000 n=554
2001 n=551
2002 n=615
2003 2004 n=686 n=202
2008 n=319
2009 n=325
Caucasian
Black
Aboriginal
Asian
Other
21
December 2011
Table 5.1: MPC 2010 Cases by Ethnicity and Sexual Preference
Ethnicity Caucasian Black Aboriginal Asian Other Unknown Total
Bisexual 7 0 2 0 0 0 9
Heterosexual
Homosexual
Unknown
Total 170 4 72 11 8 17 282
143 4 63 11 7 10 238
2 0 0 0 0 0 2
18 0 7 0 1 7 33
The majority of MPC cases in 2010 were identified as heterosexual (84.4 per cent). Among these, 60 per cent were Caucasian and 26 per cent were Aboriginal.
22

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Notifiable Sexually Transmitted Infections

2010 Annual Report

2003 n=19,914 8,364 42% 11,550 58%

2004 n=18,239 7,113 39% 11,126 61%

2005 n=18,825 6,965 37% 11,860 63%

2006 n=20,867 6,677 32% 14,190 68%

2007 n=22,365 7,157 32% 15,208 68%

2008 n=23,354 7,421 32% 16,091 68%

2009 n=23,999 6,782 28% 17,217 72%

2010 n=23,690 7,392 31% 16,298 69%

Other ND Other ND STI STI

2011 Government of Alberta

2011 Government of Alberta

600 Rates (per 100,000) 500 400 300 200 100 0

2011 Government of Alberta

South 731 255.9

Calgary 4,214 305.6

Central 1,652 369.3

Edmonton 4,588 393.8

North 1,947 443.9

800 600 400 200 0 Rates (per 100,000)

2,500 2,000 1,500 1,000 500 0

2011 Government of Alberta

Cases in Alberta (n=13,132)

1,800 1,500 Rates (per 100,000) 1,200 900 600 300 0

30-34 1,196 425.0

35-39 579 214.4

40-44 261 98.6

45-49 148 50.5

1,331.9 1,776.4 875.7

2,000 1,500 1,000

2011 Government of Alberta

6,000 4,000 2,000 0

1,114 4,742 5,313 6,132 6,349 6,990 6,762

2008 2009 2010 n=9,583 n=10,647 n=10,320

2011 Government of Alberta

2000 558 18.8

2001 755 25.0

2002 942 30.5

2003 1,016 32.4

2004 1,358 42.7

2005 1,506 46.7

2006 2,107 63.9

2007 2,154 63.2

2008 2,081 59.5

2009 1,538 42.5

2010 1,188 32.0

Rates (per 100,000)

1,000 800 600 400 200 0

1,271 1,300 1,196

2011 Government of Alberta

Rates (per 100,000)

90 75 60 45 30 15 0 Rate (per 100,000)

South 12 18 8.4 12.6

Calgary 110 172 15.9 25.0

Central 60 47 26.8 21.0

Edmonton 240 248 41.1 42.6

North 135 146 63.3 64.8

Female Cases Male Cases Female Rates Male Rates

2011 Government of Alberta

2011 Government of Alberta

609 521 829 687 462 344

2011 Government of Alberta