San Francisco (SF) is an exciting and lively city situated on seven square miles bordered by the San Francisco Bay and located in Northern California. SF is the only consolidated City and County in California, which makes the SF Department of Public Health (SFDPH) Population Health Division (PHD) responsible for the health of its entire population. SF experiences an inordinate economic and morbidity burden of STDs s coupled with health disparities by age, race, and sexual orientation. The SFDPH STD Program continues to identify a significant burden of STDs. From 2016 to 2017, the chlamydia rate increased 12.1% to 1129.4 per 100,000 and the gonorrhea rate rose 10.4% to 714.6 per 100,000. Reported early syphilis rose from 2016 to 2017 by 27% to 180.4 per 100,000. San Francisco’s gonorrhea and syphilis rates consistently exceed those for the Los Angeles Metropolitan Statistical Area (MSA), the New York MSA, the state of California and the United States as a whole yearly, for the past 5 years. Two priority populations for STD prevention due to excess rates have been identified in SF: (1) gay, bisexual, and other MSM and (2) adolescent and young adult males and females, particularly those of color. While syphilis in SF remains a disease predominantly among MSM, from 2017 through 2018, SFDPH observed an 88% increase in reported total syphilis cases among women.
To address gaps in existing case-based STD surveillance and inform the development of novel and efficient prevention interventions, the San Francisco Department of Public Health (SFDPH) Population Health Division proposes to build upon successes and lessons learned from participating in SSuN since its inception in 2005 to conduct 3 overarching activities for SSuN Cycle 4: (A) sentinel surveillance at San Francisco City Clinic (SFCC), the only municipal STD clinic, through submission of visit-level records; routinely updated HIV diagnostic and laboratory data through eHARS matches with SFCC patient records; and implementation of periodic pre-visit patient surveys; (B) enhanced case-based population surveillance through identifying a random, probability sample of all STD cases; regular submission of eHARS-matched gonorrhea and adult syphilis San Francisco morbidity; conducting patient interviews and provider investigations for a random sample of all SF gonorrhea cases; and (C) LGV surveillance among persons seeking care at SFCC, through submission of remnant CT-positive rectal NAATs to CDC by the SF Public Health Laboratory.
The proposed work draws on SFDPH expertise in developing and maintaining robust clinical and surveillance systems, and extracting and matching data from the SFDPH HIV Registry and data-collection platforms. SFDPH SSuN Project staff include STD epidemiologists and program managers with extensive experience and skills in interpreting STD case and clinic visit data, and well-trained investigational staff to conduct waiting room surveys, patient interviews, and provider investigations. This collaborative work within DPH and with CDC will further local and national capacity to describe trends and determinants of STDs, effectively monitor health outcomes, and develop high impact prevention and other interventions to reduce STD morbidity and improve uptake of HIV preventive services.