Diseases reported to the
Bureau of Sexually Transmitted Disease
Control are now available on STD
EpiQuery. EpiQuery is an interactive,
user-friendly system designed to guide users through basic data analyses.
According to Article 11 of the New York City Health Code, health care
providers diagnosing sexually transmitted diseases (STDs) and clinical
laboratories licensed to perform laboratory testing for New York City (NYC)
residents are required to report certain STDs to the Health Department. Seven
sexually transmitted diseases have been designated as ‘notifiable’ or reportable
to the Bureau of STD Control.
venereum (L-serovars of Chlamydia trachomatis)
(Treponema pallidum) - all stages, including congenital syphilis
- Chancroid [PDF]
inguinale [PDF] (Klebsiella granulomatis)
- Neonatal Herpes (Herpes simplex virus infection in
infants aged 60 days and younger) – reportable since April 2006
The Bureau of STD Control manages the data derived from these reports.
Data are cleaned, analyzed and reported as part of public health surveillance.
Detailed STD data are published in quarterly reports.
The data in EpiQuery include all cases of STD reported among NYC
residents, beginning in 2000. Reported cases and case rates (per 100,000
population) are available by select demographic (age group, sex, race/ethnicity)
and geographic (citywide, borough, neighborhood) characteristics.
Rate calculations use the NYC Health Department’s neighborhood
population estimates, modified from US Census Bureau vintage population
estimates, 2000 onwards, available on EpiQuery.
Case rates for the most recent year of data use the previous year’s population
estimates until the current year’s estimates become available; a note on the
EpiQuery page indicates where the previous year’s population was used in
calculating case rates.
For diseases affecting infants (congenital syphilis and neonatal
herpes), incidence is reported per 100,000 live births, using the annual number
of live births in NYC from the Bureau of Vital
Statistics in the most recent completed year as the denominator (also
available on EpiQuery).
Borough of residence is assigned to each case using patient borough and
zip code of residence at the time of diagnosis. Zip code 10463 crosses Manhattan
and the Bronx. For calculation of borough-specific case rates only, the
population of zip code 10463 has been attributed to the Bronx, as STD cases with
this zip code and a reported borough are generally from the Bronx. Similarly,
zip code 11370 crosses Queens and the Bronx. The population of zip code 11370
has been attributed to Queens as STD cases with this zip code and a
reported borough are generally from Queens.
Race and ethnicity data
The ordered selection rules used to define race/ethnicity of cases
first classifies as “Hispanic” any person who reports Hispanic ethnicity,
regardless of race. Those of other or unknown ethnicity are then classified by
race as non-Hispanic Asian, non-Hispanic white, non-Hispanic black, non-Hispanic
Native American/Alaskan Native, non-Hispanic Other (includes Native
Hawaiian/Pacific Islander and multiple races), or non-Hispanic Unknown
The group of non-Hispanic persons with multiple races is evenly
distributed across five other non-Hispanic groups: White, Black, Asian, American
Indian, Native Hawaiian/Pacific Islander.
Under-ascertainment of cases
For some STDs,
there are a large number of infections that are not diagnosed because they
frequently lack symptoms, such as chlamydia. Asymptomatic persons may not be
screened, and thus diseases may exist at higher levels in the population than
notifiable disease data indicate. In some instances, considerable
differences in numbers and rates of infection between subgroups may be largely
attributable to screening and testing practices, rather than real differences in
disease burden. For example, there are national recommendations that young women
be screened for chlamydia annually, while there are no similar
recommendations for young men. Consequently, the number of reported cases of
female chlamydia in NYC is substantially higher among women than men, although
the gender difference in actual disease rates is likely to be much smaller.
Under-reporting by providers and clinical
All diseases are subject to under-reporting.
While chlamydia, gonorrhea, syphilis, chancroid, lymphogranuloma venereum,
granuloma inguinale, and neonatal herpes are all notifiable diseases in NYC,
providers or laboratories may fail to report detected infections. This may be
particularly true when providers do not perform diagnostic testing and
instead treat presumptively (i.e., based on symptoms); in these instances no
laboratory tests will be generated and sent to the Health
Missing race/ethnicity data
race/ethnicity is recorded for the majority of cases diagnosed in Bureau of STD
Control clinics. However, private sector providers diagnose the majority of
citywide STD cases, and race/ethnicity is missing for many cases reported to the
Health Department from private sector providers, either because a case report
with that information was not submitted or a submitted case report lacked
information on race/ethnicity. Data tables provide these case counts.
Missing age data
Patient date of birth is
recorded for the majority of cases diagnosed in Bureau of STD Control clinics.
However, private sector providers diagnose the majority of citywide STD cases,
and birth date or age information is missing for some cases reported to the NYC
DOHMH from private sector providers, either because a case report with that
information was not submitted or a submitted case report lacked information on
date of birth or age. Data tables provide these case counts.
Artifactual changes in neighborhood case counts and
Case reports lacking patient address are attributed to
provider address, so if a provider does a substantial amount of testing for
patients for whom address is missing, this may artificially elevate the disease
rate in that provider’s neighborhood . Examples of where this
may occur are neighborhoods with jails or detention centers.