Sexually Transmitted Disease Surveillance 1995

Division of STD Prevention

September 1996

U.S. Department of Health and Human Services 
Public Health Service 
Centers for Disease Control and Prevention  
National Center for HIV, STD, and TB Prevention 
Division of STD Prevention 
Atlanta, Georgia 30333

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is appreciated.

Suggested Citation

Division of STD Prevention. Sexually Transmitted Disease Surveillance,
1995. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1996.

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                                Gonorrhea

Infections due to Neisseria gonorrhoeae, like those due to Chlamydia
trachomatis, remain a major cause of pelvic inflammatory disease, tubal
infertility, ectopic pregnancy, and chronic pelvic pain in the United
States. Epidemiologic studies provide strong evidence that gonococcal
infections facilitate HIV transmission, and biological studies have begun
to elucidate the specific mechanisms through which this facilitation may
occur. Reporting of gonococcal infections has likely been biased towards
reporting of infections among persons of minority race/ethnicity who attend
public STD clinics. This bias may partially explain the large reported race
differentials among persons with this disease.

--  In 1995, 392,848 cases of gonorrhea were reported in the United States.
    The rate of gonorrhea has continued its overall decline since 1975.
    Between 1994 and 1995 the rate decreased from 165.1 cases per 100,000
    population to 149.5 (Table_1 and Figure_6). 

--  In 1995, 27 states/areas reported gonorrhea rates below the revised
    Healthy People 2000 (HP2000) national objective of 100 cases per
    100,000 population (Figure_7 and Table_10). Gonorrhea rates
    increased between 1994 and 1995 in 6 of 36 states reporting more than
    1,000 cases in 1995, down from 20 of the 35 states with more than 1,000
    cases in 1994 (Table_11).

--  Gonorrhea rates decreased in all regions in 1995. The South continued
    to have a higher rate than other regions (Figure_8).

--  Although the overall gonorrhea rate for large cities (selected cities
    with >200,000 population) continued to decline in 1995 (Figure_9),
    55 (86%) of 64 large cities had rates exceeding the revised HP2000
    objective (Table_14).

--  The gonorrhea rate in men continued to decline in 1995, and the rate in
    women decreased after a one-year increase from 1993 to 1994. Rates in
    men remained above the HP2000 objective in 28 states and rates in women
    remained above the HP2000 objective in 26 states (Figure_10;
    Table_12 and Table_13).

--  In 1995, gonorrhea rates decreased for all racial and ethnic groups
    except Hispanics (Figure_11 and Table_9B). However, the rates
    for Hispanics and all other racial and ethnic groups except
    non-Hispanic blacks remained below the HP2000 objective (Figure_11
    and Table_9B). The gonorrhea rate for blacks decreased by 9%, from
    1,200.7 cases per 100,000 population in 1994 to 1,086.9 in 1995
    (Table_9B), but remained almost 40 times greater than the rate for
    non-Hispanic whites.

--  Between 1994 and 1995, the gonorrhea rate for 15- to 19-year-old
    adolescents decreased by 10%, from 739.2 to 664.6 cases per 100,000
    population, after increasing slightly from 1993 to 1994. Overall, 
    15- to 19-year-olds had higher rates than any other age group
    (Table_9B). In most minority populations, 20- to 24-year-olds had
    the highest age-specific rates.

--  Antimicrobial resistance remains an important consideration in the
    treatment of gonorrhea. Overall, 31.6% of isolates collected in 1995 by
    the Gonococcal Isolate Surveillance Project (GISP) were resistant to
    penicillin, tetracycline, or both (Table_18). Between 1991 and
    1995, the percentage of GISP isolates that were penicillinase producing
    Neisseria gonorrhoeae (PPNG) declined from 13.1% to 6.8%
    (Figure_14). In contrast, isolates with chromosomally mediated
    resistance to penicillin increased from 6.4% in 1991 to 7.0% in 1995
    (Figure_15). Chromosomally mediated tetracycline resistance
    increased from 1994 (13.5%) to 1995 (15.4%) after several years of
    stable prevalence (Figure_15). A growing number of GISP isolates
    have demonstrated decreased susceptibility to ciprofloxacin, one of the
    currently recommended treatments for gonorrhea. Resistance to
    ciprofloxacin was first identified in GISP in 1991 but remains rare
    (Figure_16). Reduced susceptibility and resistance to ciprofloxacin
    correlate with reduced susceptibility and resistance to other
    fluoroquinolone antibiotics.

--  Additional information about gonorrhea in racial and ethnic minority
    populations and adolescents can be found in the Special Focus Profiles
    section.

Figure_6.  Gonorrhea -- Reported rates:  United States, 1970-1995 and
               the Healthy People year 2000 objective
Figure_7.  Gonorrhea -- Rates by state:  United States, 1995
Figure_8.  Gonorrhea -- Rates by region:  United States, 1981-1995 and
               the Healthy People year 2000 objective
Figure_9.  Gonorrhea -- Rates in U.S. cities of >200,000 population,
               1981-1995 and the Healthy People year 2000 objective
Figure_10.  Gonorrhea -- Rates by gender:  United States, 1981-1995 and
                the Healthy People year 2000 objective
Figure_11.  Gonorrhea -- Rates by race and ethnicity:  United States,
                1981 1995 and the Healthy People year 2000 objective
Figure_12.  Gonorrhea -- Age- and gender-specific rates:  United States,
                1995
Figure_13.  Gonococcal Isolate Surveillance Project (GISP) -- Location
                of participating clinics and regional laboratories:  United
                States, 1995
Figure_14.  Gonococcal Isolate Surveillance Project (GISP) -- Trends in
                plasmid-mediated resistance to penicillin and tetracycline,
                1988-1995
Figure_15.  Gonococcal Isolate Surveillance Project (GISP) -- Trends in
                chromosomally mediated resistance to penicillin and
                tetracycline, 1988-1995
Figure_16.  Gonococcal Isolate Surveillance Project (GISP) -- Prevalence
                of Neisseria gonorrhoeae with decreased susceptibility or
                resistance to ciprofloxacin, 1990-1995

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