Sexually Transmitted Disease Surveillance 1993

Division of STD/HIV Prevention 

December 1994

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

                         Copyright Information 

All material contained in this report is in the public domain and may be
used and reprinted without special permission; citation to source,
however, is appreciated.

                           Suggested Citation

Division of STD/HIV Prevention. Sexually Transmitted Disease
Surveillance, 1993.  U.S. Department of Health and Human Services, Public
Health Service.  Atlanta: Centers for Disease Control and Prevention,
December 1994.

Copies can be obtained from Information Services, National Center for
Prevention Services, Centers for Disease Control and Prevention, 1600
Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

                                 
                                 Gonorrhea

     --   In 1993, 439,673 cases of gonorrhea were reported.  The rate of
          gonorrhea has continued to decline, from 196.7 cases per 100,000
          population in 1992 to 172.4 in 1993 (Table_1 and
          Figure_6).

     --   In 1993, the gonorrhea rates for 38 states were below the Healthy
          People 2000 (HP 2000) national objective of 225 cases per 100,000
          population (Figure_7 and Table_10).

     --   Gonorrhea rates declined in all regions during 1993
          (Figure_8). Although the overall gonorrhea rate for large
          cities (with >200,000 population) continued to decline in 1993
          (Figure_9), 39 (61%) of 64 large cities had rates exceeding
          the HP 2000 objective (Table_14).

     --   Gonorrhea rates for both men and women continued to decline in
          1993 and were below the HP 2000 objective (Figure_10;
          Table_12, Table_13, Table_16, and Table_17).

     --   Gonorrhea rates for all racial and ethnic groups other than
          non-Hispanic blacks were below the HP 2000 objective
          (Figure_11 and Table_9B).  The gonorrhea rate for blacks
          decreased from 1,404.8 cases per 100,000 population in 1992 to
          1,215.2 in 1993 and is now below the HP 2000 sub-objective of
          1,300 cases per 100,000 population for this special target group
          (Table_9B).

     --   The gonorrhea rate for 15- to 19-year-old adolescents decreased
          from 869.6 cases per 100,000 population in 1992 to 742.1 in 1993
          and is now below the HP 2000 sub-objective of 750 cases per
          100,000 population for this special target population
          (Table_9B).

     --   Antimicrobial resistance remains an important consideration in
          the treatment of gonorrhea.  Overall, 30.4% of GISP isolates in
          1993 were resistant to penicillin, tetracycline, or both
          (Figure_14). Between 1991 and 1993, the percentage of
          gonorrhea isolates from sentinel STD clinics participating in the
          Gonococcal Isolate Surveillance Project (GISP), which were
          penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates,
          declined from 13.1% to 9.6% (Figure_15).  Although no GISP
          isolates have yet demonstrated clinically significant resistance
          to the antimicrobial agents currently recommended for therapy
          (1), some isolates have begun to demonstrate decreased levels of
          susceptibility to some of these agents (2). 

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

(1) CDC.  1993 Sexually transmitted diseases treatment guidelines MMWR
1993;42(No. RR-14):56-66.

(2) CDC. Decreased susceptibility of Neisseria gonorrhoeae to
fluoroquinolones--Ohio and Hawaii, 1992-1994. MMWR 1994;43:325-7.

Figure_6.  Gonorrhea - Reported rates: United States, 1970-1993 and the
               year  2000 objective   
Figure_7.  Gonorrhea - Rates by state: United States, 1993   
Figure_8.  Gonorrhea - Rates by region: United States, 1981-1993 and
               the year 2000 objective   
Figure_9.  Gonorrhea - Rates in U.S. cities of >200,000 population,
               1981-1993 and the year 2000 objective   
Figure_10. Gonorrhea - Rates by gender: United States, 1981 1993 and
               the year 2000 objective   
Figure_11. Gonorrhea - Rates by race and ethnicity: United States,
               1981 1993 and the year 2000 objective   
Figure_12. Gonorrhea - Age- and gender-specific rates: United States,
               1993   
Figure_13. Gonococcal Isolate Surveillance Project (GISP) - Location of
               participating clinics and regional laboratories: United
               States, 1993
Figure_14. Gonococcal Isolate Surveillance Project (GISP) - Percentage
               distribution of antimicrobial resistance in gonorrhea
               isolates, 1993
Figure_15. Gonococcal Isolate Surveillance Project (GISP) - Trends in
               plasmid-mediated resistance, 1988-1993    
Figure_16. Gonococcal Isolate Surveillance Project (GISP) - Trends in
               chromosomally mediated resistance, 1988-1993    

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