Sexually Transmitted Disease Surveillance 1994

Division of STD Prevention

September 1995

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 (proposed)
Division of STD Prevention
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 Prevention. Sexually Transmitted Disease Surveillance,
1994. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1995.

Copies can be obtained from Information Technology and Services Office,
National Center for HIV, STD, and TB Prevention (proposed), Centers for
Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta,
Georgia 30333 or by telephone at (404) 639-1819.

Both the 1993 and 1994 reports are now available electronically on CDC
WONDER. For information about registering for CDC WONDER, please contact
CDC's Information Resource Management Office at (404) 332-4569.
                                    
                                Gonorrhea

 --  In 1994, 418,068 cases of gonorrhea were reported. The rate of
     gonorrhea has continued its overall decline since 1975. Between 1993
     and 1994 the rate decreased from 173.8 cases per 100,000 population in
     1993 to 168.4 (Table_1 and Figure_6). However, the state of
     Georgia did not report in 1994. In previous years, Georgia has
     reported among the highest rates of gonorrhea; thus, exclusion of
     Georgia lowered the overall rate for the nation in 1994 (see
     Appendix).

 --  In 1994, 37 states reported gonorrhea rates below the Healthy People
     2000 (HP2000) national objective of 225 cases per 100,000 population
     (Figure_7 and Table_10). However, gonorrhea rates increased
     between 1993 and 1994 in 21 of 35 states reporting more than 1,000
     cases in 1994. This trend was decidedly different from recent years of
     steep declines in most states (Table_11) (1).

 --  The decrease in gonorrhea rates slowed in 1994 for the West,
     Northeast, and South. The rate increased for the Midwest from 176.0
     cases per 100,000 population in 1993 to 181.4 in 1994. (Figure_8).

 --  Although the overall gonorrhea rate for large cities (with >200,000
     population) continued to decline in 1994 (Figure_9), 39 (62%) of
     63 large cities (excluding Atlanta, see Appendix) had rates exceeding
     the HP2000 objective (Table_14). The same number of large cities
     had rates exceeding the HP2000 objective in 1993.

 --  The gonorrhea rate for men continued to decline in 1994, but increased
     in women  from 147.1 per 100,000 population to 153.7. Rates for both
     men and women remained below the HP2000 objective (Figure_10;
     Table_12, Table_13, Table_16, and Table_17).

 --  In 1994, gonorrhea rates increased slightly for all racial and ethnic
     groups except Hispanics (Figure_11 and Table_9B). However,
     rates for all racial and ethnic groups except non-Hispanic blacks
     remained below the HP2000 objective (Figure_11 and Table_9B).
     The gonorrhea rate for blacks increased from 1,215.2 cases per 100,000
     population in 1993 to 1,219.3 in 1994, but remained below the HP2000
     sub-objective of 1,300 cases per 100,000 population for the second
     year in a row in this special target group (Table_9B).

 --  Between 1993 and 1994, the gonorrhea rate for 15- to 19-year-old
     adolescents increased nearly 3% from 742.1 cases per 100,000
     population to 763.4 and exceeded the HP2000 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, 30.5% of isolates collected in 1994
     by the Gonococcal Isolate Surveillance Project (GISP) were resistant
     to penicillin, tetracycline, or both (Figure_14). Between 1991 and
     1994, the percentage of GISP isolates that were penicillinase-
     producing Neisseria gonorrhoeae (PPNG), declined from 13.1% to 7.8%
     (Figure_15). In contrast, isolates with chromosomally mediated
     resistance increased from 13.9% in 1990 to 16.2% in 1994
     (Table_18). Although no GISP isolates have yet demonstrated
     clinically significant resistance to the antimicrobial agents
     currently recommended for therapy (2), some isolates have begun to
     demonstrate decreased levels of susceptibility to some of these agents
     (3).

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

(1) CDC. Increasing incidence of gonorrhea -- Minnesota, 1994. MMWR
1995;44:282-6.

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

(3) 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, 1970-1994 and the
               year 2000 objective   
Figure_7.  Gonorrhea - Rates by state: United States, 1994   
Figure_8.  Gonorrhea - Rates by region: United States, 1981-1994 and
               the year 2000 objective   
Figure_9.  Gonorrhea - Rates in U.S. cities of >200,000 population,
               1981-1994 and the year 2000 objective   
Figure_10. Gonorrhea - Rates by gender: United States, 1981-1994 and
               the year 2000 objective   
Figure_11. Gonorrhea - Rates by race and ethnicity: United States,
               1981-1994 and the year 2000 objective   
Figure_12. Gonorrhea - Age- and gender-specific rates: United States,
               1994   
Figure_13. Gonococcal Isolate Surveillance Project (GISP) - Location of
               participating clinics and regional laboratories: United
               States, 1994
Figure_14. Gonococcal Isolate Surveillance Project (GISP) - Percentage
               distribution of antimicrobial resistance in gonorrhea
               isolates, 1994
Figure_15. Gonococcal Isolate Surveillance Project (GISP) - Trends in
               plasmid-mediated resistance, 1988-1994    
Figure_16. Gonococcal Isolate Surveillance Project (GISP) - Trends in
               chromosomally mediated resistance, 1988-1994    

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