Sexually Transmitted Disease Surveillance 1996

Division of STD Prevention September 1997

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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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,
1996. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1997.

Copies can be obtained from the Office of Communications, National Center
for HIV, STD, and TB Prevention, Centers for Disease Control and
Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

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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 occurs
(1). Reporting of gonococcal infections has likely been biased towards
reporting of infections in persons of minority race or ethnicity who attend
public STD clinics.

--  In 1996, 325,883 cases of gonorrhea were reported in the United States.
    The rate of gonorrhea has continued its overall decline since 1975.
    Between 1995 and 1996 the rate decreased 17% from 149.4 cases per
    100,000 persons to 124.0 (Table_1 and Figure_11). 

--  In 1996, 30 states or outlying areas reported gonorrhea rates below the
    Healthy People 2000 (HP2000) national objective of 100 cases per
    100,000 persons (Figure_12 and Table_13). Gonorrhea rates
    decreased between 1995 and 1996 in 32 of the 35 states reporting more
    than 1,000 cases in 1996, whereas rates in the previous year decreased
    in 29 of 36 states with more than 1,000 cases (Table_14).

--  Gonorrhea rates decreased in all regions in 1996. The South continued
    to have a higher rate than other regions (Figure_13).

--  Although the overall gonorrhea rate for large cities (selected cities
    with over 200,000 population) continued to decline in 1996
    (Figure_14), 52 (81%) of the 64 cities had rates exceeding the
    HP2000 objective (Table_17).

--  The gonorrhea rates in both men and women declined in 1996. Rates in
    men and in women were above the HP2000 objective in 22 states
    (Figure_15, Table_15 and Table_16).

--  In 1996, gonorrhea rates decreased for all racial and ethnic groups
    except American Indian/Alaska Native (Figure_16 and Table_12B).
    The rates for non-Hispanic blacks and American Indians/Alaska Natives
    were above the HP2000 objective (Figure_16, Table_12B). The
    gonorrhea rate for blacks decreased by 21%, from 1,045.5 cases per
    100,000 persons in 1995 to 825.5 in 1996 (Table_12B), but was
    almost 32 times greater than the rate for non-Hispanic whites.

--  Between 1995 and 1996, the gonorrhea rate for 15- to 19-year-old
    adolescents decreased by 15%, from 670.7 to 570.8 cases per 100,000
    persons. Among women, 15- to 19-year-olds had the highest rate, while
    among men, 20- to 24-year-olds had the highest rate (Table_12B).

--  Antimicrobial resistance remains an important consideration in the
    treatment of gonorrhea. Overall, 29.0% of isolates collected in 1996 by
    the Gonococcal Isolate Surveillance Project (GISP) were resistant to
    penicillin, tetracycline, or both (Table_21). Between 1991 and
    1996, the percentage of GISP isolates that were penicillinase producing
    Neisseria gonorrhoeae (PPNG) declined from 13.1% to 5.8%
    (Figure_19). In contrast, isolates with chromosomally mediated
    resistance to penicillin increased from 6.4% in 1991 to 9.1% in 1996
    (Figure_20). The prevalence of chromosomally mediated tetracycline
    resistance, 14.3% in 1996, has been relatively stable since 1992
    (Figure_20). The proportion of GISP isolates demonstrating
    decreased susceptibility to ciprofloxacin, one of the currently
    recommended treatments for gonorrhea, has decreased from a high of 1.3%
    in 1994 to 0.5% in 1996. Resistance to ciprofloxacin was first
    identified in GISP in 1991 but remains rare (0.04%) in 1996
    (Figure_21). Reduced susceptibility and resistance to ciprofloxacin
    correlate with reduced susceptibility and resistance to other
    fluoroquinolone antibiotics.

--  The percentage of men with gonorrhea who have repeat infection within a
    one-year period, as measured by the Gonococcal Isolate Surveillance
    Project, has increased from a low of 13.8% in 1994 to 15.7% in 1996
    (Figure_22). Although the number of persons with repeat infections
    might be expected to fall as the incidence of gonorrhea declines, an
    increase in the percentage of all gonorrhea cases who are repeaters may
    nevertheless reflect a focusing of disease in the population at highest
    risk.

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

Figure_11.  Gonorrhea -- Reported rates: United States, 1970-1996 and
                the Healthy People year 2000 objective
Figure_12.  Gonorrhea -- Rates by state: United States and outlying 
                areas, 1996
Figure_13.  Gonorrhea -- Rates by region: United States, 1981-1996 and 
                the Healthy People year 2000 objective
Figure_14.  Gonorrhea -- Rates in selected U.S. cities of >200,000 
                population, 1981-1996 and the Healthy People year 2000
                objective
Figure_15.  Gonorrhea -- Rates by gender: United States, 1981-1996 and 
                the Healthy People year 2000 objective
Figure_16.  Gonorrhea -- Rates by race and ethnicity: United States, 
                1981-1996 and the Healthy People year 2000 objective
Figure_17.  Gonorrhea -- Age- and gender-specific rates: United States, 
                1996
Figure_18.  Gonococcal Isolate Surveillance Project (GISP) -- Location 
                of participating clinics and regional laboratories: United
                States, 1996
Figure_19.  Gonococcal Isolate Surveillance Project (GISP) -- Trends in 
                plasmid-mediated resistance to penicillin and tetracycline,
                1988-1996
Figure_20.  Gonococcal Isolate Surveillance Project (GISP) -- Trends in 
                chromosomally mediated resistance to penicillin and
                tetracycline, 1988-1996
Figure_21.  Gonococcal Isolate Surveillance Project (GISP) -- 
                Prevalence of Neisseria gonorrhoeae with decreased
                susceptibility or resistance to ciprofloxacin, 1990-1996
Figure_22.  Gonococcal Isolate Surveillance Project (GISP) -- 
                Proportion of men with gonorrhea who report having a
                previous gonorrhea infection within the past year,
                1992-1996

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(1) Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of
    HIV-1 in semen after treatment of urethritis: implications for
    prevention of sexual transmission of HIV-1. Lancet 1997;349:1868-1873.

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