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Recent Trends in Gonorrhea in the United States. Lori M. Newman, MD Division of STD Prevention CDC Atlanta, GA March 8, 2004. Neisseria gonorrhoeae. Sequelae of untreated infection include Pelvic inflammatory disease Infertility Chronic pelvic pain

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Recent trends in gonorrhea in the united states

Recent Trends in Gonorrhea in the United States

Lori M. Newman, MD

Division of STD Prevention

CDC

Atlanta, GA

March 8, 2004


Neisseria gonorrhoeae
Neisseria gonorrhoeae

  • Sequelae of untreated infection include

    • Pelvic inflammatory disease

    • Infertility

    • Chronic pelvic pain

  • Increases risk of HIV transmission and acquisition

  • Gonorrhea is second most common reported notifiable disease


Gonorrhea rates u s 1970 2003
Gonorrhea rates, U.S., 1970-2003*

Rate (per 100,000 population)

500

Gonorrhea rate

2010 Objective

400

300

200

100

0

1970

73

76

79

82

85

88

91

94

97

2000

03

*Preliminary 2003 data


Gonorrhea rates by sex 1981 2003
Gonorrhea rates by sex, 1981-2003*

Rate (per 100,000 population)

600

Male

480

Female

2010 Objective

360

240

120

0

1981

83

85

87

89

91

93

95

97

99

2001

03

*Preliminary 2003 data


Gonorrhea rates by age and sex 2003

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Men

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Rate (per 100,000 population)

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Women

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

Age

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

150

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

300

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

450

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

600

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

750

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

10-14

6.8

41.8

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

15-19

258.6

626.1

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

20-24

483.3

616.2

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

25-29

290.8

247.7

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

30-34

179.6

110.8

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

35-39

118.7

54.5

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

40-44

87.9

31.1

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

45-54

46.9

10.7

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

55-64

16.6

2.4

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

65+

4.1

0.5

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

Total

113.3

119.2

Gonorrhea rates by age and sex, 2003*

*Preliminary 2003 data


Gonorrhea rates among females by age 1981 2003
Gonorrhea rates among females by age, 1981-2003*

Rate (per 100,000 population)

1,500

1,200

15-19

900

20-24

600

25-29

300

30-34

0

1981

83

85

87

89

91

93

95

97

99

2001

03

*Preliminary 2003 data


Gonorrhea rates among males by age 1981 2003
Gonorrhea rates among males by age, 1981-2003*

Rate (per 100,000 population)

2,000

20-24

1,600

1,200

15-19

800

25-29

35-39

400

30-34

40-44

10-14

0

1981

83

85

87

89

91

93

95

97

99

2001

03

*Preliminary 2003 data


Gonorrhea rates by state u s 2003

Rate per 100,000

population

(n=8)

<=19.0

19.1-100.0

(n=19)

>100.0

(n=24)

Gonorrhea rates by state: U.S., 2003*

*Preliminary 2003 data

Note: The Healthy People 2010 objective for gonorrhea

is 19 cases per 100,000 population


Gonorrhea rates by county u s 2003
Gonorrhea rates by county: U. S., 2003*

*Preliminary 2003 data

Note: The Healthy People 2010 objective for gonorrhea is 19 cases per 100,000 population


Gonorrhea rates by region 1981 2003
Gonorrhea rates by region, 1981-2003*

Rate (per 100,000 population)

600

480

South

360

Midwest

240

West

Northeast

120

2010 Objective

0

1981

83

85

87

89

91

93

95

97

99

2001

03

*Preliminary 2003 data


Gonorrhea rates by race ethnicity 1981 2003
Gonorrhea rates by race/ethnicity, 1981-2003*

Rate (per 100,000 population)

2,500

Black

2,000

1,500

1,000

500

Hispanic

American Indian/Alaska Native

White

0

1981

83

85

87

89

91

93

95

97

99

2001

03

*Preliminary 2003 data


Gonorrhea rates by race ethnicity 1981 2003 excluding blacks
Gonorrhea rates by race/ethnicity, 1981-2003, excluding blacks*

Rates (per 100,000 population)

American Indian/Alaska Native

Hispanic

White

Asian/Pacific Islander

*Preliminary 2003 data


Ratios of minority gonorrhea rates to white rates 1981 2003
Ratios of minority gonorrhea rates to white rates,1981-2003* blacks*

Rate ratio

Black

American Indian/Alaska Native

Hispanic

Asian/Pacific Islander

*Preliminary 2003 data


Gonorrhea rates for 15 19 year old females by region and race ethnicity 2003
Gonorrhea rates for 15-19 year old females by region and race/ethnicity, 2003*

Rate (per 100,000 population)

*Preliminary 2003 data


Gonorrhea rates for 20 24 year old males by region and race ethnicity 2003
Gonorrhea rates for 20-24 year old males by region and race/ethnicity, 2003*

Rate (per 100,000 population)

*Preliminary 2003 data


Gonorrhea positivity among 15 24 year old females tested in family planning clinics by state 2002

Positivity (%) race/ethnicity, 2003*

See *

<1.0

1.0-1.9

>=2.0

Gonorrhea — Positivity among 15-24 year old females tested in family planning clinics by state, 2002

0.6

2.7

VT

0.2

0.4

1.0

NH

0.1

MA

0.7

0.9

RI

0.6

1.2

1.5

CT

0.8

1.2

0.2

1.8

NJ

1.3

0.9

2.8

0.5

DE

0.7

0.9

MD

0.7

DC

1.2

0.7

0.7

1.5

0.7

1.4

2.4

2.3

2.8

(n= 15)

1.0

(n= 21)

2.4

0.6

(n= 10)

0.6

(n= 7)

0.1

*Less than 500 females tested


Proportion of reported gonorrhea cases from std clinics by sex 1984 2003
Proportion of reported gonorrhea cases from STD clinics by sex,1984-2003*

% from STD clinics

Males

Females

*Preliminary 2003 data



Average completeness of gonorrhea reporting u s 2002
Average completeness of gonorrhea reporting, U.S., 2002 2003*

99.8%

98.3%

96.5%

75.9%

71.5%

32.6%

19.5%

*Proportion calculated for women only


Data limitations
Data limitations 2003*

  • Incomplete reporting

  • Reporting bias towards STD clinics

  • Limited type of data available

  • Difficult to distinguish between changes in screening & reporting practices versus changes in burden of disease


Summary
Summary 2003*

  • Males = females

  • High rates among adolescents & young adults

  • Decreases in South

  • Decreases among blacks

  • Increased reporting by private sector

  • Insufficient information on risk behavior at a national level


Future data improvements
Future data improvements 2003*

  • NEDSS and STD Program Area Module

  • NETSS collection of sex of partner info

  • OASIS Project


Acknowledgements
Acknowledgements 2003*

  • Data and Statistics Management, Division of STD Prevention, CDC

    • Sharon Clanton

    • Michael Phillips

    • Emmett Swint

  • Epidemiology and Statistics Branch, Division of STD Prevention, CDC

    • Hillard Weinstock


Contact information
Contact information 2003*

Lori Newman, MD

Epidemiology and Surveillance Branch

Division of STD Prevention

Centers for Disease Control and Prevention

Atlanta, GA 30307

(404) 639-6183

len4@cdc.gov