Gonorrhea -- United States, 1983

In 1983, the number of gonorrhea cases reported to CDC fell to 900,435, a 6.3% decrease from the 960,633 cases reported in 1982. Gonorrhea rates also declined to 387.6 per 100,000 population, down 7.3% from 1982. This continues a trend that began in 1975 (Figure 1). Between 1975 and 1983, reported gonorrhea rates remained highest in the southeastern United States but followed the national trend of decline. Rates in the mid-Atlantic region generally declined more slowly than those in other reporting regions. While the greater proportion of reported cases came from the public sector, both the public and private sectors shared in the decline.

From 1982 to 1983, rates decreased by 9.5% for males and 4.0% for females (Table 3). Even with declining morbidity, persons 20-24 years old continued to account for 35%-40%, and persons 15-19 years old, for nearly 25%, of all reported cases of gonorrhea each year. Rates for 20- to 24-year-old males and females were highest up to 1982. By 1982, rates for 15- to 19-year-old females exceeded those for 20- to 24-year-old females.

Between 1976 and 1982, the annual number of reported cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) increased from 98 cases to 4,457 cases, then decreased to 3,720 cases in 1983. Of all PPNG cases reported since 1976, 59.0% have been from three geographic areas: California (21.5%), Florida (20.4%), and New York City (17.1%).

In early 1983, an outbreak of nonpenicillinase-producing (chromosomally mediated) resistant N. gonorrhoeae occurred in North Carolina (1). Since that outbreak, this strain has been reported with increasing frequency from 16 other states (2). Reported by Sexually Transmitted Diseases Laboratory Program, Center for Infectious Diseases, Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Between 1960 and 1975, the number of gonorrhea cases reported in the United States increased substantially. The largest increases occurred among persons 15-24 years of age, partly because of the post-World War II "baby boom," which created a larger population in this age group. Since 1975, both the public and private sectors have reported a decline in gonorrhea cases. This decline may have been influenced by one or more of the following: more focused control activities; changes in surveillance and reporting resulting in better case identification and earlier treatment; or changes in biologic properties of the organism or in biologic and behavioral host factors.

Morbidity declined among both males and females but more slowly for females. This trend is disturbing, especially for younger females, because of the potential for more severe immediate and chronic sequelae, such as pelvic inflammatory disease and infertility (3).

The slower decline in morbidity among females may be due to less effective control measures to decrease transmission to females than to males, variations in surveillance and reporting between males and females, or differences between males and females in care-seeking behavior. Because more than half of all gonorrhea cases are reported from public clinics, and because males account for more than half of public clinic attendance (2,4), decreases in male morbidity may be more accurately represented, while cases among females may be underreported or undetected by the existing surveillance system. Additionally, if females seek care from sources other than public clinics, cases may not enter the reporting system.

Gonococcal antibiotic resistance has assumed increasing importance for national and local control programs. Although PPNG declined in 1983, nonpenicillinase-producing resistant N. gonorrhoeae (chromosomally mediated) has been observed with increasing frequency. While a larger proportion of PPNG has been linked to domestic transmission, foreign importation continues to contribute significantly to PPNG morbidity in the United States (5). In contrast, other resistant N. gonorrhoeae has been largely associated with endemic transmission (2), with importation infrequently documented for these cases.

Reporting of all gonorrhea cases from both public and private sectors is encouraged. Additional emphasis should be placed on examining trends and reporting patterns, especially for teenagers and females. These activities should be supported by testing all gonococcal isolates for B-lactamase (penicillinase) production. Screening of all B-lactamase-negative treatment failure isolates for penicillin susceptibility is recommended to identify other resistant organisms (1). CDC guidelines provide treatment recommendations for both penicillin-susceptible and -resistant cases of N. gonorrhoeae (6).

References

1. CDC. Penicillin-resistant gonorrhea--North Carolina. MMWR 1983;32:273-5.

2. CDC. Gonorrhea surveillance reports, 1975-1983.

3. Washington AE, Cates W, Zaidi AA. Hospitalizations for pelvic inflammatory disease. JAMA 1984;251:2529-33.

4. Zaidi AA, Aral SO, Reynolds GH, Blount JH, Jones OG, Fichtner RR. Gonorrhea in the United States: 1967-1979. Sex Trans Dis 1983;10:72-6.

5. Jaffe HW, Biddle JW, Johnson SR, Wiesner PJ. From the Centers for Disease Control. Infections due to penicillinase producing Neisseria gonorrhoeae in the United States: 1976-1980. J Infect Dis 1981;144:191-7.

6. CDC. Sexually transmitted diseases treatment guidelines, 1982. MMWR Supplement, 1982;31:35S-62S.

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