GONORRHEA

Sexually Transmitted Disease Surveillance 2009Division of STD Prevention

Gonorrhea—Rates, United States, 1941–2009

Rate (per 100,000 population)

200620011996199119861981197619711966196119561951194619410

100

200

300

400

500

Year

Gonorrhea—Rates by Sex, United States, 1990–2009

200820062004200220001998199619941990

TotalWomenMen

Rate (per 100,000 population)

0

100

200

300

400

1992

Year

Gonorrhea—Rates by Region, United States, 2000–2009

2009200820072006200520042003200220012000

SouthNortheastMidwestWest

Rate (per 100,000 population)

0

50

100

150

200

250

300

Year

Gonorrhea—Rates by State, United States and Outlying Areas, 2009

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population.

34.9

29.4

63.2

66.4

8.3

144.3

Puerto Rico5.8

Guam33.5

23.5 10.9

87.2

81.4

185.7

120.4

7.2

12.5

54.5

13.942.8

77.2

44.1

92.4

246.4160.8

141.3

113.9

150.4

100.3

139.2

147.0

107.2

127.5

109.8

128.3

204.0

156.2

154.7

89.626.257.2

50.0

55.2

89.4

<19.0 (n = 8)

Rate per 100,000population

19.1–100.0 (n = 24)

>100.0 (n = 22)

49.0

VirginIslands104.7

VT

NH

MA

RI

CT

NJ

DE

MD

DC

8.0

8.6

30.4

30.6

73.1

54.8

111.2

113.5

432.7

Gonorrhea—Rates by County, United States, 2009

<19.0 (n = 1,405)

Rate per 100,000population

19.1–100.0 (n = 1,129)

>100.0 (n = 607)

Gonorrhea—Rates by Age and Sex, United States, 2009

750 600 450 300 150 0 0 150 300 450 600 750

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

5.0

250.0

407.5

238.9

145.0

85.6

60.8

33.6

92.2

2.7

11.4

25.3

568.8

555.3

229.4

106.2

47.6

22.9

8.7

105.7

0.5

2.1

Men WomenRate (per 100,000 population)

Age

Gonorrhea—Rates by Age Among Women Aged 15–44 Years, United States, 2000–2009

Rate (per 100,000 population)

Year

0

200

400

600

800

1,000

2009200820072006200520042003200220012000

35–3940–44

30–34

25–2920–2415–19

Age Group

Gonorrhea—Rates by Age Among Men Aged 15–44 Years, United States, 2000–2009

0

150

300

450

600

750

2009200820072006200520042003200220012000

Rate (per 100,000 population)

Year

35–3940–44

30–34

25–2920–2415–19

Age Group

Gonorrhea—Rates by Race/Ethnicity, United States,

2000–2009

0

100

200

300

400

500

600

700

800

2009200820072006200520042003200220012000

WhitesHispanicsBlacksAsians/Pacific IslandersAmerican Indians/Alaska Natives

Rate (per 100,000 population)

Year

Gonorrhea—Cases by Reporting Source and Sex, United States,

2000–2009

* STD = sexually transmitted disease.

0

40

80

120

160

200

2009200820072006200520042003200220012000

STD Clinic, WomenSTD Clinic, MenNon-STD Clinic, WomenNon-STD* Clinic, Men

Cases (in thousands)

Year

Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting Sources,

United States, 2009

* HMO = health maintenance organization; STD = sexually transmitted disease; HD = health department.NOTE: These categories represent 71.9% of cases with known reporting source. Of all cases, 10.3% had a missing or unknown reporting source.

Percentage

Men Women0

5

10

15

20

25

30

35STD* Clinic

Private Physician/HMO*

Other HD* Clinic

Family Planning Clinic

Emergency Room

Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and

Outlying Areas, 2009

* States/areas not meeting minimum inclusion criteria.NOTE: Includes states and outlying areas that reported positivity data on at least 500 women aged 15–24 years who were screened during 2009.

1.0

3.4

1.1

0.2

Puerto Rico0.1

VirginIslands

2.0

0.0

0.5

0.8

2.0

2.0

0.1

0.3

1.6

0.2

0.8

0.40.3

0.3

0.12.7

2.41.8

2.0

1.2

1.2

1.0

1.8

1.4

1.1

0.6

1.0

0.8

2.1

1.9

1.4

0.50.20.4

0.4

0.5

1.0

* (n = 4)

Positivity (%)

<1.0 (n = 24)

1.0–1.9 (n = 16)>2.0 (n = 9)0.5

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.2

0.3

0.6

1.2

1.3

2.5

Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel Sites and Regional Laboratories, United States, 2009

Birmingham

Phoenix Los Angeles

Orange Co. San

Diego

San Francisco

Denver

Miami

Atlanta

Honolulu

Tripler AMC

Chicago

New Orleans

Baltimore

Detroit

Minneapolis

Kansas City Las

Vegas

Albuquerque

New York City

Greensboro

Cincinnati

Cleveland

Oklahoma City

Portland

Philadelphia

Dallas

Richmond

Seattle

Sentinel Sites

Sites and Regional Labs

Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory

Concentrations (MICs) to Ceftriaxone Among GISP Isolates, 2005–2009

0

20

40

60

80

100

0.250.1250.060.030.015<0.008

2006

2005

Percentage

2007

2009

2008

MICs (µg/ml)

Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory

Concentrations (MICs) to Cefixime Among GISP Isolates, 2005–2006 and 2009

NOTE: Isolates were not tested for cefixime susceptibility in 2007 and 2008.

0

20

40

60

80

100

0.50.250.1250.060.03<0.015

Percentage

MICs (µg/ml)

2006

2005

2009

Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory

Concentrations (MICs) to Azithromycin Among GISP Isolates, 2005–2009

0

10

20

30

40

1684210.50.250.1250.06<0.03

2006

2005

Percentage

2007

2009

2008

MICs (µg/ml)

Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeae Isolates with Resistance or Intermediate Resistance to

Ciprofloxacin, 1990–2009

NOTE: Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) >1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125–0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.

0

5

10

15

20

20092008200720062005200420032002200120001999199819971996199519941993199219911990

Intermediate Resistance

Resistance

Percentage

Year

Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and

Ciprofloxacin Resistance Among GISP Isolates, 2009

NOTE: PenR = penicillinase producing Neisseria gonorrhoeae and chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR = chromosomally and plasmid mediated tetracycline-resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

PenR/QRNG

PenR

TetR/QRNG

PenR/TetR

QRNG

PenR/TetR/QRNG

TetR

Susceptible

76.5%

1.1%0.9%2.2%

2.1%

7.9%

5.5%

3.8%

Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea Among GISP

Participants, 1988–2009

NOTE: For 2009, “Other” includes no therapy (1.5%), azithromycin 2 g (1.7%), and other less frequently used drugs.

0

20

40

60

80

100

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Ceftriaxone 125 mgSpectinomycin

Ceftriaxone 250 mgCefixime

Penicillins

Ciprofloxacin

Tetracyclines

Ofloxacin

Other

Percentage

Year

Other Cephalosporins

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

Division of STD Prevention