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Sexually Transmitted Disease Surveillance 1995
Division of STD Prevention September 1996 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 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, 1995. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1996. Copies can be obtained from Information Technology and Services Office, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333 or by telephone at (404) 639-1819. The reports for 1993 through 1995 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. These reports are also available from the Internet via the CDC home page address http://www.cdc.gov. 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 may occur. Reporting of gonococcal infections has likely been biased towards reporting of infections among persons of minority race/ethnicity who attend public STD clinics. This bias may partially explain the large reported race differentials among persons with this disease. -- In 1995, 392,848 cases of gonorrhea were reported in the United States. The rate of gonorrhea has continued its overall decline since 1975. Between 1994 and 1995 the rate decreased from 165.1 cases per 100,000 population to 149.5 (Table_1 and Figure_6). -- In 1995, 27 states/areas reported gonorrhea rates below the revised Healthy People 2000 (HP2000) national objective of 100 cases per 100,000 population (Figure_7 and Table_10). Gonorrhea rates increased between 1994 and 1995 in 6 of 36 states reporting more than 1,000 cases in 1995, down from 20 of the 35 states with more than 1,000 cases in 1994 (Table_11). -- Gonorrhea rates decreased in all regions in 1995. The South continued to have a higher rate than other regions (Figure_8). -- Although the overall gonorrhea rate for large cities (selected cities with >200,000 population) continued to decline in 1995 (Figure_9), 55 (86%) of 64 large cities had rates exceeding the revised HP2000 objective (Table_14). -- The gonorrhea rate in men continued to decline in 1995, and the rate in women decreased after a one-year increase from 1993 to 1994. Rates in men remained above the HP2000 objective in 28 states and rates in women remained above the HP2000 objective in 26 states (Figure_10; Table_12 and Table_13). -- In 1995, gonorrhea rates decreased for all racial and ethnic groups except Hispanics (Figure_11 and Table_9B). However, the rates for Hispanics and all other racial and ethnic groups except non-Hispanic blacks remained below the HP2000 objective (Figure_11 and Table_9B). The gonorrhea rate for blacks decreased by 9%, from 1,200.7 cases per 100,000 population in 1994 to 1,086.9 in 1995 (Table_9B), but remained almost 40 times greater than the rate for non-Hispanic whites. -- Between 1994 and 1995, the gonorrhea rate for 15- to 19-year-old adolescents decreased by 10%, from 739.2 to 664.6 cases per 100,000 population, after increasing slightly from 1993 to 1994. Overall, 15- to 19-year-olds had higher rates than any other age group (Table_9B). In most minority populations, 20- to 24-year-olds had the highest age-specific rates. -- Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. Overall, 31.6% of isolates collected in 1995 by the Gonococcal Isolate Surveillance Project (GISP) were resistant to penicillin, tetracycline, or both (Table_18). Between 1991 and 1995, the percentage of GISP isolates that were penicillinase producing Neisseria gonorrhoeae (PPNG) declined from 13.1% to 6.8% (Figure_14). In contrast, isolates with chromosomally mediated resistance to penicillin increased from 6.4% in 1991 to 7.0% in 1995 (Figure_15). Chromosomally mediated tetracycline resistance increased from 1994 (13.5%) to 1995 (15.4%) after several years of stable prevalence (Figure_15). A growing number of GISP isolates have demonstrated decreased susceptibility to ciprofloxacin, one of the currently recommended treatments for gonorrhea. Resistance to ciprofloxacin was first identified in GISP in 1991 but remains rare (Figure_16). Reduced susceptibility and resistance to ciprofloxacin correlate with reduced susceptibility and resistance to other fluoroquinolone antibiotics. -- Additional information about gonorrhea in racial and ethnic minority populations and adolescents can be found in the Special Focus Profiles section. Figure_6. Gonorrhea -- Reported rates: United States, 1970-1995 and the Healthy People year 2000 objective Figure_7. Gonorrhea -- Rates by state: United States, 1995 Figure_8. Gonorrhea -- Rates by region: United States, 1981-1995 and the Healthy People year 2000 objective Figure_9. Gonorrhea -- Rates in U.S. cities of >200,000 population, 1981-1995 and the Healthy People year 2000 objective Figure_10. Gonorrhea -- Rates by gender: United States, 1981-1995 and the Healthy People year 2000 objective Figure_11. Gonorrhea -- Rates by race and ethnicity: United States, 1981 1995 and the Healthy People year 2000 objective Figure_12. Gonorrhea -- Age- and gender-specific rates: United States, 1995 Figure_13. Gonococcal Isolate Surveillance Project (GISP) -- Location of participating clinics and regional laboratories: United States, 1995 Figure_14. Gonococcal Isolate Surveillance Project (GISP) -- Trends in plasmid-mediated resistance to penicillin and tetracycline, 1988-1995 Figure_15. Gonococcal Isolate Surveillance Project (GISP) -- Trends in chromosomally mediated resistance to penicillin and tetracycline, 1988-1995 Figure_16. Gonococcal Isolate Surveillance Project (GISP) -- Prevalence of Neisseria gonorrhoeae with decreased susceptibility or resistance to ciprofloxacin, 1990-1995
