Recent Trends in Gonorrhea in the United States Lori M. Newman, MD Division of STD Prevention CDC Jacksonville, FL May 9, 2006.

Recent Trends in Gonorrhea in the United States

Lori M. Newman, MDDivision of STD Prevention

CDCJacksonville, FL

May 9, 2006

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., 1970-2005*

*Preliminary 2005 data

Rate (per 100,000 population)

Gonorrhea2010 Target

0

100

200

300

400

500

1970 73 76 79 82 85 88 91 94 97 2000 03

Gonorrhea rates by sex, 1981-2005*



MaleFemale2010 Target

0

120

240

360

480

600

1981 83 85 87 89 91 93 95 97 99 2001 03 05

Gonorrhea rates by age and sex, 2005*


Men Rate (per 100,000 population) Women

Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-145.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14 34.8


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

257.2


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

611.5


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

428.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

566.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

300.8


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

270.5


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

173.1


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

112.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

124.7


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

60.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

89.4


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

33.2


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

48.4


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

11.8


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

16.9


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

2.4


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

4.0


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

0.6


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

109.8


Age750 600 450 300 150 0 0 150 300 450 600 750

Total 65+55-6445-5440-4435-3930-3425-2920-2415-1910-14

116.5

Proportion of reported gonorrhea cases from STD clinics by sex,1984-2005*

0

10

20

30

40

50

60

70

80

90

1984 86 88 90 92 94 96 98 2000 2002 2004


Males

Females

% from STD clinics

Gonorrhea rates by race/ethnicity, 1981-2005*



WhiteBlackHispanicAsian/Pacific IslanderAm Indian/AK Native2010 Target

0

500

1,000

1,500

2,000

2,500

1981 83 85 87 89 91 93 95 97 99 2001 03 05

Gonorrhea rates by state, United States and outlying

territories, 2004

Rate per 100,000population

<=19.019.1-100.0>100.0

VT 13.9 NH 10.3 MA 47.5 RI 75.8 CT 82.2 NJ 77.5 DE 109.4 MD 150.6

Guam 69.7

Puerto Rico 6.9 Virgin Is. 68.9

(n= 8)(n= 25)(n= 20)

182.3

87.4

72.8151.8

85.0 67.1

109.2

181.7

94.9

7.5

162.8 110.6

42.4

93.367.0

234.4

16.1

172.4

58.4

248.6

161.6

9.6

65.9137.3

69.7

97.6

180.7

17.4

179.0

126.8

36.6

90.9

221.1

39.8

145.1

110.2

25.6

116.0

45.8

49.3

92.3

11.8

Gonorrhea rates by county: United States, 2004

Rate per 100,000population

<=19.0 (n= 1,330)

19.1-100.0 (n= 1,139)

>100.0 (n= 670)

Gonorrhea rates by region, 1981-2005*



WestMidwestNortheastSouth2010 Target

0

120

240

360

480

600

1981 83 85 87 89 91 93 95 97 99 2001 03 05

Female gonorrhea rates for 15-19 year olds by region and

race/ethnicity, 2005*


0500

10001500

20002500

30003500

40004500

5000

Black Hispanic White

West

Midwest

South

Northeast


Male gonorrhea rates for 20-24 year olds by region and

race/ethnicity, 2005*

0

500

1000

1500

2000

2500

3000

3500

4000

Black Hispanic White

West

Midwest

South

Northeast



A closer look at increases in gonorrhea in the West……..

How to define the area of interest?

States with increases in number of reported gonorrhea cases of >= 25%

from 2000 to 2005

AND

States with at least 500 cases in 2005

States with >25% increase in reported gonorrhea cases

from 2000 to 2005* and > 500 cases in 2005*

Cases 2000

Cases 2005*

2000 to 2005

Utah 231 707 206%Hawaii 483 1,002 107%California 21,595 33,555 55%Washington 2,418 3,697 53%Oregon 1,038 1,559 50%Alaska 361 533 48%Nevada 1,553 2,169 40%

*Preliminary 2005 data, as of Jan 2006

Gonorrhea rates by sex, 7 western states, 2000-2005*

*Preliminary 2005 data for AK, CA, HI, NV, OR, UT, WA

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005

Rat

e pe

r 10

0,00

0

Male Female

+48%

+58%

Gonorrhea rates by age, 7 western states, 2000-2005*

0

50

100

150

200

250

300

350

2000 2001 2002 2003 2004 2005

Rat

e pe

r 10

0,00

0

15-19 20-24 25-29 30-34 35-39 40-44


+71%

+58%

+47%

+39%+49%+69%

Gonorrhea rates by race/ethnicity,

7 western states, 2000-2005*

0

100

200

300

400

500

600

2000 2001 2002 2003 2004 2005

Rat

e pe

r 10

0,00

0

White Black Hispanic Asian/Pac Isl Am Ind/AK Nat


+18%

+61%

+89%+80%+45%

Have providers in the West adopted more sensitive, less

specific, gonorrhea test technology than other

states?

AND/OR

Are providers in the West screening more than in other

states?

Comparison states with greatest number of gonorrhea

cases in 2005*

Cases 2000

Cases 2005*

2000 to 2005

Texas 32,919 24,527 -25%Florida 22,781 19,702 -14%Ohio 19,303 19,356 0%Illinois 20,671 18,711 -9%New York 20,067 17,099 -15%North

Carolina 17,823 14,578 -18%Georgia 20,265 13,987 -31%

*Preliminary 2005 data, as of Jan 2006

Proportion of gonorrhea tested by nucleic acid amplification tests (NAATs), and gonorrhea test

volume, American Public Health Laboratory Survey,2000 and 2004 (N=30 labs)

West*(n=20)

Comparison**(n=10)

% of gonorrhea tested by

NAATs

2000 53% 8%

2004 88% 73%

Gonorrhea test volume

2000 311,603 1,222,248

2004 593,192 1,088,608

*West: AK, CA, NI, NV, OR, UT, WA**Comparison: FL, GA, IL, NY, NC, OH, TX Source: APHL laboratory survey, unpublished data, CDC, 2001 & 2004. Methods published in: Webster Dicker L et al. Laboratory Tests Used in U.S. Public Health Laboratories for STDs, 2000. STD 2004; 31:259-264.

Hypotheses

Artifactual increases Use of more sensitive and less specific

test technology Gonorrhea screening

Increased dual gonorrhea/chlamydia testing

Outreach and screening efforts

Hypotheses, cont.

Real increases due to Increased risk behavior Reduced disease control efforts Increases in resistant gonorrhea Predominance of a more transmissible

or more virulent gonococcal strain

Other analyses

Local in-depth analyses of case report data

Enhanced gonorrhea surveillance Evaluation of laboratory test volume

and positivity Case control study Review of other data sources (DIS

interviews, STD clinics, HMOs)

Summary

National rate remains stable, but still far from HP 2010 goal of 19 per 100,000

Concerning racial disparities for gonorrhea High burden of disease among black

adolescents and young adults in all regions

Large increases in West, unclear cause, further investigation is underway

Current activities

Working with project areas to investigate AND respond to increases in the West

STD Surveillance Network (SSuN) 6 collaborating sites Enhanced gonorrhea surveillance

STD clinics Sample of cases in neighboring counties

Expanded behavioral, clinical, and lab data NEDSS and STD Program Area Module Translation of data into action

Acknowledgements

Statistics and Data Management Branch, Division of STD Prevention, CDC Rob Nelson

Epidemiology and Surveillance Branch, Division of STD Prevention, CDC Katrina Park Hillard Weinstock

The many participants in the “GC in the West” working group

Contact informationLori Newman, MD

Epidemiology and Surveillance BranchDivision of STD Prevention

Centers for Disease Control and PreventionAtlanta, GA

(404) [email protected]

For more information: http://www.cdc.gov/std/Gonorrhea/

The findings and conclusions in this presentation havenot been formally disseminated by the CDC and should not

be construed to represent any agency determination or policy.

Recent Trends in Gonorrhea in the United States Lori M. Newman, MD Division of STD Prevention CDC Jacksonville, FL May 9, 2006.

Documents

data slide

proportion of gonorrhea

acquisition gonorrhea

female gonorrhea rates

gonorrhea test volume

gonorrhea test technology

comparison states

western states