Gonorrhea

1. Sexually Transmitted Disease Surveillance 2010 Division of STD Prevention Gonorrhea

2. Gonorrhea—Rates, United States, 1941–2010 Rate (per 100,000 population) 500 400 300 200 100 0 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 Year

3. Gonorrhea—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 400 Men Women Total 300 200 100 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year

4. Gonorrhea—Rates by Region, United States, 2001–2010 Rate (per 100,000 population) 300 West Midwest 250 Northeast South 200 150 100 50 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

5. Gonorrhea—Rates by State, United States and Outlying Areas, 2010 NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 99.6 per 100,000 population.

6. Gonorrhea—Rates by County, United States, 2010 Rate per 100,000 population <19.0 (n = 1,408) 19.1–100.0 (n = 1,107) >100.0 (n = 627)

7. Gonorrhea—Rates by Age and Sex, United States, 2010 Men Rate (per 100,000 population) Women 750 600 450 300 150 0 0 150 300 450 600 750 Age 253.4 570.9 15–19 421.0 560.7 20–24 241.3 226.3 25–29 146.5 107.5 30–34 85.1 48.2 35–39 64.2 23.8 40–44 45–54 34.1 9.0 1.9 11.0 55–64 2.4 0.5 65+ 94.1 106.5 Total

8. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) Age Group 1,000 30–34 15–19 35–39 20–24 40–44 800 25–29 600 400 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

9. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, United States, 2001–2010 Rate (per 100,000 population) Age Group 750 30–34 15–19 35–39 20–24 40–44 600 25–29 450 300 150 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

10. Gonorrhea—Rates by Race/Ethnicity, United States, 2001–2010 Rate (per 100,000 population) 600 500 400 American Indians/Alaska Natives 300 Asians/Pacific Islanders Blacks Hispanics 200 Whites 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

11. Gonorrhea—Cases by Reporting Source and Sex, United States, 2001–2010 Cases (in thousands) 200 Non-STD Clinic, Men Non-STD Clinic, Women STD Clinic, Men 160 STD Clinic, Women 120 80 40 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

12. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting Sources, United States, 2010 Percentage 35 Private Physician/HMO* STD Clinic 30 Other HD* Clinic Family Planning Clinic 25 Emergency Room 20 15 10 5 0 Men Women * HMO = health maintenance organization; HD = health department. NOTE: These categories represent 69.5% of cases with known reporting source. Of all cases, 13.2% had a missing or unknown reporting source.

13. STD Surveillance Network­­ (SSuN)—Proportion of MSM,* MSW,* and Women Among Interviewed† Gonorrhea Cases by Site, 2010 Percentage MSM 100 MSW Women 80 60 40 20 0 San Francisco California‡ Colorado Louisiana Virginia Philadelphia New York City Connecticut Washington Chicago Alabama Baltimore * MSM = men who have sex with men; MSW = men who have sex with women only. † SSuN interviews conducted from a randomly selected patient population with gonorrhea (n = 3,446). ‡ California data excludes San Francisco.

14. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family Planning Clinics, by State, Infertility Prevention Project, United States and Outlying Areas, 2010 * 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 2010.

15. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel Sites and Regional Laboratories, United States, 2010

16. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP Isolates, 2006–2010 Percentage 100 2006 2007 2008 80 2009 2010 60 40 20 0 0.015 0.03 0.06 0.125 0.25 <0.008 MICs (µg/ml)

17. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Cefixime Among GISP Isolates, 2006 and 2009–2010 Percentage 100 2006 2009 80 2010 60 40 20 0 <0.015 0.03 0.06 0.125 0.25 0.5 MICs (µg/ml) NOTE: Isolates were not tested for cefixime susceptibility in 2007 and 2008.

18. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory Concentrations (MICs) to Azithromycin Among GISP Isolates, 2006–2010 Percentage 40 2006 2007 2008 30 2009 2010 20 10 0 0.06 0.125 0.25 0.5 1 2 4 8 16 <0.03 MICs (µg/ml)

19. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeae Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990–2010 Percentage 20 Resistance Intermediate Resistance 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 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.

20. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and Ciprofloxacin Resistance Among GISP Isolates, 2010 6.9% 2.0% 0.6% 1.8% 2.9% Susceptible 9.4% PenR TetR 3.5% QRNG 72.8% PenR/TetR PenR/QRNG TetR/QRNG PenR/TetR/QRNG NOTE: PenR = penicillinase producing Neisseriagonorrhoeaeand chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR = chromosomally and plasmid mediated tetracycline-resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

21. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea Among GISP Participants, 1988–2010 Percentage 100 Other Tetracyclines Penicillins Ofloxacin 80 Ciprofloxacin 60 Cefixime Ceftriaxone 250 mg 40 20 Spectinomycin Ceftriaxone 125 mg Other Cephalosporins 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NOTE: For 2010, “Other” includes no therapy (1.2%), azithromycin 2 g (1.7%), and other less frequently used drugs.