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Recent Trends in Gonorrhea in the United States

Recent Trends in Gonorrhea in the United States. Lori M. Newman, MD Division of STD Prevention CDC Atlanta, GA March 8, 2004. Neisseria gonorrhoeae. Sequelae of untreated infection include Pelvic inflammatory disease Infertility Chronic pelvic pain

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Recent Trends in Gonorrhea in the United States

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  1. Recent Trends in Gonorrhea in the United States Lori M. Newman, MD Division of STD Prevention CDC Atlanta, GA March 8, 2004

  2. 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

  3. Gonorrhea rates, U.S., 1970-2003* Rate (per 100,000 population) 500 Gonorrhea rate 2010 Objective 400 300 200 100 0 1970 73 76 79 82 85 88 91 94 97 2000 03 *Preliminary 2003 data

  4. Gonorrhea rates by sex, 1981-2003* Rate (per 100,000 population) 600 Male 480 Female 2010 Objective 360 240 120 0 1981 83 85 87 89 91 93 95 97 99 2001 03 *Preliminary 2003 data

  5. Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Men Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Rate (per 100,000 population) Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Women Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age Age 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 450 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 600 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 750 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 10-14 6.8 41.8 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 15-19 258.6 626.1 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 20-24 483.3 616.2 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 25-29 290.8 247.7 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 30-34 179.6 110.8 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 35-39 118.7 54.5 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 40-44 87.9 31.1 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 45-54 46.9 10.7 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 55-64 16.6 2.4 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 65+ 4.1 0.5 Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total 113.3 119.2 Gonorrhea rates by age and sex, 2003* *Preliminary 2003 data

  6. Gonorrhea rates among females by age, 1981-2003* Rate (per 100,000 population) 1,500 1,200 15-19 900 20-24 600 25-29 300 30-34 0 1981 83 85 87 89 91 93 95 97 99 2001 03 *Preliminary 2003 data

  7. Gonorrhea rates among males by age, 1981-2003* Rate (per 100,000 population) 2,000 20-24 1,600 1,200 15-19 800 25-29 35-39 400 30-34 40-44 10-14 0 1981 83 85 87 89 91 93 95 97 99 2001 03 *Preliminary 2003 data

  8. Rate per 100,000 population (n=8) <=19.0 19.1-100.0 (n=19) >100.0 (n=24) Gonorrhea rates by state: U.S., 2003* *Preliminary 2003 data Note: The Healthy People 2010 objective for gonorrhea is 19 cases per 100,000 population

  9. Gonorrhea rates by county: U. S., 2003* *Preliminary 2003 data Note: The Healthy People 2010 objective for gonorrhea is 19 cases per 100,000 population

  10. Gonorrhea rates by region, 1981-2003* Rate (per 100,000 population) 600 480 South 360 Midwest 240 West Northeast 120 2010 Objective 0 1981 83 85 87 89 91 93 95 97 99 2001 03 *Preliminary 2003 data

  11. Gonorrhea rates by race/ethnicity, 1981-2003* Rate (per 100,000 population) 2,500 Black 2,000 1,500 1,000 500 Hispanic American Indian/Alaska Native White 0 1981 83 85 87 89 91 93 95 97 99 2001 03 *Preliminary 2003 data

  12. Gonorrhea rates by race/ethnicity, 1981-2003, excluding blacks* Rates (per 100,000 population) American Indian/Alaska Native Hispanic White Asian/Pacific Islander *Preliminary 2003 data

  13. Ratios of minority gonorrhea rates to white rates,1981-2003* Rate ratio Black American Indian/Alaska Native Hispanic Asian/Pacific Islander *Preliminary 2003 data

  14. Gonorrhea rates for 15-19 year old females by region and race/ethnicity, 2003* Rate (per 100,000 population) *Preliminary 2003 data

  15. Gonorrhea rates for 20-24 year old males by region and race/ethnicity, 2003* Rate (per 100,000 population) *Preliminary 2003 data

  16. Positivity (%) See * <1.0 1.0-1.9 >=2.0 Gonorrhea — Positivity among 15-24 year old females tested in family planning clinics by state, 2002 0.6 2.7 VT 0.2 0.4 1.0 NH 0.1 MA 0.7 0.9 RI 0.6 1.2 1.5 CT 0.8 1.2 0.2 1.8 NJ 1.3 0.9 2.8 0.5 DE 0.7 0.9 MD 0.7 DC 1.2 0.7 0.7 1.5 0.7 1.4 2.4 2.3 2.8 (n= 15) 1.0 (n= 21) 2.4 0.6 (n= 10) 0.6 (n= 7) 0.1 *Less than 500 females tested

  17. Proportion of reported gonorrhea cases from STD clinics by sex,1984-2003* % from STD clinics Males Females *Preliminary 2003 data

  18. Proportion of reported gonorrhea cases by source and sex, 2003* *Preliminary 2003 data

  19. Average completeness of gonorrhea reporting, U.S., 2002 99.8% 98.3% 96.5% 75.9% 71.5% 32.6% 19.5% *Proportion calculated for women only

  20. Data limitations • Incomplete reporting • Reporting bias towards STD clinics • Limited type of data available • Difficult to distinguish between changes in screening & reporting practices versus changes in burden of disease

  21. Summary • Males = females • High rates among adolescents & young adults • Decreases in South • Decreases among blacks • Increased reporting by private sector • Insufficient information on risk behavior at a national level

  22. Future data improvements • NEDSS and STD Program Area Module • NETSS collection of sex of partner info • OASIS Project

  23. Acknowledgements • Data and Statistics Management, Division of STD Prevention, CDC • Sharon Clanton • Michael Phillips • Emmett Swint • Epidemiology and Statistics Branch, Division of STD Prevention, CDC • Hillard Weinstock

  24. Contact information Lori Newman, MD Epidemiology and Surveillance Branch Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GA 30307 (404) 639-6183 len4@cdc.gov

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