Gonorrhea Sexually Transmitted Disease Surveillance 2008

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					       Gonorrhea

Sexually Transmitted Disease
     Surveillance 2008

    Division of STD Prevention
                           Gonorrhea — Rates: United States, 1941–2008




Rate (per 100,000 population)
   500


   400


   300


   200


   100


     0

           1941     46     51   56   61   66   71   76   81   86   91    96   2001   06
              Gonorrhea — Rates: Total and by sex: United States, 1989–2008




Rate (per 100,000 population)
   400
                                                                              Men
                                                                              Women
   320                                                                        Total


   240


   160


    80


     0

           1989        91       93   95   97   99    2001   03     05     07
                    Gonorrhea — Rates by region: United States, 1999–2008




Rate (per 100,000 population)
   300
                                                                        West
                                                                        Midwest
   240                                                                  Northeast
                                                                        South

   180


   120


    60


     0

           1999        2000     01   02     03      04     05      06       07      08
            Gonorrhea — Rates by state: United States and outlying areas, 2008


                           48.3
                                                                                                                             VT   6.0
                                            12.7          22.4                                                     7.3       NH   7.6
                      32.7                                         58.4                                                      MA 33.0
                                   12.5                   47.1              108.7                         88.7               RI 29.0
                                               23.7                                   169.4                                  CT 80.0
                                                                     56.9                            89.0
                                                                                                                             NJ 61.0
                            84.7                          82.3                                                               DE 120.8
                                                                                          146.5
                                     18.0                                    160.9138.2                                      MD 118.6
                    70.5                           77.3                                         41.2 134.0
                                                            81.9      136.3                                                  DC 451.5
                                                                                        107.2
Guam 62.8                                                                                            176.3
                                                             143.3
                                                                                     142.6                       Rate per 100,000
                                    54.4
                                               71.2                   159.2                     214.2            population
                                                                                           170.5
                                                                              256.8210.5
                                                          134.7                                                           <=19.0        (n= 7)
                                                                          220.2                                           19.1-100.0    (n= 24)
                     84.6
                                            47.5                                                  127.8                   >100          (n= 23)


                                                                                  P uerto Rico 6.9

                                                                                                   V irgin Is. 109.3




             Note: The total rate of gonorrhea for the United States and outlying areas
             (Guam, Puerto Rico, and Virgin Islands) was 110.3 per 100,000 population.
Gonorrhea — Rates by county: United States, 2008




                                           Rate per 100,000
                                           population
                                                   <=19.0       (n= 1,305)
                                                   19.1-100.0   (n= 1,136)
                                                   >100.0       (n= 700)
       Gonorrhea — Age- and sex-specific rates: United States, 2008



Men                                 Rate (per 100,000 population)                                 Women

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

                                           5.8       10-14         31.0
                    278.3                            15-19                                             636.8
            433.6                                    20-24                                         608.6
                    269.9                            25-29                         269.4
                            163.3                    30-34                119.0
                               99.6                  35-39             55.2
                                    71.7             40-44        28.9
                                     40.1            45-54       11.2
                                       14.0          55-64       2.5
                                           3.5        65+        0.5
                               103.3                 Total                119.7
             Gonorrhea — Age-specific rates among women 15 to 44 years of age:
                               United States, 1999–2008


Rate (per 100,000 population)
     1,000
                                                         15-19                 20-24
                                                         25-29                 30-34
                                                         35-39                 40-44
       800


       600


       400


       200


         0

               1999       2000   01   02     03     04     05     06      07           08
             Gonorrhea — Age-specific rates among men 15 to 44 years of age:
                              United States, 1999–2008


Rate (per 100,000 population)
       750
                                                        15-19                  20-24
                                                        25-29                  30-34
                                                        35-39                  40-44
       600


       450


       300


       150


         0

               1999       2000   01   02    03     04     05      06     07            08
               Gonorrhea — Rates by race/ethnicity: United States, 1999–2008



Rate (per 100,000 population)
       900


       720


       540                       American Indian/AK Native
                                 Asian/Pacific Islander
                                 Black
                                 Hispanic
       360                       White



       180


         0

               1999       2000        01          02         03   04   05   06   07   08
      Gonorrhea — Cases by reporting source and sex: United States, 1999–2008



Cases (in thousands)
   200
                          non-STD Clinic Male
                          non-STD Clinic Female
                          STD Clinic Male
   160                    STD Clinic Female


   120


    80


    40


     0

          1999         2000      01         02    03   04   05   06   07        08
Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning
            clinics by state: United States and outlying areas, 2008


                                                                                                                                         VT     0.0
                                          1.0                                                                             0.0            NH
                                                                     0.5                                                                 MA
                              0.1                                                3.8                          0.5                        RI     0.3
                                                0.4                                      1.4                                             CT     0.7
                                                                      0.5                                   0.9
                                                                                                                                         NJ     1.3
                        1.8                             0.9                                                                              DE     1.4
                                                                                               1.6
                                    0.3                                           1.4   1.4                                              MD
                0.8                              0.4                                                 0.4 1.2
                                                          1.0              1.0                                                           DC     2.0
                                                                                              0.6
                                                                                                        1.4
                                                                                         0.8
                               0.6                             0.8
                                                0.6                        1.9                        2.5                    Positivity (%)
                                                                                        2.7     2.2
                                                                                  2.9
                                                         2.1                                                                          See*            (n= 7)
                                                                            2.4                                                                       (n= 23)
                 0.2                                                                                                                  <1.0
                                          0.8                                                          1.7                            1.0-1.9         (n= 14)
                                                                                                                                      >=2.0           (n= 9)
                                                                                         P uerto Rico 0.2

                                                                                                                  V irgin Is. 3.0


       *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 screened during 2008.

       DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State
       STD Control Programs, Centers for Disease Control and Prevention.
Gonococcal Isolate Surveillance Project (GISP) — Location of participating
    sentinel sites and regional laboratories in the United States, 2008


                   Seattle

                 Portland


                                                           Minneapolis
                                                                                     Detroit
                                                                                                                       New York City
                                                                           Chicago                Cleveland           Philadelphia
            San Francisco                     Denver                                 Cincinnati
                                                        Kansas City                                               Baltimore
                    Las Vegas                                                                                    Richmond

   Los Angeles                                         Oklahoma City                              Greensboro
        Orange Co.                     Albuquerque                          Birmingham
              San Diego      Phoenix                                                           Atlanta
                                                            Dallas
                                                                     New Orleans

                                      Tripler AMC
                                Honolulu                                     Sentinel Sites
                                                                             Sites and                        Miami
                                                                             Regional Labs
   Gonococcal Isolate Surveillance Project (GISP) — Distribution of MICs to
                ceftriaxzone among GISP isolates, 2004–2008


Percent
  100
                                                                       2004
                                                                       2005
   80
                                                                       2006
                                                                       2007
   60                                                                  2008



   40


   20


    0
           <=0.008     0.015       0.03         0.06     0.125      0.25
                                      MIC (µg/ml)
   Gonococcal Isolate Surveillance Project (GISP) — Distribution of MICs to
                azithromycin among GISP isolates, 2004–2008


Percent
   60
                                                                       2004
                                                                       2005
   48
                                                                       2006
                                                                       2007
   36                                                                  2008



   24


   12


    0
          <=0.03   0.06   0.125   0.25   0.5     1     2   4     8     16
                                         MIC (µg/ml)
         Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria
      gonorrhoeae isolates with resistance or intermediate resistance to ciprofloxacin,
                                        1990–2008


Percent
 16

                      Resistance
 12                   Intermediate resistance



  8



  4



  0
          1990   91    92    93    94   95      96   97   98   99   2000   01   02   03   04   05   06   07   08


                 Note: Resistant isolates have ciprofloxacin 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.
Gonococcal Isolate Surveillance Project (GISP) — Penicillin, tetracycline, and
            ciprofloxacin resistance among GISP isolates, 2008




    Note: PenR=penicillinase producing N. gonorrhoeae and chromosomally mediated
    penicillin-resistant N. gonorrhoeae; TetR=chromosomally and plasmid mediated
    tetracycline-resistant N. gonorrhoeae; QRNG=ciprofloxacin resistant N. gonorrhoeae.
      Gonococcal Isolate Surveillance Project (GISP) — Drugs used to treat
                    gonorrhea in GISP patients, 1988–2008


100                                      Other
      Tetracyclines
      Penicillins                                Ofloxacin
80

                                      Ciprofloxacin
60
                                                      Cefixime
40       Ceftriaxone 250 mg


20    Spectinomycin
                                  Ceftriaxone 125 mg

 0
                                Other Cephalosporins
  1988       1990     1992     1994       1996     1998      2000   2002     2004     2006   2008


           Note: For 2008, ―Other‖ includes no therapy (1.3%), azithromycin 2 g (1.2%),
           levofloxacin (0.02%), and other less frequently used drugs.