JACKSONVILLE, FLA. — The reasons for prominent increases in reported gonorrhea cases since 2000 in five western states as well as Hawaii and Alaska remain unknown, Dr. Lori M. Newman said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
A combination of better gonorrhea detection, increased risky sexual behavior, reduced disease control efforts, and/or increased antimicrobial resistance likely accounts for the 25% or more jump in gonorrhea cases in the “Wild West,” said Dr. Newman, medical officer, Division of STD Prevention at the CDC.
Among states with at least 500 gonorrhea cases reported in 2005, preliminary data indicate that the greatest increases since 2000 were seen in Utah (206% increase), Hawaii (107%), California (55%), Washington (53%), Oregon (50%), Alaska (48%), and Nevada (40%).
In contrast to national trends, aggregated data for these seven states indicate a 48% increase in new cases among males and a 40% increase in new cases among females between 2000 and 2005. This disparity suggests increases among men who have sex with men, Dr. Newman said. However, overall increases suggest heterosexual transmission as well.
The overall gender gap for gonorrhea has narrowed. Historically, males have had higher infection rates, but female transmission surpassed that of males slightly during the last 3 reported years. The 2004 transmission rates were 117 females per 100,000 and 110 males per 100,000 in the United States.
CDC researchers have yet to identify any demographic risk factor that might explain the increases in the seven states. The increases are not concentrated in a particular age group, for example. By ethnicity, there has been an 80% increase among whites, an 89% increase among Hispanics, and an 18% increase among blacks since 2000.
The CDC has enhanced gonorrhea surveillance through six sites in the West in the STD Surveillance Network. “Translation of data into action is the most important step,” Dr. Newman said.
Following an impressive overall decline in reported gonorrhea cases in the 1970s and 1980s, the total transmission rate in the United States has not changed much in the past decade, Dr. Newman said. According to the provisional data for 2005, the transmission rate is about 113 people per 100,000. “This is still far from our goal of 19 cases per 100,000.”
Only some states in the Northwest and Northeast (Idaho, Maine, Montana, New Hampshire, North Dakota, Vermont, and Wyoming) have met the national goal.
Racial disparities still exist and are cause for concern, Dr. Newman said. Blacks still have an 18 times higher gonorrhea rate than whites despite a 24% overall decrease in reported cases from 1996 to 2006. “This is the highest disparity for any reported infectious disease,” she said.
“Gonorrhea is of greatest concern for adolescents and young adults,” Dr. Newman said. For example, nearly 70% of gonorrhea morbidity occurs in people aged 15–24 years, she said.
Among females, the highest gonorrhea rates are in 15- to 19-year-olds, Dr. Newman said. Among males, the highest rates are in those aged 20–24 years.