Gonorrhea Control, United States, 1972–2015, A Narrative Review

Abstract

Gonorrhea is the second most commonly reported infection. It can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Rates of gonorrhea decreased after the National Gonorrhea Control Program began in 1972, but stabilized in the mid 1990’s. The emergence of antimicrobial resistant strains increases the urgency for enhanced gonorrhea control efforts. In order to identify possible approaches for improving gonorrhea control, we reviewed historic protocols, reports, and other documents related to the activities of the National Gonorrhea Control Program using Centers for Disease Control and Prevention records and the published literature. The Program was a massive effort that annually tested up to 9.3 million women, and treated up to 85,000 infected partners and 100,000 additional exposed partners. Reported gonorrhea rates fell by 74% between 1976 and 1996, then stabilized. Testing positivity was 1.6–4.2% in different settings in 1976. In 1999–2008, the test positivity of a random sample of 14–25 year-olds was 0.4%. Gonorrhea testing rates remain high, however, partner notification efforts decreased in the 1990’s as attention shifted to HIV and other STDs. The decrease and subsequent stabilization of gonorrhea rates was likely also influenced by changes in behavior, such as increases in condom use in response to AIDS. Renewed emphasis on partner treatment might lead to further decreases in rates of gonorrhea.

Fever, arthritis, and cutaneous lesions

“…Neisseria gonorrhoeae is a common bacterial sexually transmitted infection presenting with genitourinary tract, and also rectal and pharyngeal infections, often asymptomatic [1,2]. Disseminated gonococcal infection is observed in 1-3% of patients with gonococcal infection, and results from bacteremic dissemination 2 to 3 weeks after primary infection.…”

“…Isolation of Neisseria gonorrhoeae is possible from synovial fluid and blood cultures, but also on urethral, pharyngeal, and rectal mucosae [1][2][3]. Treatment consists of broadspectrum cephalosporins or fluoroquinolones with increasing quinolone resistance in Asia and in men who have sex with men, and of partners [1][2][3]. Early diagnosis (with appropriate samples and careful sexual history) and treatment are required for a good prognosis.…”

A Brief History of Evolving Diagnostics and Therapy for Gonorrhea: Lessons Learned

“…This study and documentation of increasing gonorrhea rates appear to have helped catalyze the convening of an ad hoc committee to provide advice on gonorrhea therapy which led to publication of what appear to be the CDC’s first formal national recommendations for gonorrhea treatment in the Morbidity and Mortality Weekly Reports (MMWR) of March 11, 1972 (1). Soon thereafter, formal creation of a CDC-administered national Gonorrhea Control Program permitted increased screening for gonorrhea nationwide and expanded efforts for partner notification and anticipatory treatment for sexual partners of infected persons (50).…”

Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States

“…The country developed a cadre of professionals, usually called Disease Intervention Specialists (DIS), who interviewed persons with syphilis and sought to ensure their sex partners’ medical evaluation and treatment. In the 1970s, STI programs expanded to include efforts to control gonorrhea 1,2 , and by 1984 health departments were providing partner services to over 350,000 persons with gonorrhea annually 3 .…”