Gonorrhea surveillance: estimating epidemiologic and clinical characteristics of reported cases using a sample survey methodology

BACKGROUND: Little is known about the epidemiology of gonorrhea in the United States, except for basic demographics of reported cases. Knowing the proportion of reported gonorrhea cases identified through screening, the diagnostic test used, and patient behavioral risk factors might help to better explain changes in gonorrhea rates over time. GOAL: The goal of this study was to implement and evaluate a gonorrhea sample survey surveillance methodology in San Diego, California. STUDY DESIGN: Healthcare providers caring for a representative sample of all gonorrhea patients reported during August 16 through October 18, 2001 were interviewed by telephone about patient demographics, risk factors, and management. RESULTS: The healthcare providers of 248 gonorrhea patients were contacted; data were obtained on 224 (90%) patients. Major reasons for testing included symptoms (68%), partner referral (14%), and screening (12%). Gonococcal culture, DNA probe tests, and nucleic acid amplification tests were used to diagnose 40%, 34%, and 21% of patients, respectively. At minimum, 36% of male gonorrhea patients were men who have sex with men (MSM); MSM with gonorrhea were rarely diagnosed with rectal or pharyngeal gonorrhea outside of sexually transmitted disease (STD) clinics. Estimated local resources required to conduct this survey were $12 per completed interview. CONCLUSION: Healthcare provider telephone interviews regarding recently reported gonorrhea patients are feasible and can provide important additional information to STD programs, which could be used to direct intervention strategies and monitor trends. Ultimately, a national sampling approach could be explored and incorporated into ongoing gonorrhea surveillance.