Background National notifiable disease data indicate that 99 of every 100 000 persons in the USA were infected with gonorrhoea in 2009, the lowest recorded gonorrhoea rate in US history. However, the extent to which declining case reports signify a reduction in prevalence is unknown. In order to better understand national gonorrhoea trends, we examined prevalence over time among men and women entering the National Job Training Program (NJTP).
Methods Gonorrhoea prevalence was estimated among 16–24-year-old men and women entering the NJTP in 48 states and the District of Columbia from 2004–2009. To approximate gonorrhoea screening, only data from the 105 (85% of all 123) centers that performed gonorrhoea testing on at least 50% of the population were included. Conditional logistic regression was used to assess the probability of testing positive for gonorrhoea over time, adjusted for variables associated with gonorrhoea risk.
Results 95 184 men and 91 697 women were screened for gonorrhoea upon entry to the NJTP from 2004 to 2009. For women, gonorrhoea prevalence increased from 2004 (2.6%) to 2006 (2.9%), then decreased steadily through 2009 (1.8%). For men, prevalence increased from 2004 (1.3%) to 2005 (1.6%), then decreased through 2009 (0.9%). Gonorrhoea prevalence among black women decreased from 3.6% in 2004 to 2.5% in 2009 and was 2–4 times higher than prevalence among white women during the study period. Likewise, prevalence among black men decreased from 2.0% to 1.5% and was 8–22 times higher than prevalence among white men. After adjusting for age, race, region, and test technology, the odds of a woman testing positive for gonorrhoea decreased by 50% from 2004 to 2009. Similarly, the odds of a man testing positive for gonorrhoea decreased by 40% during the study period see Abstract P1-S1.36 Figure 1.
Conclusions Declining trends in gonorrhoea infection among NJTP entrants are similar to those observed in gonorrhoea case report data, suggesting that the decrease in case reports is due to a decrease in prevalence. Both data sources also demonstrate continuing racial disparities in gonorrhoea infection between blacks and whites. Interventions to reduce gonorrhoea infections should be developed to reach populations with a disproportionate risk.