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Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is a sexually transmitted infection (STI) that occurs at the anatomic site of sexual exposure, such as the urethra, cervix, pharynx, or rectum. If untreated or inadequately treated in women, N. gonorrhoeae can ascend within the genital tract and cause severe reproductive health complications including pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and tubal infertility. Infants born to mothers with untreated cervical infections are at risk of neonatal conjunctivitis and blindness.
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Gonorrhea is believed to be an ancient disease: descriptions of symptoms consistent with gonorrhea such as urethral discharge have been mentioned in written texts for centuries.1 The term gonorrhea is thought to have been coined by the Greek physician Galen (129 AD–c.210 AD) and derived from the erroneous belief that urethral discharge was caused by excess flow (rrhea) of semen (gonos) The causative bacterium was named in honor of Albert Neisser (1855–1916), who, as a 24-year-old German physician, identified the bacterium in 1879.2
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N. gonorrhoeae is a Gram-negative intracellular diplococcus and obligate human pathogen. Infection is facilitated by (1) adherence to host cells by pili on the surface of the bacterial cells, and (2) modulation of the host immune response by the binding of bacterial Opa proteins to receptors on host immune cells.3–5 Pili and Opa proteins, both of which are potential targets of host immune systems, undergo frequent genetic mutation, allowing the bacteria to evade the immune system, prevent host immunological memory, and cause reinfection.5–7 N. gonorrhoeae mutates rapidly and is naturally competent to acquire new DNA from other bacteria in the environment, promoting acquisition of antimicrobial resistance.5
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EPIDEMIOLOGY AND TRENDS
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Gonorrhea case reporting is mandated by legislation or regulation in all 50 U.S. states and the District of Columbia and has been a nationally notifiable disease since the 1940s. Health departments in all U.S. states and the District of Columbia voluntarily report gonorrhea cases to the Centers for Disease Control and Prevention (CDC). The demographic characteristics associated with each case that are transmitted to CDC are generally limited to the county of patient residence, age, gender, race, and ethnicity.8 Health departments might collect additional epidemiological characteristics about each case, particularly if the health department STI program in a jurisdiction interviews gonorrhea cases for partner services or enhanced surveillance. Automatic electronic laboratory reporting (ELR) has contributed to improved completeness of case counts and timeliness of reporting, but expansions of ELR and relative infrequency of gonorrhea partner services interviews limit opportunities for jurisdictions to collect additional epidemiological data associated with cases.9 Epidemiological data about gonorrhea cases are supplemented by CDC-supported sentinel surveillance platforms, such as the STI Surveillance Network (SSuN), described in more detail below.
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In the United States, gonorrhea is the second most commonly reported ...