Background:
In contrast to prevailing US trends, gonorrhea (GC) rates increased significantly in California each year from 1999 (55.8 per 100,000 population) through January-September 2005 (92.5) with sharpest increases after 2003. Increases were detected in both genders and among all demographic groups. Over this period GC rates increased >100% in 56% of California's 52 largest local health jurisdictions (LHJs).

Objective:
Enhanced GC surveillance was established in 2004 in California to improve understanding of GC epidemiology and risk factors.

Method:
Approximately 100 male and 100 female GC cases and their medical providers were interviewed in each of seven high morbidity, geographically distributed LHJs. Data were collected on sexual behaviors, risk factors including drug use and incarceration history, and clinical factors.

Result:
Of 1425 cases interviewed, 49% were female, 41% were heterosexual male, and 11% were MSM (MSM range 1% to 31% across the LHJs).
Methamphetamine (meth) use was reported by 12% of females, 11% of males, and 13% of MSM, and varied substantially by race/ethnicity with African Americans significantly less likely to report meth use than Hispanics or whites.
A recent history of incarceration was common for heterosexual males (36%), as was reported partner incarceration history for females (37%). Incarceration rates did not differ significantly by race/ethnicity.
Other factors include: 18% of females were pregnant; few heterosexuals (2%) compared to 46% of MSM reported Internet use to meet partners; many cases (18%) reported a prior GC infection; and fluoroquinolones (not recommended for GC treatment in CA), were used to treat 10% of cases.


Conclusion:
Enhanced GC surveillance has been invaluable for describing risk factors among gonorrhea cases in California and informing prevention efforts.

Implications:
These finding suggest targeted areas for GC prevention, including collaborative efforts at prevention of meth use and focused jail/prison interventions. These findings should be assessed in other areas and using other methodologies.