Plummeting Gonorrhea Rates in Arizona: A True Decline?

Background: After several years of steady decline, the national rates for gonorrhea have seemed to reach a plateau.  Gonorrhea rates in Arizona, however, peaked at 96.1 cases per 100,000 population in 2006 followed by rates of 77.7 and 52.8 cases per 100,000 population in 2007 and 2008, a 45% total rate decrease over the three year time period.

Objectives: To further characterize the rapid decline in the statewide Arizona gonorrhea rates in order to determine a true versus artifactual decline in reported morbidity.

Methods: In order to better understand statewide gonorrhea rates, we undertook an in-depth evaluation of state sexually transmitted diseases surveillance data including statewide gonorrhea case rate six year annual trends by gender, age group, race/ethnicity, provider type, county, and submitting laboratory in order to identify an isolated subgroup rate decrease.  In addition, we evaluated gonorrhea screening data from the Arizona Infertility Prevention Project as well as the Maricopa County STD clinic, the state’s highest gonorrhea diagnosing provider.

Results: The annual gonorrhea rate trend decline from 2006 to 2008 is similar across all subgroups analyzed.  In addition, gonorrhea screening in the Infertility Prevention Project and the Maricopa County STD clinic over the same time period has remained the same or has increased. 

Conclusions: A similar decrease in gonorrhea rates across all subgroups analyzed in this study, in conjunction with stable or even increased gonorrhea screening among the highest gonorrhea diagnosing providers in the state (the Arizona Infertility Prevention Project and the Maricopa County STD Clinic), and the increasing implementation of the more sensitive NAAT gonorrhea testing statewide supports the likelihood that the recent rapid annual rate decrease in Arizona represents a true decline in gonorrhea morbidity.

Implications for Programs, Policy, and/or Research: It is important to further understand the rapid decrease in gonorrhea rates in a state such as Arizona with very high and stable chlamydia and syphilis (including congenital syphilis) rates.