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Background: Massachusetts experienced a 30% increase in gonorrhea case reports from 2009 to 2010. A supplemental case report form was introduced in 2011 to capture additional risk and clinical setting information.
Objectives: To describe risks for and clinical settings treating gonorrhea in Massachusetts, 2011.
Methods: SAS 9.2 was used to analyze laboratory-confirmed gonorrhea cases reported as diagnosed between 1/1/11 – 6/30/11. A dedicated staff member contacted providers repeatedly to collect missing data. Fisher’s exact test was used to compare proportions.
Results: 1066 cases were reported; 930 were laboratory-confirmed. Of these 930 cases, 44% were <25 years; 53% were male; 33% were white, 28% black, 11% Hispanic; 50% of cases were from Massachusetts’ five largest cities; 27% were treated in a community health center or hospital clinic, 18% ER/urgent care, 13% private practice/HMOs, 5% STD/HIV/family planning clinic, 3% school clinic; 31% had no treatment setting reported; 38% were reported as having heterosexual sex, 8% were reported as MSM, 5% had history of sex while intoxicated or high; <5% each for history of incarceration, travel out of state, or money for sex or drugs. However, 49% of cases had no reported risks on either case report form or medical chart. Risk information was reported on 36% of ER/urgent care cases, versus 54% of cases in other/unknown clinical settings (p<0.0001).
Conclusions: Gonorrhea remains concentrated in youth and young adults, non-white populations, and urban settings. Only 5% of treatment occured in a specialty clinic setting (STD, HIV or family planning clinic). About half of cases had reported risk; ER/urgent care cases were less likely to have risks reported.
Implications for Programs, Policy, and Research: Enhanced surveillance and reporting is unlikely to provide sufficient information to describe risk for the full spectrum of gonococcal disease in Massachusetts without further provider education about importance of risk history.