Health Advisory
INCREASE IN GONORRHEA IN THE PHILADELPHIA AREA

The Delaware Division of Public Health (DPH) is advising the Delaware medical community about an important report from the Philadelphia Department of Public Health.

In 2010 to date, the Sexually Transmitted Disease (STD) Control Program of the Philadelphia Department of Public Health (PDPH) has identified a 26% increase in reported cases of Neisseria gonorrhoeae infection (gonorrhea) compared to the same period in 2009. This increase may be due to more timely and improved reporting of cases. However, it may also reflect a true increase in gonorrhea incidence across the city. Females between the ages of 15-19 years and males between the ages of 20-24 years are at highest risk for gonorrhea infection in Philadelphia. African Americans are disproportionately affected.

In Delaware, as of July 30, 2010 there have been 565 cases of gonorrhea reported statewide. This is a 9% increase in reported cases for the same time period in 2009. The majority of cases were located in New Castle County (302 cases), followed by Sussex (151 cases) and Kent (112 cases). Of the 565 cases reported, 187 or 33% of those cases were reported from the City of Wilmington. Adolescents and young adults between the ages of 15-24 are most at risk for gonorrhea infection in Delaware.

Over the past several years Delaware has experienced decreasing trends in Gonorrhea infection as shown below.

• 2009 -  971 cases (110.1 cases per 100,000)
• 2008 - 1045 (199.3 per 100,000)
• 2007 - 1293 (149.4 per 100,000)
• 2006 - 1486 (176.0 per 100,000)

The Delaware Division of Public Health along with the Centers for Disease Control and Prevention recommends the following treatment for Gonorrhea infection:

Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum*

Recommended Regimens

Ceftriaxone 125 mg IM in a single dose

OR

Cefixime 400 mg orally in a single dose or 400 mg by suspension (200 mg/5ml)

PLUS

TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL
INFECTION IS NOT RULED OUT

* This regimen is recommended for all adult and adolescent patients, regardless of travel history or sexual behavior.

Alternative Regimens

Spectinomycin† 2 g in a single intramuscular (IM) dose

OR

Single-dose cephalosporin regimens

† Spectinomycin is currently not available in the United States.

Other single-dose cephalosporin therapies that are considered alternative treatment regimens for uncomplicated urogenital and anorectal gonococcal infections include ceftizoxime 500 mg IM; or cefoxitin 2 g IM, administered with probenecid 1 g orally; or cefotaxime 500 mg IM. Some evidence indicates that cefpodoxime 400 mg and cefuroxime axetil 1 g might be oral alternatives.

Uncomplicated Gonococcal Infections of the Pharynx*

Recommended Regimens

Ceftriaxone 125 mg IM in a single dose

PLUS

TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL
INFECTION IS NOT RULED OUT

* These regimens are recommended for all adult and adolescent patients, regardless of travel history or sexual behavior.

Gonorrhea is a reportable disease under Delaware Code.  All cases of gonorrhea must be reported to the Delaware Division of Public Health STD program.  Reporting forms and more information about the reporting of sexually transmitted diseases can be found on our website at: http://www.dhss.delaware.gov/dhss/dph/dpc/reportstds.html

Updated information on the treatment of gonorrhea can be obtained at http://www.cdc.gov/std/treatment/2006/updated-regimens.htm

For further information, contact the Division of Public Health STD program: (302) 744-1050

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