Epidemiology

Gonorrhea is among the most prevalent of the sexually transmitted diseases. In the United States, its incidence is the highest of any reportable bacterial disease other than Chlamydia infection. A steady rise in reported cases of gonorrhea from about 350,000 in 1966 to more than 1 million cases in 1976 occurred despite the availability of effective treatment. From 1976 through 1980, more than 1 million cases were reported each year, but since then the incidence has progressively declined, probably due largely to increased condom use from fear of AIDS.

Factors that influence the incidence of gonorrhea include:

■ Birth control pills. About 35% of sexually active American college and university students say that they or their partner employs a contraceptive pill. Oral contraceptives without use of a condom offer no protection against venereal diseases and may increase susceptibility to them. Use of oral contraceptives leads to migration of gonorrhea-susceptible epithelial cells from the cervical lumen onto more exposed areas of the outer cervix. Oral contraceptives also tend to increase both the pH and the moisture content of the vagina, favoring infection with gonococci and other agents of sexually transmitted diseases. Besides being more vulnerable to gonorrhea, women taking oral contraceptives are also more likely to develop serious complications from the disease.

■ Carriers. Carriers of gonococci, both male and female, can unknowingly transmit these bacteria over months or even years.

■ Lack of immunity. There is little or no immunity following recovery from the disease. Individuals can contract gonorrhea repeatedly.

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