STIs in Boston: Gonorrhea Brief 2012
Gonorrhea is a sexually transmitted infection
(STI) caused by the bacterium Neisseria
gonorrhoeae and is the second most commonly
reported STI in the United States. Gonorrhea
can be asymptomatic in males and females and
has been linked to an increased risk of HIV
infection. If left untreated, gonorrhea can lead
to serious health problems such as pelvic
inflammatory disease, infertility, and ectopic
pregnancy in females.
Boston Epidemiology:
In 2012, gonorrhea was the second most
common STI and one of the top five most
commonly reported communicable diseases in
Boston, with 824 cases reported among Boston
residents. This marks a 21% increase since 2011
(682 cases). Boston’s 2012 incidence rate
(133.4 per 100,000) was higher than the most
recent national rate (104.2 per 100,000 in 2011,
the most recent CDC data available). Gonorrhea
rates in 2012 varied by age, gender,
race/ethnicity, and neighborhood. Black
residents ages 20-24 accounted for 13% of the
Boston cases although they represent only 2%
of the City’s population. Men were
disproportionately affected by the disease in
2012, demonstrating a marked increase in male
disease rates compared to recent years.
By Gender:
Males made up the majority (63%) of reported
gonorrhea cases in Boston in 2012. This
represents a 34% increase in the number of
cases among males since 2011, when males
accounted for 57% of the total cases. Much of
this can be attributed to a large increase in
cases among White males. Within this group,
the number of reported cases has increased by
over 70% since 2011. Males 20-24 years old
accounted for more cases than any other
category, making up 17% of the total cases in
2012, up from 15% in 2011.
Since 2008, the number of reported cases has
declined in females. In 2012, the incidence rate
in males (174.7 per 100,000) was 1.8 times that
in females (95.4 per 100,000). Among women,
Black females ages 20-24 had the highest
number of reported cases, and females 15-24
accounted for 56% of all cases in women in
2012 (data not shown).
By Race:
For this analysis, race and ethnicity were
combined into one category. Black residents
represented the largest number of reported
cases compared to all other races. Black
residents had an incidence rate 3.6 times higher
than White residents and Latino residents had a
rate 1.6 times higher than White residents.
However, since 2008 the total number of cases
has also increased among White residents.
Stratifying by gender, Black men had the
highest reported incidence rate (266 cases per
100,000), which was 2.8 times that of White
men. Black women also had the highest
incidence rate among women (175 cases per
100,000). While this rate is 7.4 times the rate
for White females, the overall rate in females
was notably lower than that in males. However,
due to the high proportion of cases with an
unknown race/ethnicity, these data should be
interpreted with caution.
By Age:
Of the 824 cases of gonorrhea reported in
Boston in 2012, 41% (337 cases) were among
15-24 year olds. Within this age group, 20-24
year olds had the highest incidence rate, with
286 cases per 100,000 persons. Additionally,
there has been a marked rise in reported cases
among residents 50 years of age and older from
2008 to 2012. However, 20-24 year olds still had
a rate 10 times that of those 50 and older (data
not shown). For youth 15-24 years old, the
number of cases in 2012 increased by 10%
compared to 2011. This increase in cases can be
attributed to a rise in cases among Whites and
Latinos of this age group, who experienced
increases of 172% and 47% respectively in the
number of cases since 2011.
Females accounted for over half of gonorrhea
cases among 15-24 year olds in 2012. Among all
other age categories, rates were higher in
males. Black residents accounted for 45% of the
total cases in 15-24 year olds, representing the
largest proportion of cases compared to all
other races. However, 18% of race data are
missing in this age group. Within this age group,
Black residents ages 20-24 had the highest
incidence rate (773 cases per 100,000), with a
higher rate in females compared to males in
this race and age category. The incidence rate
reported in 20-24 year old Black residents was
eight times as high as the rate among Whites of
the same age. This represents one of the
greatest age and race based disparities
observed among gonorrhea cases reported in
Boston. The table below provides the risk ratio
for 15-24 year olds by race.
Race
15-24 Year old
Male Risk Ratio
15-24 year old
Female Risk Ratio
Black
4.17
14.90
Latino
2.00
5.56
White
1.00
1.00
By Neighborhood:
The neighborhood with the highest gonorrhea
incidence rate in 2012 was North Dorchester
with 249.7 cases per 100,000. The South End,
South Dorchester, and Roxbury also had
elevated rates over 200 per 100,000. A large
proportion of the cases in these four
neighborhoods were in 15-24 year olds.
Mattapan had the highest rate for this age
group of any neighborhood, with a rate of 654.6
per 100,000. West Roxbury had the lowest
disease rate, with fewer than 40 cases per
100,000 in 2012 (See Map).
Trends:
Gonorrhea rates increased sharply in 2012,
after having decreased in 2011. Rates are
disproportionately high in some groups, notably
young Black residents. Also, the rate in White
men ages 15-24 increased 172% over one year.
The neighborhoods with the highest overall
gonorrhea rates were North Dorchester, South
End, South Dorchester, and Roxbury, where
Black and Latino residents comprise a large
proportion of the population.
Future Directions:
While the rate of Chlamydia infection in Boston
is nearly six times as high as the rate of
gonorrhea, the increase in gonorrhea cases is
still of concern, especially when considering the
rise in antibiotic resistant gonorrhea. Early
detection and treatment of gonorrhea cases
and their partners as well as initiatives to
promote safer sex are important to decrease
the number of gonorrhea cases.
Data Collection:
Data for this report were collected by the
Massachusetts Department of Public Health and
were cleaned and analyzed by the Boston Public
Health Commission.
Infectious Disease Bureau
Boston Public Health Commission
nd
1010 Massachusetts Ave, 2 Floor
Boston, MA 02118
Ph: (617)534-5611, Fax: (617)534-5905