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GONORRHEA - Rates, by year, United States and large cities,* 1968-1984

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From 1975 to 1984, rates of gonorrhea declined by 20% for the United States and declined by 17% for combined metropolitan areas.

Age-specific rates per 100,000 population showed that teenagers and young adults were at highest risk for acquiring gonorrhea. Of all reported gonorrhea cases, nearly 40% were accounted for by persons 20-24 years old, and 25% by persons 15-19 years of age. The highest morbidity for males occurred for the 20- to 24-year age group, and the highest for females, for those 15-19 years old. This substantially higher morbidity for younger persons, particularly teenage females, may place them at higher risk for sequelae of gonococcal infection such as pelvic inflammatory disease and infertility.

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The number of reported cases of gonorrhea decreased by 2.4% from 900,435 in 1983 to 878,556 in 1984. Gonorrhea rates per 100,000 population declined from 387.6 to 374.8 during the same period.

The decline in gonorrhea rates occurred throughout the United States; however, reported rates from the South Atlantic area remained highest for the country.

GONORRHEA - Reported penicillinase-producing Neisseria gonorrhoeae (PPNG) cases,

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Gonococcal antimicrobial resistance has assumed increasing importance since the first reported case of penicillinase-producing Neisseria gonorrhoeae (PPNG) occurred in the United States in 1976. Between 1976 and 1982, the number of reported PPNG cases increased from 98 to 4,457, then decreased to 3,720 in 1983, but increased again in 1984 to 4,110. In addition to PPNG, chromosomally mediated resistant N. gonorrhoeae (CMRNG) was recognized as an important problem in early 1983, when the first large domestic outbreak occurred in North Carolina. More than 400 cases of CMRNG from 22 other states were reported in 1984. Spectinomycin-resistant N. gonorrhoeae has not yet become a significant problem in this country.

The decline in gonorrhea cases in 1983 may be attributed to one or more of the following: 1) more effective control efforts, 2) improved general surveillance and earlier detection of cases to decrease transmission, 3) variations in reporting, 4) changing biological properties of the gonococcus, 5) changing patterns of host-population susceptibility, or 6) changing sexual behavior within the populations at risk for acquiring gonorrhea. The increase of PPNG cases reported in 1984 resulted from sustained domestic transmission, primarily in three large outbreaks (Los Angeles, New York, Florida).

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In 1984, 57,557 cases of viral hepatitis were reported in the United States, for a rate of 24.4 cases/100,000 population. This was a slight increase over 1983. Of the total cases, 22,040 (9.3/100,000) were reported as hepatitis A; 26,115 (11.1/100,000) as hepatitis B; 3,871 (1.6/100,000) as hepatitis non-A, non-B; and 5,531 (2.3/100,000) as hepatitis type unspecified. For the second consecutive year, the reported incidence of hepatitis B was higher than that of hepatitis A. While hepatitis A has continued to decline, hepatitis B has continued to increase, with no change in the age or sex distribution of the cases. Sixty-five percent of cases of hepatitis B are reported in the 20- to 39-year age group, and the male-to-female ratio remains 2:1.

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The states with the highest rates of hepatitis A in 1984 are concentrated in the West and Southwest; half of these reported communitywide outbreaks, primarily involving personto-person spread. The states with the highest rates of hepatitis B are clustered primarily on the East and West coasts, as in previous years. Hepatitis non-A, non-B remains a diagnosis of exclusion. The low reported rates for this disease are believed to be due to incomplete serologic testing and underreporting.

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