Often called “the clap,” gonorrhea is one of the most common sexually transmitted diseases (STDs), spreading easily through sexual contact. Around the world, about 78 million new cases of gonorrhea occur every year, a majority of them in people between 15 and 24 years of age.

What does gonorrhea do to the body, who is most at risk of becoming infected and how have infection rates changed in the U.S. over the past several decades? Learn more about this common and easily treated STD.

What Is Gonorrhea?

Gonorrhea is a sexually transmitted bacterial infection caused by the Neisseria gonorrhoeae bacterium. The bacteria infects the mucous membranes in the reproductive system as well as the mouth, throat, eyes and rectum.

The infection spreads through bodily fluids and can be transmitted through oral, anal or vaginal sex, but it cannot spread through casual, non-sexual contact like hugging or sharing food. Many people who contract gonorrhea are not aware they have become infected, which encourages the spread of the disease.

Men, however, are more likely to display symptoms than women, and while some symptoms are similar between the two sexes, there are some differences:

Men

  • Penile discharge that can be yellow, white or green in color
  • Painful or swollen testicles
  • Burning or pain during urination

Women

  • Bleeding between periods
  • Burning or pain during urination
  • Vaginal discharge that can be bloody or yellow-colored

In both men and women, gonorrhea can infect the anus of those who have anal sex. Symptoms of anal gonorrhea include itching in or around the anus, painful bowel movements and anal discharge.

When gonorrhea goes untreated, it can cause serious, possibly permanent health problems in men and women, including infertility.

Who Is Most Likely to Get Gonorrhea?

According to CDC estimates, about two-thirds of infections in the U.S. are among those between the ages of 15 and 24. Overall, infection rates are about 40% higher in men than women, though there’s a wide degree of variation by age group.

Gonorrhea infection rates by sex, age 15+ (cases per 100,000 people)

Age group Males Females
15–19 323.3 557.4
20–24 705.2 684.8
25–29 645.9 413.7
30–34 431.6 223.3
35–39 291.8 129.3
40–44 181.6 63.8
45–54 112.8 25.7
55–64 46.6 7.2
65+ 8.3 0.8
Total 202.5 141.8

Among ethnic groups, African-Americans are more likely to be infected with gonorrhea than other groups.

Gonorrhea infection rates by race, age 15+ (cases per 100,000 people)

African-American 548.1
Native American/Alaska Native 301.9
Native Hawaiian/Pacific Islander 187.8
Hispanic/Latino 113.7
Multiracial 76.9
White 66.4
Asian 34.7

Gonorrhea Across the U.S.

Nationally, Americans are infected with gonorrhea at a rate of 171.9 per 100,000 people, but many states have rates well over double the national level.

Gonorrhea infection rate by state (cases per 100,000 people)

Mississippi 309.8
Alaska 295.1
Louisiana 256.7
South Carolina 254.4
Alabama 245.7
Oklahoma 231.4
North Carolina 225.4
Arkansas 224.5
Georgia 219.8
New Mexico 215.7
Missouri 214.8
Ohio 206.4
California 192
Nevada 187.8
Delaware 187.4
Tennessee 186.8
Illinois 186.4
Maryland 182.5
Arizona 180.4
Indiana 178.4
New York 172.7
Texas 170.2
Kentucky 167.2
Michigan 158.6
Kansas 156.3
Florida 153.7
Colorado 153
Virginia 149.7
South Dakota 149.1
Nebraska 139.1
Washington 136
Wisconsin 132.6
North Dakota 127.4
Oregon 122.7
Iowa 119.9
Pennsylvania 119.2
Minnesota 118.1
Massachusetts 113.6
Connecticut 109.4
New Jersey 105.5
Rhode Island 102.9
Hawaii 95.1
Utah 83.3
Montana 75
West Virginia 70.8
Wyoming 70.4
Idaho 58.6
Maine 46.6
New Hampshire 38.4
Vermont 32.5
Total 171.9

Every state has seen their gonorrhea infection rate rise over the past five years, and 15 states have seen their rates more than double in that time. No state has posted a decline since 2013.

Percentage change in gonorrhea infection rates (cases per 100,000 people), 2013-2017

Wyoming 523%
Idaho 347%
New Hampshire 322%
Montana 239%
Colorado 186%
Oregon 179%
Utah 154%
Maine 153%
Iowa 152%
Massachusetts 145%
Rhode Island 138%
New Mexico 134%
Washington 117%
Vermont 110%
Kansas 109%
Nevada 93%
California 93%
Alaska 92%
Nebraska 88%
North Dakota 87%
Arizona 86%
Hawaii 86%
Mississippi 82%
Maryland 81%
Virginia 78%
Missouri 72%
New York 70%
Kentucky 70%
South Carolina 69%
Oklahoma 68%
Arkansas 66%
Wisconsin 66%
Minnesota 65%
Tennessee 65%
Indiana 64%
North Carolina 62%
South Dakota 61%
Georgia 54%
Michigan 49%
Illinois 46%
Florida 44%
Ohio 44%
Alabama 42%
Connecticut 38%
Louisiana 37%
New Jersey 34%
Texas 33%
Delaware 25%
West Virginia 24%
Pennsylvania 10%

Gonorrhea rates also vary by the city or metro area in question, with many cities across the country posting rates that outpace the national level, while other major cities’ rates are far lower.

Gonorrhea rates by metro area (cases per 100,000 population)

Memphis, TN-MS-AR 346.5
Milwaukee-Waukesha-West Allis, WI 312.2
Birmingham-Hoover, AL 303.8
New Orleans-Metairie, LA 286.7
Cleveland-Elyria, OH 284.2
Virginia Beach-Norfolk-Newport News, VA-NC 277.1
Indianapolis-Carmel-Anderson, IN 270.9
Louisville-Jefferson County, KY-IN 265.9
San Francisco-Oakland-Hayward, CA 260.1
Columbus, OH 254.6
Jacksonville, FL 251.7
Kansas City, MO-KS 250.6
Richmond, VA 249.7
Oklahoma City, OK 248.9
Baltimore-Columbia-Towson, MD 246.2
St. Louis, MO-IL 238.7
Los Angeles-Long Beach-Anaheim, CA 222.9
Charlotte-Concord-Gastonia, NC-SC 218.7
Cincinnati, OH-KY-IN 217.8
Buffalo-Cheektowaga-Niagara Falls, NY 216.1
Austin-Round Rock, TX 214.6
Atlanta-Sandy Springs-Roswell, GA 213.7
Las Vegas-Henderson-Paradise, NV 205.5
Phoenix-Mesa-Scottsdale, AZ 202.4
Detroit-Warren-Dearborn, MI 201.7
San Antonio-New Braunfels, TX 201.3
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 199.3
Chicago-Naperville-Elgin, IL-IN-WI 195.1
Raleigh, NC 191.2
Denver-Aurora-Lakewood, CO 189.5
San Diego-Carlsbad, CA 180
Dallas-Fort Worth-Arlington, TX 177.6
Sacramento-Roseville-Arden-Arcade, CA 176.7
Orlando-Kissimmee-Sanford, FL 175.7
Seattle-Tacoma-Bellevue, WA 175.5
Riverside-San Bernardino-Ontario, CA 161.9
Houston-The Woodlands-Sugar Land, TX 159.3
New York-Newark-Jersey City, NY-NJ-PA 158.9
Washington-Arlington-Alexandria, DC-VA-MD-WV 157.9
Tampa-St. Petersburg-Clearwater, FL 153.7
Hartford-West Hartford-East Hartford, CT 151.7
Minneapolis-St. Paul-Bloomington, MN-WI 148.1
Miami-Fort Lauderdale-West Palm Beach, FL 145.9
Nashville-Davidson-Murfreesboro-Franklin, TN 145.1
Salt Lake City, UT 142.7
Portland-Vancouver-Hillsboro, OR-WA 142
San Jose-Sunnyvale-Santa Clara, CA 127.8
Pittsburgh, PA 101.2
Providence-Warwick, RI-MA 96.7

Today, the gonorrhea rate is storming back after remaining relatively low for about a decade. In fact, between 2016 and 2017 alone, the gonorrhea rate in the U.S. went up by 18%, and it’s gone up more than 60% since 2013. Still, gonorrhea is less common today than it was 30 years ago.

Gonorrhea rates by year (cases per 100,000 population)

1984 372.5
1985 383
1986 371.5
1987 325
1988 301.9
1989 297.1
1990 276.4
1991 245.8
1992 196
1993 171.1
1994 163.9
1995 147.5
1996 121.8
1997 120.2
1998 129.2
1999 129.3
2000 128.7
2001 126.8
2002 122
2003 115.2
2004 112.4
2005 114.6
2006 119.7
2007 118
2008 110.7
2009 98.1
2010 100.2
2011 103.3
2012 106.7
2013 105.3
2014 109.8
2015 123
2016 145
2017 171.9

Conclusion

Between 1984 and 2010, infection rates for gonorrhea in the United States plummeted by more than 70%, but the rate has gone up every year since 2013, and gonorrhea today is as prevalent as it was in the mid-1990s.

Despite advancements in treatment methods that mean it’s often possible to treat gonorrhea with a single pill, the CDC estimates that only about half the cases of the disease that occur in the country each year are actually reported to the agency. This means hundreds of thousands of people may be unknowingly spreading this bacteria to their sexual partners and could well be endangering their own long-term health outlook.

Knowing your status is the first step to ensuring that your body is free from the STD once called the clap.

Additional References