Is the clinical spectrum of gonorrhea changing?

The study's objective was to determine whether the high rates of gonorrhea in one inner city teen health care program were due to an increase in detection of asymptomatic cases and consequently a decrease in symptomatic gonococcal infections over a 4 1/2 year study period.

A chart review was conducted of all females ages 11-19 years with gonorrhea during the last six months of 1988 and all of 1990 and 1992. The presenting symptoms, physical signs, diagnosis, co-infections, and history of STD contacts were analyzed.

Four hundred and twenty-five charts were reviewed: 104 (24%) cases in the 11-15 year old age group, 169 (40%) in the 16-17 year old age group and 152 (36%) in the 18-19 year old age group. Approximately two-thirds had physical signs consistent with a sexually transmitted disease. About 25% presented as a contact of someone with a known STD or with symptoms suggestive of a STD. Fewer than 2% had pelvic inflammatory disease. The majority of all groups had symptoms, though older teenagers provided complaints significantly more often (p < 0.01). Teenagers under 15 years that were significantly more likely to have no symptoms or signs (p < .05).

There were no significant changes detected in the percent of symptomatic subjects over the 4 1/2 year period, i.e., the clinical spectrum of gonorrhea remained unchanged.