California Gonorrhea Surveillance System: Methodologic Aspects and Key Results of a Sample-Based System

Abstract

Objectives. This article describes findings from the California Gonorrhea Surveillance System (CGSS), developed in response to the need for detailed risk behavior data and clinical data required to control increasing gonorrhea (GC) infections in California. Methods. CGSS is a sample-based surveillance system implemented throughout California in 2007. In 34 of 61 local health jurisdictions (LHJs), 10% of GC cases are sampled for interview; in the other 27 LHJs, all cases are followed. A standardized case investigation record collects case-reported risk data and provider-reported clinical data, and is electronically prepopulated with available contact data. Exclusion criteria include age younger than 14 years, a GC diagnosis within the previous 30 days, and provider request that patient not be contacted. Analyses are weighted to account for sample design. Results. In 2007, 31,192 cases of GC were reported in California. Of these, 5,388 were sampled for follow-up and 2,715 were interviewed, for a response rate of 54.2%. Of those interviewed, 49.6% were female, 28.8% were heterosexual males, and 21.6% were men who have sex with men (MSM). CGSS collects a wide range of behavioral and clinical data for targeted programmatic action. Findings from the 2007 CGSS included data on the following areas: incarceration (highest among heterosexual males [22.4%]); methamphetamine use (high overall [12.2%] and lower among African Americans [4.6%]); co-infection with human immunodeficiency virus (high among MSM [31.9%] and very low among heterosexual males and females [<0.5%]); and improper antibiotic use (8.3% overall; 25.6% among patients attending urgent care clinics). Conclusion. CGSS, an innovative sample-based surveillance system, is effective and flexible. The system provides actionable data on an ongoing basis.