Declining Gonorrhea Case Rates in the United States, 2021-2023: A Spatial Analysis.

OBJECTIVE: To examine the spatial distribution of the decline in gonorrhea case rates in the contiguous United States between 2021 and 2023. METHODS: Using surveillance data from the Centers for Disease Control and Prevention, we computed the percent change in county-level gonorrhea case rates between 2021 and 2023 for 3,076 counties. We mapped and examined the spatial distribution of changes in gonorrhea case rates to describe substate trends. RESULTS: Nearly three-quarters (74%) of all counties had greater than 10% declines in gonorrhea case rates between 2021 and 2023. Trajectories were similar in urban compared to rural areas. Despite widespread declines, several counties within the Northeast and South regions had increasing gonorrhea case rates. Some were densely populated and had high disease burden. CONCLUSIONS: Declines in county-level gonorrhea case rates were substantial between 2021 and 2023. But the identification of a few large metropolitan counties in the Northeast and South with elevated, and persistently increasing, case rates suggest the need for further epidemiological investigation.