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Philos Trans R Soc Lond B Biol Sci. 1999 April 29; 354(1384): 787–797.
PMCID: PMC1692556

The transmission dynamics of gonorrhoea: modelling the reported behaviour of infected patients from Newark, New Jersey.


A survey of the sexual behaviour of gonorrhoea patients in Newark was undertaken to evaluate parameters within a model of gonorrhoea transmission. Modelling work aimed to explain observed epidemiological patterns and to explore the potential impact of interventions. Reported behaviours, along with values derived from the literature, were used within a standard deterministic model of gonorrhoea transmission, where the population was stratified according to sex and rates of sex-partner change. The behaviours reported, particularly among women, are insufficient by themselves to explain the continued existence of gonorrhoea within the population. The majority of symptomatic patients seek treatment within a few days, and report that they do not have unprotected sex while symptomatic. The proportion of patients with low numbers of sex partners suggests that sexual mixing between people categorized according to sexual behaviour is near random. To explain the persistence of gonorrhoea, there must be some patients who, when infected, do not seek care in public clinics. In addition, gonorrhoea incidence in the model is sensitive to change, such that very small reductions in risk behaviour could lead to its elimination. This does not accord with the observed failure of many interventions to eliminate infection, suggesting that the modelled infection is too sensitive to change. The model, which has been influential in gonorrhoea epidemiology, is not consistent with the observed epidemiology of gonorrhoea in populations. Alternative models need to explore the observed stability of gonorrhoea before robust modelling conclusions can be drawn on how best to control infection. However, the current results do highlight the potential importance of asymptomatic infections and infections in those who are diseased and do not attend public health services. Screening and contact-tracing to identify asymptomatic infections in both men and women will be more effective in reaching those who maintain the infection within the community rather than simply treating symptomatic cases.

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Selected References

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  • Anderson RM, Gupta S, Ng W. The significance of sexual partner contact networks for the transmission dynamics of HIV. J Acquir Immune Defic Syndr. 1990;3(4):417–429. [PubMed]
  • Blower SM, Anderson RM, Wallace P. Loglinear models, sexual behavior and HIV: epidemiological implications of heterosexual transmission. J Acquir Immune Defic Syndr. 1990;3(8):763–772. [PubMed]
  • Brunham RC. The concept of core and its relevance to the epidemiology and control of sexually transmitted diseases. Sex Transm Dis. 1991 Apr-Jun;18(2):67–68. [PubMed]
  • Brunham RC, Plummer FA. A general model of sexually transmitted disease epidemiology and its implications for control. Med Clin North Am. 1990 Nov;74(6):1339–1352. [PubMed]
  • Catchpole MA. The role of epidemiology and surveillance systems in the control of sexually transmitted diseases. Genitourin Med. 1996 Oct;72(5):321–329. [PMC free article] [PubMed]
  • Cates WC, Jr, Holmes KK. Re: Condom efficacy against gonorrhea and nongonococcal urethritis. Am J Epidemiol. 1996 Apr 15;143(8):843–844. [PubMed]
  • Crawford C, Knapp JS, Hale J, Holmes KK. Asymptomatic gonorrhea in men: caused by gonococci with unique nutritional requirements. Science. 1977 Jun 17;196(4296):1352–1353. [PubMed]
  • Garnett GP, Anderson RM. Contact tracing and the estimation of sexual mixing patterns: the epidemiology of gonococcal infections. Sex Transm Dis. 1993 Jul-Aug;20(4):181–191. [PubMed]
  • Garnett GP, Anderson RM. Sexually transmitted diseases and sexual behavior: insights from mathematical models. J Infect Dis. 1996 Oct;174 (Suppl 2):S150–S161. [PubMed]
  • Garnett GP, Johnson AM. Coining a new term in epidemiology: concurrency and HIV. AIDS. 1997 Apr;11(5):681–683. [PubMed]
  • Garnett GP, Hughes JP, Anderson RM, Stoner BP, Aral SO, Whittington WL, Handsfield HH, Holmes KK. Sexual mixing patterns of patients attending sexually transmitted diseases clinics. Sex Transm Dis. 1996 May-Jun;23(3):248–257. [PubMed]
  • Ghani AC, Swinton J, Garnett GP. The role of sexual partnership networks in the epidemiology of gonorrhea. Sex Transm Dis. 1997 Jan;24(1):45–56. [PubMed]
  • Ghani AC, Donnelly CA, Garnett GP. Sampling biases and missing data in explorations of sexual partner networks for the spread of sexually transmitted diseases. Stat Med. 1998 Sep 30;17(18):2079–2097. [PubMed]
  • Granath F, Giesecke J, Scalia-Tomba G, Ramstedt K, Forssman L. Estimation of a preference matrix for women's choice of male sexual partner according to rate of partner change, using partner notification data. Math Biosci. 1991 Dec;107(2):341–348. [PubMed]
  • Handsfield HH, Lipman TO, Harnisch JP, Tronca E, Holmes KK. Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence and significance. N Engl J Med. 1974 Jan 17;290(3):117–123. [PubMed]
  • Harrison WO, Hooper RR, Wiesner PJ, Campbell AF, Karney WW, Reynolds GH, Jones OG, Holmes KK. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med. 1979 May 10;300(19):1074–1078. [PubMed]
  • Hook EW, 3rd, Richey CM, Leone P, Bolan G, Spalding C, Henry K, Clarke P, Smith M, Celum CL. Delayed presentation to clinics for sexually transmitted diseases by symptomatic patients. A potential contributor to continuing STD morbidity. Sex Transm Dis. 1997 Sep;24(8):443–448. [PubMed]
  • Hooper RR, Reynolds GH, Jones OG, Zaidi A, Wiesner PJ, Latimer KP, Lester A, Campbell AF, Harrison WO, Karney WW, et al. Cohort study of venereal disease. I: the risk of gonorrhea transmission from infected women to men. Am J Epidemiol. 1978 Aug;108(2):136–144. [PubMed]
  • Koopman J, Simon C, Jacquez J, Joseph J, Sattenspiel L, Park T. Sexual partner selectiveness effects on homosexual HIV transmission dynamics. J Acquir Immune Defic Syndr. 1988;1(5):486–504. [PubMed]
  • Kretzschmar M, van Duynhoven YT, Severijnen AJ. Modeling prevention strategies for gonorrhea and Chlamydia using stochastic network simulations. Am J Epidemiol. 1996 Aug 1;144(3):306–317. [PubMed]
  • Morris M. Telling tails explain the discrepancy in sexual partner reports. Nature. 1993 Sep 30;365(6445):437–440. [PubMed]
  • Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea. JAMA. 1983 Dec 16;250(23):3205–3209. [PubMed]
  • Plummer FA, Simonsen JN, Chubb H, Slaney L, Kimata J, Bosire M, Ndinya-Achola JO, Ngugi EN. Epidemiologic evidence for the development of serovar-specific immunity after gonococcal infection. J Clin Invest. 1989 May;83(5):1472–1476. [PMC free article] [PubMed]
  • Potterat JJ, Woodhouse DE, Pratts CI, Markewich GS, Fogle JS., 2nd Women contacts of men with gonorrhea: case-finding yields. Sex Transm Dis. 1983 Jan-Mar;10(1):29–32. [PubMed]
  • Potterat JJ, Dukes RL, Rothenberg RB. Disease transmission by heterosexual men with gonorrhea: an empiric estimate. Sex Transm Dis. 1987 Apr-Jun;14(2):107–110. [PubMed]
  • Renton A, Whitaker L, Ison C, Wadsworth J, Harris JR. Estimating the sexual mixing patterns in the general population from those in people acquiring gonorrhoea infection: theoretical foundation and empirical findings. J Epidemiol Community Health. 1995 Apr;49(2):205–213. [PMC free article] [PubMed]
  • Rothenberg RB. The geography of gonorrhea. Empirical demonstration of core group transmission. Am J Epidemiol. 1983 Jun;117(6):688–694. [PubMed]
  • Rothenberg R, Narramore J. The relevance of social network concepts to sexually transmitted disease control. Sex Transm Dis. 1996 Jan-Feb;23(1):24–29. [PubMed]
  • Rothenberg RB, Potterat JJ, Woodhouse DE. Personal risk taking and the spread of disease: beyond core groups. J Infect Dis. 1996 Oct;174 (Suppl 2):S144–S149. [PubMed]
  • Sherrard J, Barlow D. Gonorrhoea in men: clinical and diagnostic aspects. Genitourin Med. 1996 Dec;72(6):422–426. [PMC free article] [PubMed]
  • Stigum H, Magnus P, Bakketeig LS. Effect of changing partnership formation rates on the spread of sexually transmitted diseases and human immunodeficiency virus. Am J Epidemiol. 1997 Apr 1;145(7):644–652. [PubMed]
  • Thomas JC, Tucker MJ. The development and use of the concept of a sexually transmitted disease core. J Infect Dis. 1996 Oct;174 (Suppl 2):S134–S143. [PubMed]
  • Upchurch DM, Brady WE, Reichart CA, Hook EW., 3rd Behavioral contributions to acquisition of gonorrhea in patients attending an inner city sexually transmitted disease clinic. J Infect Dis. 1990 May;161(5):938–941. [PubMed]
  • Wasserheit JN, Aral SO. The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies. J Infect Dis. 1996 Oct;174 (Suppl 2):S201–S213. [PubMed]
  • Xia M, Whittington WL, Holmes KK, Roberts MC. Genomic homogeneity of the AHU/IA-1,2 phenotype of Neisseria gonorrhoeae during its disappearance from an urban population. Sex Transm Dis. 1997 Nov;24(10):561–566. [PubMed]
  • Yorke JA, Hethcote HW, Nold A. Dynamics and control of the transmission of gonorrhea. Sex Transm Dis. 1978 Apr-Jun;5(2):51–56. [PubMed]

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