The eradication of gonorrhoea

The continued global survival of Neisseria gonorrhoeae is inevitable because of its immunobiology,1 the seeming lack of natural or acquired immunity, human sexual behaviour, and the frequency of asymptomatic infection. Nevertheless, endemic gonorrhoea could be eradicated from Britain in the 1990s. Sweden has achieved this public health goal, and many other developed countries report dramatic reductions in incidence.2 In Britain reported cases of gonorrhoea have declined every year since 1977, with a particularly big decrease in 1987. Many health districts have already achieved the nationally set target for 1995 of fewer than 49 cases per 100 000 population aged 15-64.3 Geographical variation in the incidence of gonorrhoea in England is, however, considerable, with some urban areas still substantially above this target.4

Has any one factor been decisive in recent successes in controlling gonorrhoea? Certainly, radical innovations in treatment cannot take the credit. Effective drugs have been available throughout the rise and fall in the incidence of gonococcal infection during the 1960s, 1970s, and 1980s. Effective treatment is, however, a key component in control and has required some major …