To develop an operational approach to the identification of high risk gonorrhea transmitters, three groups of women infected with Neisseria gonorrhoeae (recent repeaters, routine discoveries, and women with pelvic inflammatory disease) were offered intensive casefinding services during an 18-month period. Approximately three contacts per case were investigated, and 27.4 per cent of the contacts were infected. Of infected contacts, 61 per cent were asymptomatic. Asymptomatic, remote contacts to theseThe decade preceding 1976 witnessed a substantial national increase in gonorrhea and produced considerable concern among public health workers.' Fortunately, the epidemic curve peaked in 1976 and has since stabilized. Accounting for these changes is problematical at best, but the alarming rise has provoked a search for more effective control mechanisms.Yorke et a12 recently proposed a theoretical model for one such mechanism. They discuss the concept of "core" groups of transmitters: numerically small populations of gonorrhea infectees who may be directly or indirectly responsible for virtually all gonorrhea transmission, and, by virtue of sociodemographic and behavioral qualities, form the substrate for continued endemicity.It follows that program initiatives directed at these groups might interrupt transmission. A pilot study of prostitutes in Colorado Springs provided some support to the "core" consept.3 The prostitutes, however, represent an easily identifiable group; and other "core" groups may be much harder to specify from a sociodemographic and behavioral point of view. We present here an operational approach to the identification of groups of possible gonorrhea transmitters, and attempt to assess the impact of control measures applied to such groups.
Materials and MethodsBetween August 1976 and March 1978, 323 women appear to be important in the continuing transmission of gonorrhea. The interviewing approach used reflected that employed in syphilis (thorough, detailed, and long) rather than the more casual interviews usually employed for gonorrhea patients. During this period, gonorrhea morbidity declined 22 per cent. Further exploration of a targeted approach to gonorrhea epidemiology is indicated. (Am J Public Health 1980; 70: 705-708.) orado were offered intensive interview, counseling, and case investigation services. The patients were drawn from three classifications based on the circumstances surrounding their diagnosis: 1) Pelvic Inflammatory Disease (PID)-women with gonorrhea and concomitant acute salpingitis (since no stringent criteria exist, a physician's diagnosis was considered sufficient for inclusion); 2) Recent Repeaters (RRwomen with a second gonococcal infection within three months of the first and with an intervening negative test of cure for N. gonorrhoeae; 3) Routine Discoveries (RD)-women found to be infected through other than casefinding activities (i.e., through screening and presentation with symptoms, but excluding known or suspected contacts to gonorrhea). These thr...
