Date of Award

Fall 4-18-2019

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Richard Rothenberg, MD, MPH

Second Advisor

Michelle Hollberg, MPH

Third Advisor

Deborah Lee, MPH


INTRODUCTION: Gonorrhea is the second most commonly reported notifiable disease in the United States, with approximately 820,000 cases reported in the U.S each year. Since 2009, the rate of reported gonorrhea has increased in the U.S. population among non-foreign born persons. All immigrants and refugees applying for U.S. residency are required to undergo an overseas medical exam that requires screening for various conditions, including gonorrhea. CDC provides the guidelines for medical exam performed by panel physicians overseas.

OBJECTIVE: To describe the characteristics of gonorrhea in U.S.- bound immigrants and refugees and to evaluate compliance with CDC’s Technical Instructions for Gonorrhea for Panel Physicians. Recommendations may be made to help inform any programmatic approaches in addressing STI screening and treatment for U.S.- bound immigrants and refugees.

METHODS: We used data from the CDC’s Electronic Disease Notification (EDN) System. The study population includes all immigrants and refugees that arrived in the U.S. during 2018 that were screened by overseas panel physicians. All immigrants and refugees included in this analysis are ≥15 years old. The proportion of gonorrhea screening tests, positive test results, gonorrhea treatment, and proportion of gonorrhea screening among U.S. panel physician exam sites were calculated.

RESULTS: A total of 37,179 U.S. - bound immigrants and refugees were entered into CDC’s EDN database in 2018. 27,284 (73%) were screened for gonorrhea. 25,799 (94%) of those who reported having a gonorrhea test were screened using a NAAT or PCR test. Among those screened, 163 (0.6%) tested positive for gonorrhea. Thirty-two (20%) of these positive cases were not documented as treated according to CDC’s Technical Instructions and STD Treatment Guidelines.

DISCUSSION: Preliminary results of this analysis indicate that there is overall compliance with the current Technical Instructions for Gonorrhea. However, because the data were limited to only those entered into CDC’s EDN database the results of this analysis are not representative of all U.S. - bound immigrants. This analysis may provide a preliminary justification for reassessing recommendations outlines by CDC’s Technical Instructions; however, additional years of data collection and investigation will be required before any programmatic decisions can be made.