{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T02:06:39Z","timestamp":1781316399617,"version":"3.54.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2009,3,19]],"date-time":"2009-03-19T00:00:00Z","timestamp":1237420800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Gonorrhoea, a bacterial infection caused by <jats:italic>Neisseria gonorrhoeae<\/jats:italic>, has been increasing in several European countries, particularly among men who have sex with men (MSM) and teenagers. We describe the epidemiology of gonorrhoea in Norway in the recent 15 years in order to guide recommendations on the diagnosis, treatment and prevention of gonorrhoea. An evaluation of the Norwegian Surveillance System for Communicable Diseases (MSIS) in 1994, involving GPs and microbiological laboratories, suggested that the system has a high coverage, capturing over 90% of patients diagnosed with gonorrhoea.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Using MSIS data on gonorrhoea cases we analysed specific trends by route of transmission, age, gender, anatomical sampling site, antimicrobial resistance and travel history from 1993\u20132007 and, to focus on more recent trends, from 2003\u20132007. MSM and heterosexual cases were defined by route of transmission.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>From 1993 to 2007, 3601 gonorrhoea cases were reported. MSM cases increased from 10 in 1994 to 109 cases in 2004. From 2003\u20132007, the incidence of gonorrhoea was 5.4\/100,000 person-years (95%CI: 4.9\u20136.0). Over these five years, MSM accounted for an average of 80 cases per year, of which 69% were infected by casual partners. In the same period, 98% of heterosexually infected had a positive swab from urethra only and only two (0.3%) from the pharynx. Only one woman (0.5%) was positive from the rectum. From 1993 \u2013 2007, antimicrobial resistance results were reported for 3325 <jats:italic>N. gonorrhoeae<\/jats:italic> isolates (98% of cultured samples). The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The overall incidence of gonorrhoea in Norway remains low, but the increasing number of MSM cases calls for new, more effective approaches to prevention. Infections originating from abroad represent a constant risk of importing antimicrobial resistant <jats:italic>N. gonorrhoeae<\/jats:italic>. Due to the prevalence of quinolone resistant <jats:italic>N. gonorrhoeae<\/jats:italic> in Norway, third-generation cephalosporins should replace quinolones as the first choice in treatment guidelines. We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2334-9-33","type":"journal-article","created":{"date-parts":[[2009,3,19]],"date-time":"2009-03-19T19:13:37Z","timestamp":1237490017000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The epidemiology of gonorrhoea in Norway, 1993\u20132007: past victories, future challenges"],"prefix":"10.1186","volume":"9","author":[{"given":"Irena","family":"Jakopanec","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrine","family":"Borgen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preben","family":"Aavitsland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2009,3,19]]},"reference":[{"key":"798_CR1","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/978-1-4615-5327-4_16","volume-title":"Bacterial Infections of Humans: Epidemiology and Control","author":"J DeMaio","year":"1998","unstructured":"DeMaio J, Zenilman J: Gonococcal infections. Bacterial Infections of Humans: Epidemiology and Control. Edited by: Evans AS, Brachman PS. 1998, New York: Plenum Medical Book Company, 285-304."},{"key":"798_CR2","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1136\/sti.76.2.110","volume":"76","author":"JH Van der Heyden","year":"2000","unstructured":"Heyden Van der JH, Catchpole MA, Paget WJ, Stroobant A: Trends in gonorrhoea in nine western European countries, 1991\u20136. European Study Group. Sex Transm Infect. 2000, 76: 110-116. 10.1136\/sti.76.2.110.","journal-title":"Sex Transm Infect"},{"key":"798_CR3","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1136\/sti.2004.009415","volume":"80","author":"KA Fenton","year":"2004","unstructured":"Fenton KA, Lowndes CM: Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex Transm Infect. 2004, 80: 255-263. 10.1136\/sti.2004.009415.","journal-title":"Sex Transm Infect"},{"issue":"6","key":"798_CR4","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S1286-4579(99)80049-5","volume":"1","author":"YT van Duynhoven","year":"1999","unstructured":"van Duynhoven YT: The epidemiology of Neisseria gonorrhoeae in Europe. Microbes Infect. 1999, 1 (6): 455-464. 10.1016\/S1286-4579(99)80049-5.","journal-title":"Microbes Infect"},{"key":"798_CR5","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1136\/bmj.324.7349.1324","volume":"324","author":"A Nicoll","year":"2002","unstructured":"Nicoll A, Hamers FF: Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe?[see comment]. BMJ. 2002, 324: 1324-1327. 10.1136\/bmj.324.7349.1324.","journal-title":"BMJ"},{"key":"798_CR6","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/00007435-200102000-00009","volume":"28","author":"T Berglund","year":"2001","unstructured":"Berglund T, Fredlund H, Giesecke J: Epidemiology of the reemergence of gonorrhea in Sweden. Sex Transm Dis. 2001, 28: 111-114. 10.1097\/00007435-200102000-00009.","journal-title":"Sex Transm Dis"},{"key":"798_CR7","first-page":"602","volume":"144","author":"JS Fennema","year":"2000","unstructured":"Fennema JS, Cairo I, Coutinho RA: [Substantial increase in gonorrhea and syphilis among clients of Amsterdam Sexually Transmitted Diseases Clinic]. Ned Tijdschr Geneeskd. 2000, 144: 602-603.","journal-title":"Ned Tijdschr Geneeskd"},{"key":"798_CR8","unstructured":"Health Protection Agency: Recent trends in gonorrhoea in England, Wales, and Northern Ireland. [Commun Dis Rep CDR Wkly]. 16 (39): 1-4. [updated 2006 Sep 28; cited], [http:\/\/www.hpa.org.uk\/cdr\/archives\/2006\/STIrep_3906.pdf]"},{"key":"798_CR9","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/000155502320624104","volume":"82","author":"JD Johansen","year":"2002","unstructured":"Johansen JD, Smith E: Gonorrhoea in Denmark: high incidence among HIV-infected men who have sex with men. Acta Derm Venereol. 2002, 82: 365-368. 10.1080\/000155502320624104.","journal-title":"Acta Derm Venereol"},{"key":"798_CR10","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1097\/OLQ.0b013e3181812cdf","volume":"35","author":"GG van Rijckevorsel","year":"2008","unstructured":"van Rijckevorsel GG, Sonder GJ, Bovee LP, Thiesbrummel HF, Geskus RB, Hoek Van Den A: Trends in hepatitis A, B, and shigellosis compared with gonorrhea and syphilis in men who have sex with men in Amsterdam, 1992\u20132006. Sex Transm Dis. 2008, 35: 930-934. 10.1097\/OLQ.0b013e3181812cdf.","journal-title":"Sex Transm Dis"},{"key":"798_CR11","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1086\/508460","volume":"43","author":"SR Morris","year":"2006","unstructured":"Morris SR, Klausner JD, Buchbinder SP, Wheeler SL, Koblin B, Coates T, Chesney M, Colfax GN: Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis. 2006, 43: 1284-1289. 10.1086\/508460.","journal-title":"Clin Infect Dis"},{"key":"798_CR12","first-page":"491","volume":"49","author":"A Bro-Jorgensen","year":"1973","unstructured":"Bro-Jorgensen A, Jensen T: Gonococcal pharyngeal infections. Report of 110 cases. Br J Vener Dis. 1973, 49: 491-499.","journal-title":"Br J Vener Dis"},{"key":"798_CR13","doi-asserted-by":"publisher","first-page":"655","DOI":"10.7326\/0003-4819-104-5-655","volume":"104","author":"DM Hutt","year":"1986","unstructured":"Hutt DM, Judson FN: Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med. 1986, 104: 655-658.","journal-title":"Ann Intern Med"},{"key":"798_CR14","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1136\/bmj.1.6176.1462","volume":"1","author":"J Wallin","year":"1979","unstructured":"Wallin J, Siegel MS: Pharyngeal neisseria gonorrhoeae: coloniser or pathogen?. Br Med J. 1979, 1: 1462-1463.","journal-title":"Br Med J"},{"key":"798_CR15","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/00007435-200110000-00005","volume":"28","author":"JA Rottingen","year":"2001","unstructured":"Rottingen JA, Cameron DW, Garnett GP: A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?. Sex Transm Dis. 2001, 28: 579-597. 10.1097\/00007435-200110000-00005.","journal-title":"Sex Transm Dis"},{"key":"798_CR16","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1093\/jac\/dkl265","volume":"58","author":"IM Martin","year":"2006","unstructured":"Martin IM, Hoffmann S, Ison CA: European Surveillance of Sexually Transmitted Infections (ESSTI): the first combined antimicrobial susceptibility data for Neisseria gonorrhoeae in Western Europe. J Antimicrob Chemother. 2006, 58: 587-593. 10.1093\/jac\/dkl265.","journal-title":"J Antimicrob Chemother"},{"key":"798_CR17","unstructured":"Norwegian Surveillance System for Communicable Diseases (MSIS). [Norwegian Institute of Public Health.]. [updated 2008; cited], [http:\/\/www.msis.no\/]"},{"key":"798_CR18","first-page":"39","volume":"5","author":"P Aavitsland","year":"1995","unstructured":"Aavitsland P, Nilsen \u00d8: A new anonymous case reporting system for sexually transmitted diseases in Norway. Norsk Epidemiologi. 1995, 5: 39-43.","journal-title":"Norsk Epidemiologi"},{"key":"798_CR19","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1136\/sti.2004.010389","volume":"80","author":"CM Lowndes","year":"2004","unstructured":"Lowndes CM, Fenton KA, European Surveillance of STI's Network: Surveillance systems for STIs in the European Union: facing a changing epidemiology. Sex Transm Infect. 2004, 80: 264-271. 10.1136\/sti.2004.010389.","journal-title":"Sex Transm Infect"},{"key":"798_CR20","first-page":"21","volume-title":"Health Protection Agency","author":"ESSTI","year":"2007","unstructured":"ESSTI: Sexually Transmitted Infections in Europe [European Surveillance of Sexually Transmitted Infections]. Health Protection Agency. 2007, 21-84. [updated 2007; cited], [http:\/\/www.essti.org\/docs\/ESSTI%20_Surveillance_Annual_Report_2007.pdf]"},{"key":"798_CR21","unstructured":"Responsibility and Consideration: A strategy for the prevention of HIV and Sexually Transmitted Diseases [The Norwegian Ministry of Health and Care Services]. The Norwegian Ministry of Health and Care Services, 1-28. [updated 2002 Oct 7; cited], [http:\/\/www.regjeringen.no\/nn\/dep\/hod\/Dokument\/Rapportar-og-planar\/Rapportar\/2002\/Responsibility-and-Consideration.html?id=420163]"},{"key":"798_CR22","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/01.olq.0000230442.13532.c7","volume":"34","author":"T Berglund","year":"2007","unstructured":"Berglund T, Asikainen T, Grutzmeier S, Ruden AK, Wretlind B, Sandstrom E: The epidemiology of gonorrhea among men who have sex with men in Stockholm, Sweden, 1990\u20132004. Sex Transm Dis. 2007, 34: 174-179. 10.1097\/01.olq.0000230442.13532.c7.","journal-title":"Sex Transm Dis"},{"key":"798_CR23","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1136\/sti.79.4.345","volume":"79","author":"M Janier","year":"2003","unstructured":"Janier M, Lassau F, Casin I, Morel P: Pharyngeal gonorrhoea: the forgotten reservoir. Sex Transm Infect. 2003, 79: 345-10.1136\/sti.79.4.345.","journal-title":"Sex Transm Infect"},{"key":"798_CR24","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1136\/sti.2007.027847","volume":"84","author":"AT Bodley-Tickell","year":"2008","unstructured":"Bodley-Tickell AT, Olowokure B, Bhaduri S, White DJ, Ward D, Ross JD, Smith G, Duggal HV, Goold P: Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system. Sex Transm Infect. 2008, 84: 312-317. 10.1136\/sti.2007.027847.","journal-title":"Sex Transm Infect"},{"key":"798_CR25","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/00007435-199804000-00001","volume":"25","author":"E Hiltunen-Back","year":"1998","unstructured":"Hiltunen-Back E, Rostila T, Kautiainen H, Paavonen J, Reunala T: Rapid decrease of endemic gonorrhea in Finland. Sex Transm Dis. 1998, 25: 181-186. 10.1097\/00007435-199804000-00001.","journal-title":"Sex Transm Dis"},{"issue":"23","key":"798_CR26","doi-asserted-by":"crossref","first-page":"pii","DOI":"10.2807\/ese.13.23.18897-en","volume":"13","author":"I Jakopanec","year":"2008","unstructured":"Jakopanec I, Hassfjord JJ, Nilsen O, Larsen AL, Aavitsland P: A local outbreak of quinolone-resistant gonorrhoea in Norway, January 2008. Euro Surveill. 2008, 13 (23): pii-18897, [http:\/\/www.eurosurveillance.org\/ViewArticle.aspx?ArticleId=18897]","journal-title":"Euro Surveill"},{"issue":"Suppl 4","key":"798_CR27","doi-asserted-by":"publisher","first-page":"iv6","DOI":"10.1136\/sti.2006.023036","volume":"82","author":"C Bignell","year":"2006","unstructured":"Bignell C, Ison CA, Jungmann E: Gonorrhoea. Sex Transm Infect. 2006, 82 (Suppl 4): iv6-iv9. 10.1136\/sti.2006.023036.","journal-title":"Sex Transm Infect"},{"key":"798_CR28","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1136\/sti.2006.021329","volume":"83","author":"PD Benn","year":"2007","unstructured":"Benn PD, Rooney G, Carder C, Brown M, Stevenson SR, Copas A, Robinson AJ, Ridgway GL: Chlamydia trachomatis and Neisseria gonorrhoeae infection and the sexual behaviour of men who have sex with men. Sex Transm Infect. 2007, 83: 106-112. 10.1136\/sti.2006.021329.","journal-title":"Sex Transm Infect"},{"key":"798_CR29","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1097\/OLQ.0b013e318177ec70","volume":"35","author":"RA Gunn","year":"2008","unstructured":"Gunn RA, O'Brien CJ, Lee MA, Gilchick RA: Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997\u20132003. Sex Transm Dis. 2008, 35: 845-848. 10.1097\/OLQ.0b013e318177ec70.","journal-title":"Sex Transm Dis"},{"key":"798_CR30","first-page":"1577","volume":"116","author":"P Aavitsland","year":"1996","unstructured":"Aavitsland P, Hoiby EA: [Treatment of uncomplicated gonorrhea in adults. New guidelines from the working group against gonorrhea]. Tidsskr Nor Laegeforen. 1996, 116: 1577-1580.","journal-title":"Tidsskr Nor Laegeforen"},{"key":"798_CR31","first-page":"1","volume-title":"National guideline on the diagnosis and treatment of gonorrhoea in adults 2005","author":"C Bignell","year":"2005","unstructured":"Bignell C: National guideline on the diagnosis and treatment of gonorrhoea in adults 2005. 2005, London (England), British Association for Sexual Health and HIV (BASHH), 1-9. Ref Type: Report"},{"key":"798_CR32","first-page":"332","volume":"56","author":"CDC","year":"2007","unstructured":"CDC: Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007, 56: 332-336.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"Suppl 3","key":"798_CR33","doi-asserted-by":"publisher","first-page":"S84","DOI":"10.1086\/511422","volume":"44","author":"LM Newman","year":"2007","unstructured":"Newman LM, Moran JS, Workowski KA: Update on the management of gonorrhea in adults in the United States. Clin Infect Dis. 2007, 44 (Suppl 3): S84-101. 10.1086\/511422.","journal-title":"Clin Infect Dis"},{"key":"798_CR34","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1086\/319607","volume":"32","author":"A Matteelli","year":"2001","unstructured":"Matteelli A, Carosi G: Sexually transmitted diseases in travelers. Clin Infect Dis. 2001, 32: 1063-1067. 10.1086\/319607.","journal-title":"Clin Infect Dis"},{"key":"798_CR35","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1086\/422721","volume":"39","author":"AS Abdullah","year":"2004","unstructured":"Abdullah AS, Ebrahim SH, Fielding R, Morisky DE: Sexually transmitted infections in travelers: implications for prevention and control. Clin Infect Dis. 2004, 39: 533-538. 10.1086\/422721.","journal-title":"Clin Infect Dis"},{"key":"798_CR36","first-page":"3915","volume":"119","author":"P Aavitsland","year":"1999","unstructured":"Aavitsland P, Nilsen O: [HIV infection, gonorrhea and syphilis from Thailand to Norway]. Tidsskr Nor Laegeforen. 1999, 119: 3915-3918.","journal-title":"Tidsskr Nor Laegeforen"},{"key":"798_CR37","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2165\/00066982-200509040-00002","volume":"9","author":"P Vickerman","year":"2005","unstructured":"Vickerman P, Peeling RW, Watts C, Mabey D: Detection of gonococcal infection: pros and cons of a rapid test. Mol Diagn. 2005, 9: 175-179. 10.2165\/00066982-200509040-00002.","journal-title":"Mol Diagn"},{"key":"798_CR38","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1136\/sti.79.2.94","volume":"79","author":"JM Zenilman","year":"2003","unstructured":"Zenilman JM, Miller WC, Gaydos C, Rogers SM, Turner CF: LCR testing for gonorrhoea and chlamydia in population surveys and other screenings of low prevalence populations: coping with decreased positive predictive value. Sex Transm Infect. 2003, 79: 94-97. 10.1136\/sti.79.2.94.","journal-title":"Sex Transm Infect"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2334-9-33.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2334-9-33\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2334-9-33","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2334-9-33.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T07:53:59Z","timestamp":1630482839000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/1471-2334-9-33"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,3,19]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2009,12]]}},"alternative-id":["798"],"URL":"https:\/\/doi.org\/10.1186\/1471-2334-9-33","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,3,19]]},"assertion":[{"value":"15 October 2008","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2009","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2009","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"33"}}