The ~311,000 cases reported in the United States in 2012 probably represent only half the true number of cases because of underreporting, self-treatment, and nonspecific treatment without a laboratory diagnosis.

• 60% of reported cases in the United States occur in 15- to 19-year-old women and 20- to 24-year-old men.
• Gonorrhea is transmitted from males to females more efficiently than in the opposite direction, with 50-70% of women acquiring gonorrhea during a single unprotected sexual encounter with an infected man. Roughly two-thirds of all infected men are asymptomatic.
• Drug-resistant strains are widespread. Penicillin, ampicillin, and tetracycline are no longer reliable therapeutic agents, and oral cephalosporins and fluoroquinolones are no longer routinely recommended. In addition, strains highly resistant to ceftriaxone have been isolated in Japan and some European countries.