We thank Dr. Arkfeld for his letter. First, the Gonococcal Isolate Surveillance Project (GISP) is not designed to monitor gonorrhea incidence in the United States; it is a sentinel surveillance system to monitor antimicrobial resistance in Neisseria gonorrhoeae. Second, as noted in our Results section, which described the demographic characteristics of patients in the GISP, African-American men were underrepresented in GISP compared with their proportion among nationally reported male patients with gonorrhea. During 1988 to 2003, 74.1% of patients in the GISP were African American, whereas during that same period, 83.0% of male patients in the United States reported through the National Notifiable Disease Surveillance System to have gonorrhea were African American. This figure comes from health care providers or laboratories who report gonorrhea cases to local health departments, which, in turn, report these results to the Centers for Disease Control and Prevention. In 2005, the gonorrhea rate among African Americans was 18 times greater than the rate for white persons (1). Before 2005, the difference in gonorrhea rates between the 2 groups was larger (2).

Persons who are treated for gonorrhea on the basis of symptoms alone without laboratory confirmation may be less likely to get reported to health departments. However, cases of persons who undergo laboratory testing, such as Neisseria gonorrhoeae nucleic acid amplification diagnostic tests, and have positive gonococcal test results are likely to get reported because of state health department reporting requirements for laboratories.