CEPHALOSPORIN-RESISTANT

NEISSERIA GONORRHOEAE 

PUBLIC HEALTH RESPONSE PLAN

August 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of STD Prevention
i

Acknowledgments

We wish to thank members of the Centers for Disease Control and Prevention (CDC) working group 

for cephalosporin-resistant gonorrhea response plan at the Division of STD Prevention, National 

Center for HIV, STD, and TB Prevention, CDC : Ron Ballard, PhD; Stuart Berman, MD, ScM; Russell 

Cantrell, MPA; Charlotte Kent, PhD; Robert Kirkcaldy, MD, MPH; Kevin O’Connor, MA; John Papp, 

PhD; Steven J. Shapiro, BS; David Trees, PhD; Hillard Weinstock, MD; Kimberly A. Workowski, MD; 

Tun Ye, MBBS, PhD; and all external consultants who participated in the consultation meeting on 

cephalosporin-resistant gonorrhea outbreak response plan, September 14-15, 2009: Mark Aubin, 

Department of Health, Seattle, WA; Susan Blank, MD, MPH, New York City Department of Health 

and Mental Hygiene, New York, NY; Gail Bolan, MD, California Department of Public Health, 

Richmond, CA; Ted Cieslak, MD, DoD Liaison Officer, CDC, Atlanta, GA; Peter Kerndt, MD, Los 

Angeles County Department of Public Health, Los Angeles, CA; Venie Lee, MS, Hawaii Department 

of Health, Honolulu, HI; Marc Lipstich, PhD, Harvard School of Public Health, Boston, MA; William G 

Meyer, Global Emerging Infections Surveillance & Response (GEIS) Core Dept, DoD, Silver Spring, 

MD; William L.H. Whittington, University of Washington School of Medicine, Seattle, WA; Dean E. 

Willis, DrPH, MPH, MA, Florida Department of Health, Jacksonville, FL; William Wong, MD, Division 

of STI/HIV/AIDS, Chicago, IL.

This document was prepared by Sarah Kidd, Robert Kirkcaldy, Tun Ye, 

John Papp, David Trees, and Steven J. Shapiro

Division of STD Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention
ii

Guide to Acronyms

AST Antimicrobial Susceptibility Testing

CDC Centers for Disease Control and Prevention

Ceph-R NG Cephalosporin-Resistant Neisseria gonorrhoeae

CLSI Clinical and Laboratory Standards Institute

EPT Expedited Partner Therapy

GISP Gonococcal Isolate Surveillance Project

MIC Minimum Inhibitory Concentration

MSM Men who have Sex with Men

NAAT Nucleic Acid Amplification Test

PPNG Penicillinase-Producing Neisseria gonorrhoeae

QRNG Fluoroquinolone-Resistant Neisseria gonorrhoeae

STD Sexually Transmitted Disease

STI Sexually Transmitted Infection
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Contents

Acknowledgments ....................................................................................................................................i

Guide to Acronyms ..................................................................................................................................ii

Background ...............................................................................................................................................1

Objectives ..................................................................................................................................................3

Surveillance for Cephalosporin-Resistant N. gonorrhoeae (Ceph-R NG) .........................................3

Working Case Definitions for Ceph-R NG .............................................................................................7

Challenges to Surveillance for Ceph-R NG ..........................................................................................10

Expansion of Culture and Antimicrobial Susceptibility Testing (AST) Capacity .............................10

Recommended Clinical Management and Public Health Response Following Detection of 

Suspect or Probable Ceph-R NG ...............................................................................................12

Guidance on Test of Cure .......................................................................................................................16

Guidance on Partner Services and Management of Partners of Suspected or Probable 

Ceph-R NG ...................................................................................................................................16

Monitoring the Effectiveness of the Ceph-R NG Response Plan ......................................................17

Role of Enhanced Gonorrhea Prevention and Control Activities .....................................................18

Need for Alternative Treatment Options ............................................................................................18

Conclusions ..............................................................................................................................................19

References ................................................................................................................................................20

Appendices

I. Contact Information and Selected Web Resources ........................................................22

II. Sample Regulatory Language for Mandated Reporting of AST Results .......................23

III. CLSI cefixime and ceftriaxone agar dilution MIC and disk diffusion zone diameter 

standards for N. gonorrhoeae ............................................................................................24

IV. Interview Record for Gonorrhea/Chlamydia ....................................................................25
1

Background

Gonorrhea is the second most commonly reported notifiable disease in the United States, with 

309,341 cases reported in 2010 [1]. Although the national gonorrhea rate decreased 21.7%

during 2000–2010, from 128.7 to 100.8 cases/100,000 population, future progress in gonorrhea 

control and prevention is threatened by resistance to an increasing number of antimicrobial 

agents and limited remaining treatment options. 

Over the years, Neisseria gonorrhoeae has readily acquired resistance to a broad spectrum of 

antimicrobial agents traditionally used for the treatment of gonococcal infections. In the 

United States, the antimicrobial susceptibility patterns of N. gonorrhoeae have been closely 

monitored since 1986 through the Gonococcal Isolate Surveillance Project (GISP), and the 

information has been used to update treatment recommendations. In 2010, 27.2% of all GISP 

isolates were resistant to penicillin, tetracycline, ciprofloxacin, or some combination of those 

antimicrobials and 6.9% of isolates were resistant to all three antimicrobials [1]. Penicillin, 

tetracycline, and fluoroquinolone antimicrobials are no longer recommended as appropriate 

treatment for gonorrhea in the United States. Currently, the Centers for Disease Control and 

Prevention (CDC) recommends dual therapy with ceftriaxone (an injectable cephalosporin) 250 

mg intramuscularly as a single dose plus either azithromycin 1 gram orally as a single dose or 

doxycycline 100 mg orally twice a day for 7 days as the most effective treatment for

uncomplicated gonorrhea [2, 3]. For patients allergic to cephalosporins, azithromycin 2 grams 

orally as a single dose is the only alternative treatment option available; however, the use of 

monotherapy with azithromycin should be extremely judicious due to concerns about possible 

rapid emergence of azithromycin resistance. Other potential treatment options for gonorrhea 

are either not available in the United States, do not meet clinical effectiveness criteria for 

recommended treatment, or have not been adequately studied. Therefore, the emergence and 

spread of cephalosporin-resistant N. gonorrhoeae (Ceph-R NG) would severely limit treatment

options for gonorrhea in the United States. 

The emergence of Ceph-R NG in the United States could occur either through the importation 

of Ceph-R NG from other countries, through genetic transformations by obtaining genetic 

material from other organisms, or through domestic drug selection pressures in the United 

States. While mutations through drug selection pressures generally take time, the more rapid

introduction of antimicrobial-resistant N. gonorrhoeae strains to the United States through the 

importation of resistant strains, followed by subsequent transmission of resistant strains 

through local sexual networks has always been a concern.
2

In the last decade, N. gonorrhoeae strains with decreased susceptibility to cephalosporins have 

been reported with increasing frequency from countries in Asia and the Pacific region [4-10], as 

well as from Europe, Canada, and the United States [2, 11, 12]. Cefixime treatment failures 

were first reported from Japan in 2003 [6] and have subsequently been reported from Norway, 

the United Kingdom, Austria, and France [13-17]. More recently, and of great concern, a 

gonococcal isolate with high-level ceftriaxone resistance was identified in a Japanese woman 

with pharyngeal infection and apparent ceftriaxone treatment failure in 2009 [10]. Gonococcal 

isolates with high-level ceftriaxone resistance have subsequently been identified in men with 

urogenital infections in France and in Spain [17, 18]. 

While confirmed cephalosporin treatment failures have not yet been identified in the United 

States, GISP has detected recent increases in minimum inhibitory concentrations (MICs) for

cephalosporins among gonococcal isolates in the United States. From 2006 to the first six 

months of 2011, the proportion of GISP isolates with an elevated cefixime MIC (MIC ≥0.25 

μg/ml) increased from 0.1% to 1.7%, and the proportion with an elevated ceftriaxone MIC (MIC 

≥0.125 μg/ml) increased from 0.05% to 0.5% [19]. These increases were most notable in the 

western United States and among MSM. In the West, the proportion of isolates with an 

elevated cefixime MIC increased from 0.2% to 3.6% and the proportion with an elevated 

ceftriaxone MIC increased from 0.04% to 1.9%. Among MSM, the proportion with an elevated 

cefixime MIC increased from 0.2% to 4.7%, and the proportion with an elevated ceftriaxone 

MIC increased from 0% to 1.0%. There is concern that this pattern is reminiscent of the pattern 

that was seen with the emergence of fluoroquinolone-resistant N. gonorrhoeae (QRNG): 

detection first in Hawaii and then the western United States, before spreading widely in the 

continental United States. While the first QRNG cases were detected among heterosexuals, 

QRNG became widespread in the continental United States among men who have sex with men 

(MSM) with gonorrhea before becoming widespread among heterosexuals [20-22].

It is likely Ceph-R NG infections will emerge in the United States. A significant challenge to 

developing an effective response strategy is the lack of a successful model for prevention and 

control of antimicrobial-resistant N. gonorrhoeae. In previous efforts to address the emergence 

of penicillinase-producing N. gonorrhoeae (PPNG) [23] and QRNG [20-22], CDC and the United 

States public health community have been unable to prevent or control the introduction and 

spread of antimicrobial-resistant N. gonorrhoeae, even when more effective alternative 

antimicrobial options were available and greater resources were available for patient and 

partner follow-up. 

Limiting the impact of antimicrobial-resistant N. gonorrhoeae will require a concerted and 

sustained effort involving multidisciplinary groups. Although new drug classes or synergistic 
3

combinations of different antimicrobials may be identified for the treatment of Ceph-R NG and 

multidrug-resistant N. gonorrhoeae, it is critical to prepare for the emergence of Ceph-R NG in 

the current reality of limited treatment options and limited public health resources. This public 

health response plan identifies strategies for enhanced surveillance to detect the emergence of 

Ceph-R NG in the United States and outlines programmatic steps that can be taken to mitigate 

the impact until cost-effective treatment alternatives can be identified. The effectiveness of 

this plan should be closely monitored, and the plan should be periodically reviewed and 

revised, based on updated surveillance, epidemiological and clinical data. 

Objectives

General Objective

This document is intended to be a resource for state and local health departments in order to

minimize the impact of Ceph-R NG on the prevention and control of gonorrhea and its sequelae 

at the community level in the United States.

Specific Objectives

(1) To establish enhanced surveillance for patients with suspect or probable Ceph-R NG 

infections (see case definitions, pages 8–9)

(2) To outline the recommended public health actions to be implemented at the national, 

state, and local levels following detection of suspect or probable Ceph-R NG cases

Surveillance for Ceph-R NG

CDC currently conducts surveillance for antimicrobial resistance among N. gonorrhoeae isolates 

through GISP [24]. Since its inception in 1986, GISP has successfully detected trends in 

resistance, provided prevalence data, and directly informed CDC treatment recommendations 

for gonorrhea. However, because GISP is a sentinel surveillance system that only conducts 

surveillance on isolates from symptomatic men attending selected sexually transmitted disease 

(STD) clinics, and because it takes time to process isolates and measure MICs through GISP’s 

network of reference laboratories, there is a need for additional, more sensitive and timely 

surveillance approaches in order to detect the emergence of cephalosporin resistance. 

The expanded surveillance approach will utilize clinical detection and reporting of suspect and 

probable Ceph-R NG cases in addition to continued surveillance through GISP. Local 
4

surveillance could be expanded further by establishing a network of clinics where gonorrhea is 

commonly diagnosed, and implementing culture-based testing and monitoring of antimicrobial 

susceptibility of isolates. State and local health departments could also enhance surveillance by 

monitoring and investigating patients with multiple reports of N. gonorrhoeae infection within 

the preceding 30 days or 60 days to determine whether such reports are possible treatment 

failures (see possible options for enhancing surveillance, page 5). Together with data from 

GISP, findings from expanded surveillance will inform future CDC recommendations for 

gonorrhea treatment, screening, and test of cure.

Clinicians

Clinicians are requested to (1) maintain vigilance for cephalosporin treatment failures, (2)

obtain specimens for culture and antimicrobial susceptibility testing (AST) from patients

experiencing possible cephalosporin treatment failure as described below, and (3) report cases 

that meet the criteria for suspect or probable Ceph-R NG infection (see case definitions, pages 

8–9) to the state or local health department. 

(1) Detecting possible cephalosporin treatment failure. Cephalosporin treatment failure is 

the persistence of N. gonorrhoeae infection despite appropriate cephalosporin 

treatment, and could indicate infection with Ceph-R NG. Patients diagnosed with 

gonorrhea should be educated about Ceph-R NG and instructed to return to care if 

symptoms do not resolve within 3–5 days or if test of cure is recommended. Patients 

also should be informed of the need for their partners to be treated and advised to 

avoid sex for one week following treatment.

Treatment failure due to Ceph-R NG infection should be considered in:

• Patients whose symptoms do not resolve within 3-5 days after appropriate 

treatment and who report no sexual contact during the post-treatment followup period

• Patients with a positive test of cure (positive culture ≥72 hours or positive 

nucleic acid amplification test [NAAT] ≥7 days after appropriate treatment) when 

no sexual contact is reported during the post-treatment follow-up period

• Patients with a positive N. gonorrhoeae culture within 30–60 days (but ≥72 

hours) after treatment for gonorrhea who are found to have elevated 

cephalosporin MICs on AST (see laboratory criteria for suspect or probable CephR NG cases, pages 7–8), regardless of whether sexual contact is reported during 

the post-treatment follow-up period
5

(2) Obtaining specimens for culture and AST. Clinicians should obtain culture specimens 

for AST from patients with possible treatment failure. In addition, clinicians should also 

consider obtaining culture specimens from patients who have been diagnosed with 

another N. gonorrhoeae infection in the past 30–60 days, even when re-infection cannot 

be excluded. Clinicians serving populations at increased risk for gonorrhea (i.e., sexually 

active patients with one or more of the following risk factors: age <25 years, history of 

previous gonorrhea infection or other sexually transmitted infection, new or multiple 

sex partners, inconsistent condom use, sex work, or drug use [25]) should establish 

gonococcal culture procedures in their clinical settings that can be implemented when a 

case with possible treatment failure is identified.

(3) Reporting. Cases that meet the criteria for suspect or probable Ceph-R NG infection 

(see case definitions, pages 8–9) should be reported to the state or local health 

department. Clinicians should also contact the state or local health department if there 

is concern about Ceph-R NG infection in a patient who does not meet the case definition 

or if they require assistance obtaining access to culture and AST.

Laboratorians

Laboratorians are requested to report N. gonorrhoeae isolates that meet laboratory-based 

criteria for suspect or probable Ceph-R NG (see case definitions, pages 8–9) to the state or local 

health departments.

State and Local Health Departments

State and local health departments are requested to investigate cases of suspect or probable 

Ceph-R NG (see case definitions, pages 8–9) and take appropriate public health action, including 

ensuring that sex partners of case-patients are tested using culture and AST (if culture is 

positive) and are adequately treated for gonorrhea based on the AST results of the casepatient’s isolate. Health departments are requested to report cases of suspect or probable 

Ceph-R NG to CDC at gispinfo@cdc.gov or (404) 639-8659. State and local health departments 

are also requested to enhance surveillance for Ceph-R NG cases. 

Possible options for enhancing surveillance include:

• Monitoring and investigating patients with multiple laboratory or clinical reports of N. 

gonorrhoeae infections documented within the preceding 30 days or 60 days, to 

determine whether such reports are duplicative, re-infections, or cephalosporin 

treatment failures, and following up with possible treatment failures to obtain a test of 

cure
6

• Strengthening of local culture and AST capacity and access (see Expansion of Culture and 

AST Capacity, page 10)

• Routinely reviewing local N. gonorrhoeae AST results (if available) from the local public 

health laboratory or commercial laboratories doing AST. Reporting of AST results has 

been successfully mandated in at least one jurisdiction, and sample regulatory language 

is available (see Appendix II, page 23).

• Implementing routine test of cure for patients with gonorrhea for prospective case

finding of cephalosporin treatment failures 

• Establishing a local gonococcal susceptibility surveillance system in a few clinics with a 

high volume of gonorrhea cases

CDC

CDC will continue to conduct sentinel surveillance of antimicrobial susceptibility through GISP;

disseminate surveillance data; provide surveillance, epidemiological, laboratory, clinical and 

programmatic technical assistance resources and tools to state and local health departments;

update treatment recommendations; provide training and technical assistance resources and 

tools on culture and AST techniques to clinicians and laboratorians; and act as a reference 

laboratory for confirmatory susceptibility testing. CDC will also work with partners to evaluate 

and recommend N. gonorrhoeae transport media; provide reference strain panels to 

laboratories for AST quality assurance; evaluate and define the Etest and disk diffusion results 

that are comparable to the agar dilution MIC breakpoints listed in the Suspect and Probable 

Ceph-R NG Case Definitions (pages 8–9); evaluate optimal test of cure algorithms; and will 

continue to collaborate with international partners to enhance and strengthen global 

surveillance and communication of gonococcal resistance.
7

Working Case Definitions for Ceph-R NG

The working case definitions for Ceph-R NG infection are based on clinical evidence of 

cephalosporin treatment failure and/or laboratory-based AST results. 

Many clinicians do not have access to AST and, thus, the laboratory criteria may not be 

applicable. However, laboratory criteria are included since laboratory data without clinical 

outcome data may be available in some instances, such as GISP isolates. Defining laboratory 

criteria for Ceph-R NG infection is challenging, since the Clinical and Laboratory Standards 

Institute (CLSI) has not defined MIC breakpoints for resistance [26]. Furthermore, since 

cephalosporin treatment failures have not been reported yet in the United States, we lack a 

clear understanding of the relationship between MIC breakpoints and likelihood of treatment 

failure. The MIC breakpoints for cefixime used in the case definitions below differ from the 

breakpoints for ceftriaxone because cefixime MICs are generally one-dilution higher than 

ceftriaxone MICs. 

The laboratory criteria in this document refer to cephalosporin MICs obtained by the agar

dilution method. CDC is currently in the process of evaluating antimicrobial susceptibility 

results obtained by the Etest and disk diffusion methods, and is working to establish Etest and 

disk diffusion breakpoints that are equivalent to the agar dilution breakpoints listed below. 

Until these data are available, facilities using the Etest method should use the MIC breakpoints 

listed below (the same breakpoints that are used for agar dilution). Facilities using the disk 

diffusion method should use the standards published by the CLSI [26] (see table in Appendix III, 

page 24).

These working case definitions are expected to evolve as new data become available.

Case Description

A sexually transmitted infection (STI) caused by a cephalosporin-resistant strain of N.

gonorrhoeae
8

Case Classification

Suspect Case

A suspect case fulfills either the clinical criteria or laboratory criteria described below:

Suspect Case: Clinical Criteria

The patient experienced possible cephalosporin treatment failure (symptomatic or 

asymptomatic) with the following specific components: 

• Patient had laboratory-confirmed N. gonorrhoeae infection, and

• Patient received CDC-recommended cephalosporin-based antimicrobial regimen as 

treatment, and

• Patient subsequently had a positive N. gonorrhoeae test result (positive culture ≥72 

hours after treatment or positive NAAT ≥7 days after treatment), and

• Patient did not engage in sexual activity after treatment

OR

Suspect Case: Laboratory Criteria

AST of pre-treatment or post-treatment isolate of N. gonorrhoeae demonstrates:

• Cefixime MIC ≥0.25 μg/ml, or

• Ceftriaxone MIC ≥0.125 μg/ml
9

Probable Case

A probable case fulfills the clinical and laboratory criteria described below or fulfills the 

elevated laboratory criteria described below:

Probable Case: Clinical Criteria and Laboratory Criteria

The patient experienced possible cephalosporin treatment failure (symptomatic or 

asymptomatic) with the following specific components: 

• Patient had laboratory-confirmed N. gonorrhoeae infection, and

• Patient received CDC-recommended cephalosporin-based antimicrobial regimen as 

treatment, and

• Patient subsequently had a positive N. gonorrhoeae test result (positive culture ≥72 

hours after treatment or positive NAAT ≥7 days after treatment), and

• Patient did not engage in sexual activity after treatment

AND

AST of pre-treatment or post-treatment isolate of N. gonorrhoeae demonstrates:

• Cefixime MIC ≥0.25 μg/ml, or

• Ceftriaxone MIC ≥0.125 μg/ml

OR

Probable Case: Elevated Laboratory Criteria

AST of pre-treatment or post-treatment isolate of N. gonorrhoeae demonstrates:

• Cefixime MIC ≥0.5 μg/ml, or

• Ceftriaxone MIC ≥0.25 μg/ml
10

Challenges to Surveillance for Ceph-R NG

There are operational difficulties for clinicians, laboratorians and health departments to detect 

suspect and probable Ceph-R NG cases. The main implementation barriers include: 

• Existing surveillance systems that are not likely to be sensitive or timely enough to 

detect initial emergence. For example, as a sentinel surveillance system, GISP only 

samples approximately 4% of male urethral gonorrhea morbidity and usually takes 

>1 month to return a confirmed abnormal MIC result to the sentinel clinic site.

• Lack of clinician’s awareness regarding emerging Ceph-R NG

• Lack of clinician’s training in the appropriate collection of clinical samples suitable 

for culture and AST, and lack of quality assurance monitoring

• Lack of clinic availability of laboratory supplies and protocols/procedures for 

collection and transport of culture specimens (i.e. swab, transport medium, culture 

plates, CO2 tablets/candle jars and incubators)

• Limited availability of laboratory services for gonococcal culture and AST at the 

clinical laboratories

• Lack of mandatory laboratory reporting of gonococcal AST results to the local, state, 

and national public health authorities

• Declining national, state and local STI control resources, personnel and funding

• Test of cure is no longer routine standard for care for management of gonorrhea, so 

that asymptomatic treatment failures are unlikely to be detected

• Limited data on the expected duration of NAAT-positivity after successful treatment

• Inadequate data on the comparability of agar dilution, Etest, and disk diffusion for 

AST

Expansion of Culture and AST Capacity

The reduction of culture and AST capability in the many clinical laboratories is a challenge to 

achieving timely and effective monitoring of Ceph-R NG. NAAT is now the standard of care for 

N. gonorrhoeae diagnosis, and the availability of routine cultures and AST for N. gonorrhoeae is 

increasingly limited, especially for the increasing proportion of patients seen in settings other 

than an STD clinic. In most clinics, supplies and proper conditions for gonococcal culture 

specimen collection (direct inoculation onto selective or non-selective media), storage, and 

transport (an atmosphere supplemented with CO2 and maintained at 35–37o

C) are not 

available. Access to transport media that adequately maintains the viability of N. gonorrhoeae

until the specimen reaches a laboratory needs to be established for clinicians, especially those 
11

working in Federally Qualified Health Centers, primary care, HIV care, corrections facilities, and 

other clinical settings serving adolescents, young adults, and MSM at high risk for gonorrhea.

A strategic approach to expansion of culture and AST capacity is required to support the 

proposed enhanced surveillance and response activities for Ceph-R NG. The strategy should 

include:

At state and local health departments:

• Local assessment by health departments of commercial and public health laboratory 

capacity in gonococcal culture and AST

• In locales that lack culture and AST capabilities, establishment of partnerships with 

laboratories that can provide culture and AST. These partnerships may include the 

establishment of local, state, or regional networks to support culture and AST.

• Local health department facilitation of access to gonococcal culture, especially in clinics 

serving patients at risk for gonorrhea or from where a high volume of gonorrhea cases 

are reported, either through developing referral systems with documented linkage to 

culture for local clinicians, or facilitation of local availability of N. gonorrhoeae culture 

plates, transport media and appropriate transport supplies to clinicians

• Facilitation of local training for clinicians and laboratorians

At CDC:

• Assist with assessment of state and local health department access to gonococcal 

culture and AST

• Evaluation of existing transport media (e.g., Amies charcoal, Transgrow, InTrayTM) and 

identification or development of transport media that maintain N. gonorrhoeae viability 

and that can be used in the non-STD clinic setting or in other clinic settings where 

appropriate culture plates, candle jars, and incubators are not available

• Development of training and technical assistance resources (website materials, 

protocols, and manuals) on specimen collection, transport, culture & AST techniques 

and implementation of website-based training activities, in collaboration with public 

(e.g. Association of Public Health Laboratories) and private sector partners (e.g., Quest, 

LabCorp, and Kaiser)

At this time, the molecular mechanisms associated with cephalosporin resistance have not 

been fully elucidated. Laboratory studies to improve our knowledge-base of molecular and 

biologic mechanisms of resistance should be continued and might contribute to the 

development of molecular detection methods for resistant organisms. A point-of-care 
12

molecular test for detection of resistance would dramatically enhance our national response to 

cephalosporin resistant and multi-drug resistant gonorrhea.

Recommended Clinical Management and Public Health

Response Following Detection of Suspect or Probable 

Ceph-R NG

Clinician Responsibilities

Cefixime treatment failures. When a clinician identifies a patient with gonorrhea and possible 

treatment failure (see Detecting possible cephalosporin treatment failure, page 4) following 

treatment with an oral cephalosporin (i.e., cefixime), he/she should:

• Based on anatomic exposure history, obtain specimens for culture from pharyngeal, 

rectal, and genital sites for AST. Clinicians should notify the laboratory that the 

specimen was obtained from a patient with possible cephalosporin treatment failure.

• Re-treat with 250 mg of ceftriaxone as a single intramuscular dose and azithromycin 2

grams orally as a dual therapy

• Ensure eradication of infection with a test of cure after re-treatment, preferably with 

culture (≥72 hours after re-treatment), or if culture is not available, with NAAT (≥7 days 

after re-treatment). If the test of cure NAAT is positive, a specimen for culture should 

be obtained to both ensure that the NAAT result is reliable for active infection and to 

allow for AST.

• Test the patient’s sex partners from the two months preceding the patient’s initial 

gonorrhea diagnosis date (preferably with culture from all exposed sites) and empirically 

treat these partners with ceftriaxone 250 mg intramuscularly and azithromycin 2 grams

orally as dual therapy

• Promptly notify the state or local health departments within 24 hours of identification

Ceftriaxone treatment failures. When a clinician identifies a patient with gonorrhea and 

possible treatment failure (see Detecting possible cephalosporin treatment failure, page 4)

following treatment with an injectable cephalosporin (i.e., ceftriaxone), he/she should:

• Consult with a local infectious diseases expert or STD/HIV Prevention Training Center

(see www.nnptc.org for regional contact information), and with the state or local health 

department, regarding re-treatment and partner management. The state or local health 

departments should inform CDC.
13

• Based on anatomic exposure history, obtain specimens for culture from pharyngeal, 

rectal, and genital sites for AST. Clinicians should notify the laboratory that the 

specimen was obtained from a patient with possible cephalosporin treatment failure.

• Ensure eradication of infection with a test of cure after re-treatment, preferably with 

culture (≥72 hours after re-treatment), or if culture is not available, with NAAT (≥7 days 

after re-treatment). If the test of cure NAAT is positive, a specimen for culture should 

be obtained to both ensure that the NAAT result is reliable for active infection and to 

allow for AST.

• Test the patient’s sex partners from the two months preceding the patient’s initial 

gonorrhea diagnosis date (preferably with culture from all exposed sites) and empirically 

treat these partners with the same antimicrobial regimen with which the index patient 

was re-treated and which most likely will cure him/her (based on consultation with a 

local infectious disease expert, state or local health department, and CDC)

• Promptly notify the state or local health department within 24 hours of identification

Laboratorian Responsibilities

Laboratorians who identify a N. gonorrhoeae isolate with AST results that are consistent with 

suspect or probable Ceph-R NG (see Case Definitions, pages 8–9) should promptly notify (within 

24 hours) the ordering clinician as well as the state or local health department. Results from 

isolates associated with possible clinical treatment failures should also be promptly reported. 

Culture specimens obtained from all patients with possible treatment failure or suspect or 

probable Ceph-R NG infection should be sent to CDC for AST by agar dilution and stored at the 

local laboratory and/or CDC in case further testing is needed.

Testing and/or storage of specimens or isolates at CDC should be facilitated by the state or local

health department according to local public health protocols. Instructions for shipping isolates 

to CDC can be found at: 

www.cdc.gov/std/Gonorrhea/arg/specimen_shipping_instructions1-29-08.pdf

N. gonorrhoeae is classified as Category B (UN 3373).

State and Local Health Department Responsibilities

When notified by a clinician or laboratorian of gonorrhea case with possible treatment failure 

or with suspect or probable Ceph-R NG infection, local public health authorities should initiate 

an investigation to collect the clinical and epidemiological information outlined in the Interview 

Record for Gonorrhea/Chlamydia (see Appendix IV, page 25, or 

http://www.cdc.gov/std/Program/forms/GC_CT_IR_6_05_2008.pdf and 

http://www.cdc.gov/std/Program/forms/GC-CT/GC_CT-IRInstructions.pdf for instructions) from

the index case and sexual partner(s). Locally developed interview instruments that collect 
14

these data can be used. Data elements that state and local health departments should consider 

collecting during an investigation are outlined below, and health departments should aim to 

gather these data within 30 days of the identification of a case. State and local health 

departments are requested to promptly notify (within 24 hours) CDC’s Division of STD 

Prevention (at (404) 639-8659 or gispinfo@cdc.gov) of suspect or probable Ceph-R NG cases

(see case definitions, pages 8–9), or if there is concern about Ceph-NG infection in a patient 

who does not meet the case definition. 

Epidemiological Investigation of Suspect or Probable Ceph-R NG Cases

All cases and sex partners who can be traced should be interviewed to identify the 

demographic characteristics, sexual behavior, and risk factors outlined on the Interview Record 

for Gonorrhea/Chlamydia (see Appendix IV, page 25, or 

www.cdc.gov/std/Program/forms/GC_CT_IR_6_05_2008.pdf). Ideally, other persons within the 

patient’s socio-sexual network should be interviewed also.

The Interview Record for Gonorrhea/Chlamydia includes the following data elements for cases:

• Age, sex at birth, race, and ethnicity

• Address of residence, contact information

• Provider and facility type where tested

• Date(s) of test(s), type of test(s), source(s) of specimen(s) (anatomic site), and result of 

test(s)

• Treatment date(s), drug(s) and dosage(s) given

• Gender of sex partners in last 12 months

• History of anonymous sex in the last 12 months

• History of incarceration in the last 12 months

• History of injection or non-injection drug use in the last 12 months

• Method of case detection, reason for seeking care

• HIV status

• History of signs or symptoms

• STD history

• Type of partner services offered and provided

• Place where patient met his/her partner(s)

• Incidental antimicrobial treatment in the last 12 months, treatment dates, drug and 

dosage, and reason for use
15

In addition, it is recommended that state and local health departments collect the following 

data elements during interviews with a suspect or probable Ceph-R NG case and partner(s) and 

medical record review: 

• Type of sex (oral, vaginal, and/or anal; insertive and/or receptive)

• Travel history during past 3 months (including place and whether the patient had sex 

during travel)

• Travel history of sex partners in the past 3 months (if known) (including place and 

whether the partner had sex during travel)

• Results of AST (if available and performed)

• History of commercial sex work (involvement in or solicitation of)

• Incarceration of sex partners

Below are additional epidemiological and descriptive investigations to consider if a Ceph-R NG 

case is identified and if local capacity exists. CDC can provide technical assistance for such 

investigations. 

Evaluate epidemiological characteristics associated with Ceph-R NG strains:

• Case-control study comparing demographic and risk behaviors between Ceph-R NG 

cases and cephalosporin-susceptible cases

• Geospatial analysis of cases

Evaluate epidemiological or network linkages between cases:

• Interview index cases, sex partners, and sex partners of partners to establish network 

linkages of people and places/venues/internet sites/smart-phone apps

• Conduct strain typing of isolates to assess microbiological linkages.

Evaluation of estimated local prevalence of Ceph-R NG:

• Review case-based surveillance data to identify repeat infections in a single person 

within a short time frame (e.g., within preceding 30 to 60 days)

• Assess local AST capacity and review local AST results

• Systematically collect local specimens for culture and AST

• Implement routine test of cure for prospective local surveillance for Ceph-R NG cases 
16

Guidance on Test of Cure

Patients treated for gonorrhea who (1) have symptoms which fail to resolve within 3-5 days

after appropriate treatment, (2) are found to have AST results consistent with the laboratory 

criteria for suspect or probable Ceph-R NG (see case definitions, pages 8–9), (3) are treated 

with an alternative regimen (i.e., a regimen other than ceftriaxone 250 mg intramuscularly plus 

either azithromycin 1 gm orally as a single dose or doxycycline 100 mg orally twice a day for 7 

days) should receive a test of cure.

In addition, if clinicians or health departments are concerned about local emergence of Ceph-R 

NG based on available local GISP and epidemiological data, they might consider implementing 

or recommending routine test of cure 7–10 days after treatment for all gonorrhea cases for a 

period of time to determine yield. Routine test of cure may allow for rapid identification of 

treatment failures and provide timely prevalence estimates of cephalosporin resistance. 

If done, test of cure is preferably performed with culture (≥72 hours after treatment), but may 

be performed with NAAT (≥7 days after treatment), if culture is not available. The possibility of 

false-positivity with NAAT as early as 7 days after treatment is a concern, but is likely to be low 

[27]. However, further study on the feasibility and cost-effectiveness of this approach is 

warranted, and the recommendations on timing of test of cure are expected to evolve as new 

data become available. At present, asymptomatic patients with a positive NAAT on test of cure

should be cultured. While awaiting the culture result, these patients should be managed 

according to clinical history and reported if they meet the current criteria for a suspect or 

probable Ceph-R NG case (see case definitions, pages 8–9).

Guidance on Partner Services and Management of Partners of 

Suspected and Probable Ceph-R NG 

Providers should discuss with their patients who have suspect or probable Ceph-R NG infection 

the critical need for their sex partners to seek medical evaluation and treatment, and the role 

of health department assistance regarding linking partners to care and treatment.

Clinicians and health departments should make strenuous efforts to link partners to care. 

Partners of patients with suspect or probable Ceph-R NG infection should be prioritized for 

Disease Intervention Specialist partner services by state and local health departments, and 
17

should be prioritized for urgent clinical care at STD clinics or other settings so they can be 

tested and treated appropriately. 

All sex partners of suspect or probable Ceph-R NG cases from the two months preceding the 

index patient’s initial test date (i.e., date of diagnosis) should be tested for N. gonorrhoeae

infection (preferably with culture from all exposed anatomic sites), and empirically treated as 

follows: Sex partners of patients with possible cefixime treatment failure should be treated 

with 250 mg ceftriaxone intramuscularly and azithromycin 2 grams orally in a single dose. Sex 

partners of patients with possible ceftriaxone treatment failure should be treated with the 

same antimicrobial regimen with which the index patient was re-treated and which most likely 

will cure him/her (based on consultation with a local infectious disease expert or STD/HIV 

Prevention Training Center, state or local health department, and CDC). All sex partners should 

be tested and re-treated as described above, even if they were previously treated with oral 

cefixime.

State and local health departments and CDC should continue to evaluate the role and 

advisability of expedited partner therapy (EPT) after the emergence of Ceph-R NG. Because 

local susceptibility data is unlikely to be collected systematically, decision-making may be based 

upon regional GISP data. Exposed sex partners should be informed that dual therapy with 

ceftriaxone and either azithromycin or doxycycline is the most effective treatment for 

gonorrhea, and should be strongly advised to present to a clinic for dual treatment that 

includes ceftriaxone. However, for heterosexual patients with gonorrhea whose partners are 

unlikely to seek evaluation and treatment, EPT using cefixime and either azithromycin or 

doxycycline can be considered. This approach should always be accompanied by efforts to 

encourage partners to seek clinical evaluation and to educate partners about the need for test 

of cure if a cefixime-based regimen is used.

Monitoring the Effectiveness of the Ceph-R NG Response Plan

State and local health departments should monitor the effectiveness of Ceph-R NG response 

activities by establishing state and local program improvement indicators. Positive 

improvements could be indicated by: 

• Increases in number of laboratories with N. gonorrhoeae culture and AST capacity

• Increases in number of clinics with appropriate transport media and specimen collection 

and transport procedures
18

• Improvements in level of awareness on the emergence of Ceph-R NG and recommended 

public health response actions among clinicians and laboratorians 

• Increases in timely reporting and investigation of suspect or probable Ceph-R NG cases 

• Increases in the proportion of gonorrhea patients treated with CDC-recommended 

regimen: ceftriaxone 250 mg intramuscularly plus either azithromycin 1 gm orally as a 

single dose or doxycycline 100 mg orally twice a day for 7 days

• Other surveillance system indicators such as sensitivity, specificity, timeliness in 

detecting suspect or probable Ceph-R NG cases

CDC should assess the overall impact of national Ceph-R NG public health response action by 

monitoring local access to culture/AST and the trends of emergence and transmission of Ceph-R 

NG strains in the United States by using epidemiology and mathematical modeling approaches. 

Role of Enhanced Gonorrhea Prevention and Control Activities

While the clinical and public health responses recommended by the Ceph-R NG Response Plan

largely focus on targeted intervention activities for suspect or probable Ceph-R NG cases, public 

health authorities should also continue to scale up general gonorrhea prevention and control 

activities. These activities are designed to reduce the overall gonorrhea disease burden 

through prevention, early diagnosis, timely and effective treatment, and partner services.

Effective gonorrhea prevention and control activities will reduce overall disease burden and 

thus the response needed when Ceph-R NG strains are identified.

Need for Alternative Treatment Options

Currently, CDC recommends dual therapy with ceftriaxone 250 mg intramuscularly as a single 

dose with either azithromycin 1 gram orally as a single dose or doxycycline 100 mg orally twice 

a day for 7 days for the treatment of uncomplicated gonorrhea [2, 3]. Based on available data, 

this is the most effective regimen against urogenital, rectal, and pharyngeal gonorrhea; 

however, it is not known whether use of this dual regimen can delay the emergence of Ceph-R 

NG. 

In the past, CDC recommendations for gonorrhea treatment have been based on the criteria of 

efficacy in ≥95% of N. gonorrhoeae infections in the population [28]. When resistance 

developed to recommended treatment regimens in the past, the public health response was to 
19

switch to an alternative class of antimicrobials that would effectively treat ≥95% of N. 

gonorrhoeae strains in the United States. The current lack of well-studied and effective therapy 

for Ceph-R NG is a major challenge for public health authorities in responding to the threat of 

emerging Ceph-R NG. 

Effective alternative antimicrobials or antimicrobial combinations for the treatment of 

gonorrhea are needed urgently; thus, the development of novel antimicrobials and clinical trials 

to study combinations of existing antimicrobials is necessary.

In collaboration with international and national partners, CDC will develop an evidence base of 

the effectiveness of existing antimicrobials and drug combinations and support the 

development and evaluation of novel antimicrobial agents and drug combinations that are 

ideally oral, single dose, meet the 95% effectiveness standard, and are not cost-prohibitive. 

CDC will work with the National Institutes of Health (NIH) and the new National Center for 

Advancing Translational Sciences (NCATS) to develop additional gonorrhea treatment options. 

CDC will also work with professional organizations concerned with antimicrobial resistance, 

such as Infectious Diseases Society of America (IDSA), the Association of Public Health 

Laboratories (APHL), and the National Coalition of STD Directors (NCSD). Lastly, CDC will 

continue to work with WHO, especially in the implementation of the Global Action Plan [29], as 

Ceph-R NG is a global public health concern.

Conclusions

This response plan is prepared as a pro-active attempt to minimize the impact of Ceph-R NG

through the implementation of effective clinical services and public health prevention practices.

As more evidence becomes available, the case definitions, clinical management, and public 

health response strategies outlined in this document will need to be reviewed and revised. 

Barriers to the effective control of Ceph-R NG exist, and in an era of declining STI public health 

infrastructure, local, state, and federal resources may need to be reprioritized to implement

this plan. However, a coordinated and sustained effort that includes clinicians, laboratorians, 

and state and local health departments will limit the impact of antimicrobial-resistant N. 

gonorrhoeae. Preparation and action now, prior to the emergence of resistant strains, will 

allow for a more effective and less costly response later.
20

References 

[1] Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2010. 

Atlanta: U.S. Department of Health and Human Services, 2011.

[2] Centers for Disease Control and Prevention. Cephalosporin susceptibility among Neisseria 

gonorrhoeae isolates - United States, 2000-2010. MMWR 2011;60(26):873-7.

[3] Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases 

treatment guidelines, 2010: Oral cephalosporins no longer recommended for treatment of gonococcal 

infections. MMWR in press.

[4] Akasaka S, Muratani T, Yamada Y, et al. Emergence of cephem- and aztreonam-high resistant 

Neisseria gonorrhoeae that does not produce β-lactamase. J Infect Chemother 2001;7:49-50.

[5] Deguchi T, Yasuda M, Yokoi S, et al. Treatment of uncomplicated gonococcal urethritis by 

double-dosing of 200 mg cefixime at a 6-h interval. J Infect Chemother 2003;9:35-9.

[6] Yokoi S, Deguchi T, Ozawa T, et al. Threat to cefixime treatment for gonorrhea. Emerg Infect Dis 

2007;13(8):1275-7.

[7] Lo JYC, Ho KM, Leung AOC, et al. Cefibuten resistance and treatment failure of Neisseria 

gonorrhoeae infection. Antimicrob Agents Chemother 2008;52(10):3564-7.

[8] Ito M, Yasuda M, Yokoi S, et al. Remarkable increase in central Japan in 2001-2002 of Neisseria 

gonorrhoeae isolates with decreased susceptibility to penicillin, tetracycline, oral cephalosporins, and 

fluoroquinolones. Antimicrob Agents Chemother 2004;48(8):3185-7.

[9] Su X, Jiang F, Quimuge, et al. Surveillance of antimicrobial susceptibilities in Neisseria 

gonorrhoeae in Nanjing, China, 1999-2006. Sex Transm DIs 2007;34(12):995-9.

[10] Ohnishi M, Saika T, Hoshina S, et al. Ceftriaxone-resistant Neisseria gonorrhoeae, Japan. Emerg 

Infect Dis 2011;17:148-9.

[11] Cole MJ, Chisholm SA, Hoffmann S, Stary A, Lowndes CM, Ison CA, et al. European surveillance of 

antimicrobial resistance in Neisseria gonorrhoeae. Sex Transm DIs 2010;86:427-32.

[12] Martin I, Swatzky P, Allen V, Hoang L, Lefebvre B, Mina N, et al. Emergence and characterization 

of Neisseria gonorrhoeae isolates with decreased susceptibilities to ceftriaxone and cefixime in Canada: 

2001-2010. Sex Transm DIs 2012;39(4):316-23.

[13] Unemo M, Golparian D, Syversen G, et al. Two cases of verified clinical failures using 

internationally recommended first-line cefixime for gonorrhoea treatment, Norway, 2010. Eurosurv 

2010;15(47).

[14] Ison CA, Hussey J, Sankar KN, et al. Gonorrhoea treatment failures to cefixime and azithromycin 

in England, 2010. Eurosurv 2011;16(14).

[15] Forsyth S, Penney P, Rooney G. Cefixime-resistant Neisseria gonorrhoeae in the UK: a time to 

reflect on practice and recommendations. Internat J STD & AIDS 2011;22:296-7.

[16] Unemo M, Golparian D, Stary A, Eigentler A. First Neisseria gonorrhoeae strain with resistance to 

cefixime causing gonorrhoeae treatment failure in Austria, 2011. Euro Surveill 2011;16(43):pii=19998.

[17] Unemo M, Golparian D, Nicholas R, Ohnishi M, Galay A, Sednaoui P. High-level cefixime- and 

ceftriaxone-resistant N. gonorrhoeae in Europe (France): novel penA mosaic allele in a successful 

international clone causes treatment failure. Antimicrob Agents Chemother 2012;56(3):1273-80.

[18] Camara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization 

of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J 

Antimicrob Chemother 2012;Epub ahead of print.

[19] Bolan GA, Sparling PP, Wassherheit JN. The emerging threat of untreatable gonococcal infection. 

N Engl J Med 2012;366(6):485-7.
21

[20] Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria 

gonorrhoeae -- Hawaii and California, 2001. MMWR 2002;51:1041-4.

[21] Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria 

gonorrhoeae among men who have sex with men -- United States, 2003, and revised recommendations 

for treatment, 2004. MMWR 2004;53:335-8.

[22] Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment 

Guidelines, 2006. MMWR 2006;55(RR-11).

[23] Centers for Disease Control and Prevention. Antibiotic-resistant strains of Neisseria 

gonorrhoeae. Policy guidelines for detection, management, and control. MMWR 1987;36(5S).

[24] Schwarz S, Zenilman J, Schnell D, et al. National surveillance of antimicrobial resistance in 

Neisseria gonorrhoeae. JAMA 1990;264:1413-7.

[25] U.S. Preventive Services Task Force. Screening for gonorrhea: recommendation statement. Ann 

Fam Med 2005;3:263-7.

[26] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial 

susceptibility testing. Twenty-first informational supplement. CLSI document M100-S21. Wayne, PA: 

Clinical and Laboratory Standards Institute, 2011.

[27] Bachmann LH, Desmond RA, Stephens J, et al. Duration of persistence of gonococcal DNA 

detected by ligase chain reaction in men and women following recommended therapy for 

uncomplicated gonorrhea. J Clin Microbiol 2002;40(10):3596-601.

[28] Handsfield HH, McCutchan JA, Corey L, Ronald AR. Evaluation of new anti-infective drugs for the 

treatment of uncomplicated gonorrhea in adults and adolescents. Clin Infect Dis 1992;15(Suppl 1):S123-

30.

[29] World Health Organization. Global action plan to control the spread and impact of antimicrobial 

resistance in Neisseria gonorrhoeae. Geneva, Switzerland: World Health Organization, 2012.
22

Appendix I:

Contact Information and Selected Web Resources

To report cases of suspect or probable Ceph-R NG to CDC: 

Email gispinfo@cdc.gov or call (404) 639-8659

To consult with a STD/HIV Prevention Training Center: 

Visit www.nnptc.org for the contact information of the Training Center closest to you

Instructions for shipping isolates to CDC can be found at: 

www.cdc.gov/std/Gonorrhea/arg/specimen_shipping_instructions1-29-08.pdf

Electronic copies of the Interview Record for Gonorrhea/Chlamydia and instructions can be 

found at:

http://www.cdc.gov/std/Program/forms/GC_CT_IR_6_05_2008.pdf

http://www.cdc.gov/std/Program/forms/GC-CT/GC_CT-IRInstructions.pdf

STD Treatment Guidelines:

http://www.cdc.gov/STD/treatment/
23

Appendix II:

Sample Regulatory Language for Mandated Reporting of 

Antimicrobial Susceptibility Testing (AST) Results

The following is an excerpt from New York City’s regulations concerning reportable conditions: 

“The director of a clinical laboratory conducting an examination of a specimen submitted for 

analysis shall, except as noted below with respect to blood banks, report to the Department, 

within 24 hours of obtaining results, all positive or reactive laboratory findings which indicate 

the presumptive or confirmed presence of any disease or condition required to be reported by 

subdivision (a) of § 11.03 of this Code, and also any laboratory findings which are otherwise 

required to be reported pursuant to this Article; ... Reports shall contain all of the information 

and data elements required by the reporting forms or electronic reporting format approved by 

the Department, including but not limited to: ... (8) The antibiotic susceptibility testing results 

for bacterial diseases listed under subdivision (a) of § 11.03 of this Code. This requirement 

includes traditional broth, agar and newer automated methods of antibiotic susceptibility 

testing, as well as molecular-based methods that assay for molecular determinants of antibiotic 

resistance.” 

Reference: New York City, N.Y., Tit. 24, Health Code, § 13.03.
24

Appendix III:

Table: CLSI cefixime and ceftriaxone agar dilution MIC and 

disk diffusion zone diameter standards for N. gonorrhoeae

[26]

Antimicrobial agent MIC by agar dilution Zone diameter by disk diffusion

Cefixime ≥0.25 μg/ml ≤31 mm

≥0.5 μg/ml Not defined

Ceftriaxone ≥0.125 μg/ml Not defined

≥0.25 μg/ml ≤35 mm
25

Appendix IV: 

Interview Record for Gonorrhea/Chlamydia

and 

Instructions for Interview Record for Gonorrhea/Chlamydia
Patient ID Condition(s) ReInfection? If yes, # Case ID Interview 

Record ID 

1 1

2 2

Y N U

Y N U

Patient Name Case ID 

Last Name First Name Middle Name 

Preferred Name / AKA Maiden Name 

Name 

Residence Street (Apt. #) City 

State Zip County District Country 

Residence Type 

Currently 

Institutionalized? Name of Institution 

Living With 

Address 

Y N U Institution

 Type 

STD Testing 

Local Use: A B C D E F G H I J K L 

Date Original Interview 

/ / Date First Assigned for 

Interview 

/ / 

Worker 

Worker 

/ / 

Worker 

Date Case Closed 

 Interview Period (mos.) Supervisor #

E-Mail Address(es) 

Home Phone 

Work Phone 

Cellular Phone 

Phone/Contact 

Method of Case 

Detection 

Age 

Other 

Laboratory Report Date 

/ /

Facility First Tested 

If Other, Describe 

Reporting 

Information 

Condition 1 

Date of Birth 

Demographics 

/ / Hispanic/Latino 

Race 

Marital Status 

Sex at Birth 

AI/AN A B NH/PI W U R 

S M Sep D W C U R

M F 

Pregnancy 

Pregnant at Exam? 

# Weeks 

Y N U R 

Date Collected Provider Test Qualitative Result 

/ / 

/ / 

P N I U 

P N I U 

P N I U 

Specimen Source 

Treatment Comments: 

Treatment Date Provider Drug and Dosage 

/ / 

/ / 

STD Treatment 

Risk Factors 

1. Had sex with a male? 

2. Had sex with a female? 

3. Had sex with an anonymous partner? 

In the last 12 months has the patient: 

5. During the past 12 months, which of the 

following injection or non-injection drugs have 

been used? 

4. Been incarcerated? 

Y - Yes N - No R - Refused to Answer D - Did not Ask 

Y N R D 

Y N R D 

Y N R D 

Y N R D 

Other, specify: None 

Y N R D 

Y N U R

Emergency Contact 

Pregnant in Last 12 Mos? 

Y N U R 

Provider Choice: 

Time At Address W M Time In State Time In Country Y W M Y W M Y 

Date Original Interview 

/ / Date First Assigned for 

Interview 

/ / 

Worker 

Worker 

/ / 

Worker 

Date Case Closed 

 Interview Period (mos.) Supervisor #

Method of Case 

Detection 

Other 

Laboratory Report Date 

/ /

Facility First Tested 

If Other, Describe 

Reporting 

Information 

Condition 2 

/ / 

Erectile dysfunction 

medications (e.g., Viagra) 

Nitrates/Poppers 

Methamphetamines 

Heroin 

Cocaine 

Crack 

None 

Please place an “X” for all that apply: 

Other 
Page 2 

HIV T esting 

Case ID 

Date Collected Provider Test Qualitative Result 

Provider 

Confirmed 

Tested for HIV at this event? Y N U R Previously Tested for HIV? Not Asked

/ / 

P N I U Q C

Not Asked Y N U R

Specimen 

Source 

Signs and Symptoms 

If Other, Please Describe: 

Duration 

(Days) 

Anatomic 

Site 

Earliest Observation 

Date 

/ / 

/ / 

/ / 

1. 

3. 

2. 

Signs/ 

Symptoms 

STD History 

Dx Date (mm/yyyy) 

Previous STD History? 

Condition 

3. 

2. 

1. 

Rx Date (mm/yyyy) 

Y N U R 

/ 

/ 

/ 

/ 

/ 

/ 

1 

Interview Period Partners 

Did not ask 

Refused to answer 

Did not ask 

Refused to answer 

Places Met Partners Places Had Sex 

Type Name Type Name 

Female 

Male 

Unknown Refused 

U R 

U R 

Female 

Male 

Unknown Refused 

U R 

U R 2 

Par tner/Cl uster Information 

3 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ / Init. Date 

/ / Init. Date 

Ix Date

/ / 

Ix Date

/ / Ix Type 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

1 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ / Init. Date 

/ / Init. Date 

Ix Date

/ / 

Ix Date

/ / 

Ix DIS # 

Ix DIS # 

Ix Type 

DIS # 

DIS # 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

2 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ / Init. Date 

/ / Init. Date 

Ix Date

/ / 

Ix Date

/ / Ix Type 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

FR# 

FR# 

FR# 

DIS # 

DIS # 

DIS # 

DIS # 

Ix DIS # 

Ix DIS # 

Ix DIS # 

Ix DIS # 

Social History Interview, Internet, and Investigation Comments 

Condition 

Incidental Antibiotic Treatment in Last 12 Months? 

Rx Date (mm/yyyy) Drug/Dosage/Duration 

Y N U

/ 

/ 
 

 

Ag

 

 

 

 

 

 

 

 

 

 

 

 

 

Interview 

1 

Patient ID Condition(s) ReInfection? If yes, # Case ID 

Y 

Y 

2 

Record ID 

1
 N U

N U

1
 

3 4 

2
 2
 

Patient Name Case ID 

Last Name First Name Middle Name 

Preferred Name / AKA Maiden Name 

Name 

Residence Street (Apt. #) City 

State Zip County District Country 

Residence Type 

Currently 

Institutionalized? Name of Institution 

Living With 

Address 

Y N U Institution

 Type 

STD Testing 

Local Use: A B C D E F G H I J K L 

Date Original Interview 

/ / Date First Assigned for 

Interview 

/ / 

Worker 

Worker 

/ / 

Worker 

Date Case Closed 

 Interview Period (mos.) Supervisor #

E-Mail Address(es) 

Home Phone 

Work Phone 

Cellular Phone 

Phone/Contact 

Method of Case 

Detection 

e 

Other 

Laboratory Report Date 

/ / Facility First Tested 

If Other, Describe 

Reporting 

Information 

Condition 1 

Date of Birth 

Demographics 

/ / 

Hispanic/Latino 

Race 

Marital Status 

Sex at Birth 

AI/AN A B NH/PI W U R 

S M Sep RUCWD

M F 

Pregnancy 

Pregnant at Exam? 

# Weeks 

Date Collected Provider Test Qualitative Result 

/ / 

/ / 

P N I U 

P N I U 

P N I U 

Specimen Source 

Treatment Comments: 

Treatment Date Provider Drug and Dosage 

/ / 

/ / 

STD Treatment 

Risk Factors Y - Yes N - No R - Refused to Answer D - Did not Ask 

RUNY 

Emergency Contact 

Pregnant in Last 12 Mos? 

Provider Choice: 

Time At Address W M Time In State Time In Country Y W M Y 

Date Original Interview 

/ / Date First Assigned for 

Interview 

/ / 

Worker 

Worker 

/ / 

Worker 

Date Case Closed 

 Interview Period (mos.) Supervisor #

Method of Case 

Detection 

Other 

Laboratory Report Date 

/ / Facility First Tested 

If Other, Describe 

Reporting 

Information 

Condition 2 

/ / 

Y - Y e s , A n a l o r V a g i n a l I n t e r c o u r s e ( w i t h o r w i t h o u t O r a l S e x ) O - Y e s , O r a l S e x 

O n l y U - U n s p e c i f i e d T y p e o f S e x N -No R - R e f u s e d t o A n s w e r D - D i d N o t A s k 

1. Had sex with a male? 

2. Had sex with a female? 

3. Had sex with an anonymous partner? 

In the last 12 months has the patient: 

5. During the past 12 months, which of the 

following injection or non-injection drugs have 

been used? 

4. Been incarcerated? 

Other, specify: 

Nitrates/Poppers 

Methamphetamines 

Heroin 

Cocaine 

Crack 

None 

Other 

Y N R D 

Y O U N R D 

Y O U N R D 

Y O U N R D 

Erectile dysfunction 

medications (e.g., 

Viagra) 

Y N R D 

5 

6 

7 

9 

10 

11 

12 

8 

13 14 

15 

Y N U R 

Y N U R 

W M Y 

Y N R D Y N R D 

Y N R D Y N R D

Y N R D 

Y N R D 

Y N R D 

3 

5 
 

 

 

 

 

 

 

 

 

 mat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2 

HI V Testi n g 

Case ID 

Date Collected Provider Test Qualitative Result 

Provider 

Confirmed 

Tested for HIV at this event? Y N U R Previously Tested for HIV? Not Asked

/ / 

Not Asked Y N U R

Specimen 

Source 

Signs and Symptoms 

If Other, Please Describe: 

Duration 

(Days) 

Anatomic 

Site 

Earliest Observation 

Date 

/ / 

/ / 

/ / 

1. 

3. 

2. 

Signs/ 

Symptoms 

STD History 

Dx Date (mm/yyyy) 

Previous STD History? 

Condition 

3. 

2. 

1. 

Rx Date (mm/yyyy) 

Y N U R 

/ 

/ 

/ 

/ 

/ 

/ 

1 

Interview Period Partners 

Did not ask 

Refused to answer 

Did not ask 

Refused to answer 

Places Met Partners Places Had Sex 

Type Name Type Name 

Female 

Male 

Unknown Refused 

U R 

U R 

Female 

Male 

Unknown Refused 

U R 

U R 2 

Par tne r/ S oci al Con tac t Infor io n 

3 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ /

Init. Date 

/ /

Init. Date 

Ix Date

/ / 

Ix Date

/ / Ix Type 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

1 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ /

Init. Date 

/ /

Init. Date 

Ix Date

/ / 

Ix Date

/ / 

Ix DIS # 

Ix DIS # 

Ix Type 

DIS # 

DIS # 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

2 

Ix Type FR# 

Freq. 

Last Name First Name 

P/CL 

Referral 

Spouse 

Condition 

1 

Dispo 

Pregnant / / Last 

Exposure 

Condition 

2 

Dispo 

Y N U R Y N U R First 

Exposure / / 

Sex 

M F U R 

AKA 

/ /

Init. Date 

/ /

Init. Date 

Ix Date

/ / 

Ix Date

/ / Ix Type 

/ /

Dispo Date 

/ /

Dispo Date 

1 2 3 

Referral 

1 2 3 

Cond. 

Cond. 

T 

Jurisdiction 

FR# 

FR# 

FR# 

DIS # 

DIS # 

DIS # 

DIS # 

Ix DIS # 

Ix DIS # 

Ix DIS # 

Ix DIS # 

Social History Interview, Internet, and Investigation Comments 

Condition 

Incidental Antibiotic Treatment in Last 12 Months? 

Rx Date (mm/yyyy) Drug/Dosage/Duration 

Y N U

/ 

/ 

16 

17 

18 19 

20 

21 

22 

23 

P N I U Q C
 

1 

Interview Record Instructions (GC/CT Version) 

The Centers for Disease Control and Prevention (CDC) Interview Record is primarily designed for use by state and local 

Disease Intervention Specialists (DIS) who interview individuals with sexually transmitted diseases (STDs), including 

HIV/AIDS and other related conditions, and conduct sex and needle sharing partner notifications and referrals. This 

instrument is meant to assist DIS and their managers in documenting and evaluating case management activities 

according to local program priorities and/or regulations. State and local program priorities and regulations will also 

determine what types of information should be documented and retained on this form. A small portion of the information 

recorded within this document will be transmitted to CDC. 

Though some data elements (excluding personal identifiers, i.e. names, addresses, telephone numbers, etc.) will be 

forwarded to CDC, this form does not represent a document that is to be used for federal data collection purposes in its 

entirety. Also, this form and accompanying documentation is an example of an Interview Record that can be used by 

local and state programs and is made available for local and state program use and adaptation. 

These instructions describe how to complete the interview record form. Each numbered item in the instructions 

corresponds to a number on the sample interview record form. 

NOTE: The “Month/Day/Year” (MM/DD/YYYY) format should be utilized for all date fields on this record, unless otherwise 

specified. 

1 

2 

Patient ID Number: Document the patient ID for this person, if known or applicable. 

NOTE: If using a computerized system, this number may be assigned by the software system. 

Condition: Document the specific disease code for the diagnosed and/or interviewed condition. Conditions will be 

interviewed for and/or documented on an interview form depending on local programmatic procedures and policies in 

place. If one of the conditions being interviewed is syphilis or HIV related, this is not the proper interview record to be 

completed. 

030 - HepB acute w/o delta 100 - Chancroid
 

031 - HepB acute w/ delta 200 - Chlamydia 

033 - HepB chronic w/o delta 300 - Gonorrhea (uncomplicated)
 

034 - HepB chronic w/ delta 350 - Resistant Gonorrhea
 

042 - Hepatitis delta 400 - Non-Gonoccocal Urethritis (NGU) 

051 - Hepatitis C, acute 450 - Mucopurulent Cervicitis (MPC) 

053 - Hepatitis E 490 - PID Syndrome
 

054 - Hepatitis C, chronic 500 - Granuloma Inguinale
 

070 - Hepatitis, unknown 600 - Lymphogranuloma Venereum (LGV) 

 Second Condition: Document a 2nd Condition, if one exists, using same list as above for disease(s) interviewed. 

Reinfection? If yes, #: Document if the interviewed condition is a ReInfection of same condition within the last 12 

months. If yes, document the number of times, including current infection, patient has been infected with this conditition 

in the last 12 months. 

3 

4 

Case ID(s) Number: Document the case ID number(s) for the corresponding condition(s). 

NOTE: If using a computerized system, this number may be assigned by the software system. 

Interview Record ID: Document the interview record number for this case, if known. This number is used for data 

processing/control purposes to link related cases. 

NOTE: If using a computerized system, this number may be assigned by the software system. 

Name 

5 Name: Document the patient’s last, first and middle names, any aliases or nicknames (AKAs), and maiden name (as 

applicable). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

6 

2 

Demographics 

Date of Birth: Document the patient’s date of birth. Leave blank if unknown. 

Age: Document the patient’s age at the time of initial exam for the earliest condition reported on this interview record. 

Document ‘0' if age is less than one year or ’999' if unknown. 

Hispanic or Latino*: Place an “X” in the appropriate box to identify the ethnic group with which the patient self identifies. 

Hispanic origin means a person of Spanish, Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish 

culture or origin, regardless of race. 

Y - Yes, Hispanic/Latino 

N - No, not Hispanic/Latino 

U - Unknown 

 R - Refused to answer 

Sex at Birth: Place an “X” in the appropriate box for the patient’s biologic sex at birth: male or female. Leave blank if 

unknown. 

Race*: Place an “X” in as many boxes as applicable. Base on the racial group(s) with which the patient self identifies. 

AI/AN (American Indian or Alaska Native): A person having origins in any of the original peoples of North 

and South America (including Central America). 

A (Asian): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the 

Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the 

Philippine Islands, Thailand, and Vietnam. 

B (Black or African American): A person having origins in any of the black racial groups of Africa. 

NH/PI (Native Hawaiian or Other Pacific Islander): A person having origins in any of the original peoples 

of Hawaii, Guam, Samoa, or other Pacific Islands.
 

W (White): A person having origins in any of the original peoples of Europe, the Middle East, or North 

Africa. 

U (Unknown): The patient could not answer this question for any reason. 

R (Refused): The patient refused to answer this question. 

Marital Status: Place an “X” in the appropriate box indicating marital status at the time of the interview or morbidity 

report. 

S - Single, Never Married W - Widowed 

M - Married C - Cohabitation 

SEP - Separated U - Unknown 

D - Divorced R - Refused to Answer 

7 

Address 

Address: Document the complete address where the patient currently resides. If the patient is currently institutionalized 

(e.g., in jail, in a group home, in a mental health facility, etc.), do not document the address of the institution unless it is 

determined that the condition was acquired in the institution. Include apartment number, city, county, 2-letter abbreviation 

for the state, 5-digit zip code, district or region (if applicable), and country for the address where the patient resides. 

Note: Work address(es) can be documented within the 

NOTE: If this is a temporary address, record the patient’s permanent address and any other interview period addresses in 

the Comments section. For an institutionalized person, list the last known address where the person resided. 

NOTE: Work address(es) can be documented within the comment section. 

Living With: Document the RELATIONSHIP (such as spouse, parents, sibling, roommate, etc., not the name) of those 

living with the patient. 

Residence Type: Document the appropriate code in the box for the type of residence for the above address. 

A - Apartment 

B - Mobile Home 

N - Homeless

 O - Other 
 

 

 

 

 

 

 

 

 

 

 

 

3 

Address 

C - Migrant Camp 

D - Dorm 

G - Group Home 

H - House/Condo

 J - Jail 

M - Hotel/Motel 

P - Prison 

Q - Mental Health Center 

R - Rehabilitation Center 

U - Unknown 

X - Drug Treatment/Detox Center 

 Y - Juvenile Detention 

Time At Address: Document the length of time the patient has lived at the current address, in this state/territory, and in 

the country. Also, place an “X” in the appropriate box to indicate whether the time at the corresponding location is in (W) 

weeks, (M) months, or (Y) years. If length of time is unknown, please document “UNK”. 

Currently Institutionalized?: Place an “X” in the appropriate box to indicate if the patient is institutionalized (i.e., in jail, in 

a group home, in a mental health facility, etc.). If institutionalized, document the name of the facility. 

Institution Type: Document the appropriate code in the box for the type of facility where the patient is currently 

institutionalized. 

 G - Group Home 

J – Jail 

 O - Other 

P - Prison 

Q - Mental Health Center 

R - Rehabilitation Center 

X - Drug Treatment/Detox Center 

 Y - Juvenile Detention 

Phone/Contact 

Phone/Contact: Document the phone number(s) where the patient can be reached and the patient’s e-mail address(es) if 

applicable. Include an emergency contact name, phone number, and relationship to patient, if available. 

8 

STD Testing 

Test Results: Summarize all STD lab results relevant to this case, noting at least the last negative result, the first positive 

result, and the most recent test if applicable. 

NOTE: HIV testing is not to be documented here but in HIV Testing Section. 

NOTE: Hepatitis testing can be documented within this section. 

Date Collected - Document the date the specimen was obtained from the patient. 

Provider - Document the specific name or code of the provider (physician, clinic, hospital, etc.) who ordered the testing. 

Test - Document the name (or type) of the test performed (e.g., RPR, TP-PA, darkfield, etc.). Ensure that the test type and 

condition (disease) being asked for is clear. 

Source - Document the code from the list below for the source of specimen collection. 

01 - Cervix/Endocervix 09 - Rectum 

02 - Lesion-Genital 10 - Urethra 

03 - Lesion-Extra Genital 11 - Urine 

04 - Lymph Node Aspirate 12 - Vagina 

05 - Oropharynx 13 - Blood/Serum 

06 - Ophthalmia/Conjunctiva 14 - Cerebrospinal fluid (CSF) 

07 - Other 88 - Not Applicable 

08 - Other Aspirate 99 - Unknown 

Qualitative Results – Place an “X” in the appropriate box to indicate the test result(s). 

P - Positive 

N - Negative 

9 
 

 

 

4 

I - Indeterminate/Equivocal

 U - Unknown/No Result 

Pregnancy 

10 

11 

Pregnant at Exam?*: Place an “X” in the appropriate box to indicate the patient’s pregnancy status at initial exam for the 

condition(s) documented on this interview record. If the patient was pregnant at the time of the initial exam, document the 

duration of the pregnancy in weeks at exam. Y - Yes, N - No, U - Unknown, R - Refused to Answer. 

Pregnant in Last 12 Months?: Determine if the patient has been pregnant during the last 12 months and place an “X” in 

the appropriate box. If currently pregnant, a “Yes” answer indicates that the patient had another pregnancy within the past 

12 months, not including her current pregnancy. Y - Yes, N - No, U - Unknown, R - Refused to Answer. 

STD Treatment 

Treatment: Document all relevant treatment regimen(s). For the recommendations of adequate treatment, see the 

current CDC Treatment Guidelines. 

Treatment Date - Document the date treatment was first started. 

Provider - Document the name or code of the provider (physician, clinic, hospital, etc.) that provided the treatment. 

Drug and Dosage - Document the name of the drug given, as well as the dosage and duration (e.g., 2.4 Bicillin x 3 weeks 

or Doxycycline 100mg bid x 28 days). 

Treatment Comments - Place treatment related comments, if any, here. 

Provider Choice - Document patient’s preferred provider for treatment. 

12 

Risk Factors 

NOTE: Each risk factor should be addressed for the last 12 months prior to the date of the original interview. Also, for the 

purposes of risk assessment, sex is defined as having engaged in oral, anal and/or vaginal contact with another individual. 

NOTE: For each risk 1 – 3, the patient should be asked what type of sexual exposure occurred. Document the 

appropriate response, one response per risk factor. 

Y – Yes, Anal or Vaginal Intercourse (with or without Oral Sex) 

O – Yes, Oral Sex Only 

U – Unspecified Type of Intercourse 

N – No Sexual Exposure 

R – Refused to Answer 

D – Did Not Ask 

Anonymous - a sex partner whose name is unknown (e.g., met at a sex party, website, bathhouse, etc.). 

Drug Use Behaviors: Document the appropriate response of Y - Yes, N - No, R - Refused to Answer, or D - Did Not Ask. 

Please place an “X” in the appropriate box(es) for all recreational drug types used within the last 12 months. 

Condition(s) Reporting Information 

13 Method of Case Detection: Document the specific method of case detection code, i.e., how the patient first came to the 

attention of the health department, for each condition(s). 

20 - Screening: An asymptomatic patient was identified through screening (routine testing of populations 

who are asymptomatic in order to identify those with disease). Examples of screening programs include 

health department outreach to high-risk populations (e.g., commercial sex-workers), HIV care clinics, family 

planning, blood donation, corrections-based, and prenatal. This includes STD and other health department 
 

 

 

 

 

 

 

5 

clinic visits by a client who tests positive for a condition with which they were unaware (e.g., asymptomatic 

walk-ins) of before being seen at the clinic. 

21 - Self-Referred: Refers to patient who sought health services because of signs of an STD and were
 

subsequently tested for the disease being reported. This includes symptomatic STD clinic testing. 

22 - Patient Referred Partner: Patient referred by another infected person. This may be a named or 

unnamed partner. No health department involvement was necessary for this referral. 

23 - Health Department Referred Partner: This patient is a named partner of a known case. Patient 

identified through DIS, or other health department personnel, activity following an interview of another 

known case. The health department was involved in the referral of this individual (e.g., the DIS contacted, 

called, visited, sent letter, etc., the patient to inform them of their need to be tested). 

24 - Cluster Related: Patient was originally identified as a Social Contact (Suspect) or Associate. Cluster 

brought to the attention of the program as a result of a DIS interview.
 

88 - Other: In the event of NONE of the above being applicable, accurately describe how the patient came
 

to the attention of the health department. 

Interview Period: Document the interview period in months for each condition. 

Type Facility First Tested: Document the specific type of facility code where the patient was first tested for each 

condition. If ‘88’ (Other) please describe as specifically as possible in the space provided. 

01 - HIV Counseling/Testing Site 13 - Blood Bank 

02 - STD Clinic 14 - Labor and Delivery 

03 - Drug Treatment 15 - Prenatal 

04 - Family Planning 16 - Job Corps 

05 - RETIRED 17 - School-based Clinic 

06 - TB Clinic 18 - Mental Health Services 

07 - Other HD Clinic 29 – Hospital (Other) 

08 - Private MD/HMO 66 - Indian Health Services 

09 - RETIRED 77 - Military 

10 - Hospital (ER) 88 - Other 

11 - Correctional facility 99 - Unknown 

12 - Lab 

Date of Laboratory Report: Document the date the first laboratory report related to the interviewed condition 

documented on this interview record was initially received at the health department (or any authorized public health 

agency, e.g., the STD clinic) for each condition(s). 

Case Information 

Date First Assigned for Interview: Document the date this case was initially assigned for interview and the worker 

number of the DIS to whom it was assigned for each condition. 

Date Original Interview: Document the date of the initial interview and the worker number of the DIS that performed the 

interview for each condition. 

Date Case Closed: Document the date of case closure as well as the worker numbers of the investigating DIS and 

supervisor, if applicable, responsible for the management of this case for each condition(s). The determination of closure 

should be made by the DIS and supervisor, if applicable, after all reasonable efforts have been expended on the case. 

14 

15 Local Use: This area is provided for special data collection needs of individual program areas. 

16 

HIV Testing 

Tested for HIV at this event?: Place an “X” in the appropriate box to indicate whether the patient was tested for HIV at 

the time of the initial screening that led to this reported condition(s). Y - Yes, N - No, U – Unknown, R - Refused to 

Answer, or Not Asked. 
 

 

 

6 

NOTE: Relevant HIV testing and interview may occur on the same day. Also, the answer “No” for Tested for HIV at this 

event includes opt-out/routine HIV testing in settings where HIV pretest counseling is not conducted. 

Previously Tested for HIV?: Place an “X” in the appropriate box to indicate whether the patient has tested for HIV prior to 

the event that led to the Original Interview. Y - Yes, N - No, U – Unknown, R - Refused to Answer, or Not Asked. 

HIV Test Results: Place the most recent or relevant HIV lab results. Document the date collected, the provider name or 

code who ordered the test, the name of the test, the source, and the qualitative result (see item #9 for codes). 

Provider Confirmed – Place a ‘Y’ for ‘Yes’ if HIV test result(s) has been provider confirmed by record search or direct 

contact with a provider. Place an ‘N’ for ‘No’ if based on interviewee responses only. 

17 

Signs and Symptoms 

Signs and Symptoms: Determine if there are signs or symptoms related to the condition(s) documented on this interview 

record. This includes all symptoms experienced by the patient and signs observed by a clinician. Additional signs and 

symptoms can be documented within the Interview/Investigation Comments. 

Signs/Symptoms - Document the code for each sign/symptom observed on exam or described: 

A - Discharge or Mucopurulent Cervicitis (MPC) 

B - Chancre, Sores, Lesions, or Ulcers 

C - Rash 

D - Dysuria 

E - Itching 

F - Alopecia (Hair loss) 

G - Condyloma Lata 

H - Bleeding 

I - Pharyngitis (Sore Throat) 

J - Painful Sex 

K - Abdominal Pain 

L - Swelling/Inflammation 

M - Mucous Patch 

N - Lymphadenopathy 

O - Other 

P - Balanitis 

Q - Fever 

R - Cervical Friability 

S - Ectopy 

T - Epididymitis 

V - Proctitis 

W - Adnexal tenderness/Cervical motion tenderness 

Earliest Observation Date - Document the earliest date the symptom was first experienced by the patient and/or the date 

the sign was first observed by a clinician. 

Anatomic Site* - Document the code indicating the anatomic site of the sign/symptom. 

A - Anus/Rectum 

B - Penis 

C - Scrotum 

D - Vagina 

E - Cervix 

F - Naso-Pharynx 

 G - Mouth/Oral Cavity 

H - Eye-Conjunctiva 

I - Head 

J - Torso 

K - Extremities (Arms, Legs, Feet, Hands) 

N - Not Applicable 

O - Other 

U - Unknown 

Duration (Days) - Document the number of days signs/symptoms were present. Document “99” if unknown. 

If Other, Please Describe - if sign/symptom code “O” is used, please describe in the space provided. 

18 

STD History 

STD History*: Place an “X” in the appropriate box indicating if the patient has a history of STDs (prior to the condition(s) 

documented on this interview record). HIV testing history should be documented in the HIV Testing section. 

Y - Yes, patient has a history of STD 

N - No, patient has never had a prior STD 

U - Unknown if patient has had a prior STD 

R - Patient refused to answer any questions regarding prior STD History 

If ‘Yes’, document the condition code(s), diagnosis date(s) (MM/YYYY), and treatment date(s) (MM/YYYY) in the space 

provided. 
 

 

 

 

 

 

7 

030 - HepB acute w/o delta 100 - Chancroid 

031 - HepB acute w/ delta 200 - Chlamydia 

033 - HepB chronic w/o delta 300 - Gonorrhea (uncomplicated) 

034 - HepB chronic w/ delta 350 - Resistant Gonorrhea 

042 - Hepatitis delta 400 - Non-Gonoccocal Urethritis (NGU) 

051 - Hepatitis C, acute 450 - Mucopurulent Cervicitis (MPC) 

053 - Hepatitis E 490 - PID Syndrome 

054 - Hepatitis C, chronic 500 - Granuloma Inguinale 

070 - Hepatitis, unknown 600 - Lymphogranuloma Venereum (LGV) 

Interview Period Partners: Document the total number of female, male, and transgender sex partners claimed by this 

patient during the interview period for each Condition(s). Note that this includes initiated partners, marginal partners, and 

anonymous partners. For example, the patient may claim 10 sex partners during the 3-month interview period (Primary 

Syphilis), while there is only enough information to initiate 3; the total of 10 (rather than 3) should be documented for 

interview period partners. Select ‘unknown’ if patient is unsure or ‘refused’ if the patient would not answer the question. 

Document “0” if there are no partners for corresponding gender field. 

Interview Period Partners 

20 

19 

Partner/Cluster Information 

This section of the form is used to record all interview activity and the results of investigations regarding partners and 

clusters. Guidelines for completing the partner/cluster initiation section are: 

NOTE: If a patient is interviewed, complete at least one partner/cluster section. If no partners/clusters are added, 

document the date of interview, the number of the DIS/worker who conducted the interview, and the type of interview 

conducted. 

NOTE: Document only the names of sex partners, social contacts and associates for whom sufficient information has 

been obtained to initiate a Field Record. Information on marginal contacts and clusters should be documented in the 

space provided and/or on a buff. 

NOTE: All re-interview or cluster activity must be listed in separate sections. Use of Re-Interview and Cluster Interview 

Forms are encouraged for complete documentation. 

NOTE: Clusters must be named by the index patient, named contacts or named clusters to be documented on the 

interview record. General field screening not specifically associated with this interviewed patient should not be included in 

this section. Other mechanisms must be used to collect this type of screening information. 

Name: Document the Last and First name and, if applicable, known aliases of the partner/cluster. 

Jurisdiction: Document the county, state or country code or name for where the partner/cluster resides. Use of code or 

name depends on local programmatic discretion. 

P/Cl (Partner/Cluster): Document the appropriate identifier for the specific type of partner or cluster (Suspect and/or 

Associate). 

PARTNER - Persons having sexual activities (of any type) or sharing needles with the Index patient. 

P1 - Sex Partner 

P2 - Needle sharing Partner 

P3 - Both Sex and Needle sharing Partner 

SOCIAL CONTACT (SUSPECT) - Persons named by an infected person (e.g., the Index patient or an infected 

partner or cluster). 

S1 - Person who has or had symptoms suggestive of the Condition(s) documented. 

S2 - Person who is named as a sex partner of a known infected person. 

S3 - Any other person who would benefit from an exam (i.e., someone who has engaged in a behavior that 
 

 

 

 

 

 

 

 

 

 

 

 

8 

Partner/Cluster Information 

might put them at risk). 

ASSOCIATE - Persons named by an uninfected partner or cluster. 

A1 - Person who has or had symptoms suggestive of the Condition(s) documented. 

A2 -Person who is named as a sex partner of a known infected person. 

A3 - Any other person who would benefit from an exam (i.e., someone who has engaged in a behavior that 

might put them at risk). 

Exposure to Original Patient: Document the Index Patient’s contact with the partner. 

First Exposure - Document the date of the first sexual/needle-sharing exposure to the Index patient. 

Freq. (Frequency) - Document the frequency (number) of sexual/needle-sharing exposure to the Index patient between the 

first and last (most recent) exposure. This should be described as specifically as possible: 1x = one time, 2x/wk = two 

times a week, etc. If the frequency is unknown, document “99”. 

Last Exposure - Document the date of the last (most recent) sexual/needle-sharing exposure. 

NOTE: Exposure information should only be documented for partners of the Index patient; only what the Index patient 

claimed as exposure should be documented, NOT what the partners claimed as exposure. 

Sex: Place an “X” in the appropriate box to indicate the gender of the partner or cluster, as identified by the person being 

interviewed: M - Male, F - Female, T - Transgender, U - Unknown, R - Refused. 

NOTE: If transgender is marked, MTF or FTM should be documented on the corresponding Cluster Interview Record. 

Pregnant: Document if this partner/cluster is pregnant: Y - Yes, N - No, U - Unknown, R - Refused to Answer. 

Spouse: Document if this partner/cluster is the Index patient’s spouse: Y - Yes, N - No, U - Unknown, R - Refused to 

Answer. 

IX Date (Interview Date): Document the date the original interview, re-interview or cluster interview was performed. 

Document interview dates where no partners or clusters are initiated as well using. 

Init. Date (Initiation Date): Document the date this partner/cluster was initiated for field investigation. 

IX DIS # (Interview DIS): Document the worker number of the DIS who conducted the interview for each condition (if 

multiple conditions). Also, document the worker number if no contacts or clusters are initiated. 

Ix Type (Interview Type): Document the type of interview that was the source of the partner/cluster information. 

O - Original Interview - the initial interview with an infected patient. 

R - Re-Interview - any interview after the Original Interview of an infected patient. 

C - Cluster Interview - any interview of a partner or cluster regarding the index case. 

U - Unable to interview - (may include situations where the Index patient was not interviewed, but sex 

partners and/or clusters were initiated from other activities). 

Referral: This describes how initiated partners and clusters are brought to examination and/or treatment. This 

documentation will take place at the time of the disposition (closure) of the field record. Document the type of referral for 

each condition. 

1 - Provider: DIS or other health department staff were involved in the referral of this partner/cluster. 

2 - Patient (Client): No health department involvement in the referral of this partner/cluster. 

3 - Dual (Contract): A combination of provider and patient effort to bring contact/cluster to services. 

FR # (Field Record Number): Document the entire field record number(s) for the partner/cluster initiated. This number is 

located in the lower left corner of the CDC form 73.2936S, or may be generated by the software system. 
 

 

 

9 

Partner/Cluster Information 

Dispo (Disposition): Document the STD or HIV disposition code from the field record for each Condition(s): 

STD Dispositions 

A - Preventative Treatment 

B - Refused Preventative Treatment 

C - Infected, Brought to Treatment 

D - Infected, Not Treated 

E - Previously Treated for This Infection 

F - Not Infected 

G - Insufficient Information to Begin Investigation 

H - Unable to Locate 

J - Located, Refused Examination and/or Treatment 

K - Out Of Jurisdiction 

L - Other 

HIV Dispositions 

1 - Previous Positive 

2 - Previous Negative, New Positive 

3 - Previous Negative, Still Negative 

4 - Previous Negative, Not Re-tested 

5 - Not Previously Tested, New Positive 

6 - Not Previously Tested, New Negative 

7 - Not Previously Tested, Not Tested Now 

G - Insufficient Information to Begin Investigation 

H - Unable to Locate 

J - Located, Refused Counseling and/or Testing 

K - Out Of Jurisdiction 

L - Other 

Dispo Date (Disposition Date): Document the appropriate date as it relates to the following examination or treatment 

situation for each Condition(s). 

Newly Examined and Treated - Use the date of treatment. 

Newly Examined, not Treated - Use the date of examination. 

Previously Examined and/or Treated - Use the date the partner/cluster investigation is closed (i.e., the date 

the investigator became aware of the previous examination and/or treatment). 

Not Examined - Use the date the investigation is closed. 

NOTE: A partner/cluster CAN NOT be dispositioned before it is initiated. Therefore, if examination and/or treatment 

occurred prior to the partner/cluster being initiated (e.g., disposition ‘E’ or ‘A’), the disposition date can be no earlier than 

the initiation date. 

Cond. (Condition): If partner/cluster is dispositioned as infected, whether previously or currently, document the diagnosis 

code for the condition. 

030 - HepB acute w/o delta 

031 - HepB acute w/ delta 

033 - HepB chronic w/o delta 

034 - HepB chronic w/ delta 

042 - Hepatitis delta 

051 - Hepatitis C, acute 

053 - Hepatitis E 

054 - Hepatitis C, chronic 

070 - Hepatitis, unknown 

100 - Chancroid 

200 - Chlamydia 

300 - Gonorrhea (uncomplicated) 

350 - Resistant Gonorrhea 

400 - Non-Gonoccocal Urethritis (NGU) 

450 - Mucopurulent Cervicitis (MPC) 

490 - PID Syndrome 

500 - Granuloma Inguinale 

600 - Lymphogranuloma Venereum (LGV) 

710 - Syphilis, primary 

720 - Syphilis, secondary 

730 - Syphilis, early latent 

740 - Syphilis, unknown duration 

745 - Syphilis, late latent 

750 - Syphilis, late w/ symptoms 

800 - Genital Warts 

850 - Herpes 

900 - HIV Infection 

950 - AIDS (Syndrome) 

DIS #: Document the worker number of the DIS who brought this partner or cluster to disposition for each Condition(s). 

Social History 

21 Places Met Partners: Document the codes for the types of places where the patient met sex partners within the last 12 

months (document as many as apply): 

A - Adult Book Store/Cinema J - Jail/Prison S - Partner's Home 

B - Bars K - Clubs T - Street 

C - Cruising in Automobile
 L - Beach U - Circuit Party 
10 

D - Dance Halls M - Motel/Hotel V - Cruise (Boat) 

E - Escort Services
 N - Shopping Mall W - Work 

F - Baths/Spas/Resorts O - Other X - Park/Rest Area 

G - Place of Worship
 P - Project/Shelter 

H - Home
 Q - School
 

I - Chat Rooms/Lines/Email/Internet
 R - Gyms/Health Clubs 

Document the names (or descriptions) of places the patient goes to meet sex partners. Document ‘did not ask’ or ‘refused 

to answer’ if applicable. If additional space is needed, document within the Interview/Investigation Comments (item 23). 

Places had Sex: Document the codes (from above list) for the types of places where the patient had sex with partners 

within the last 12 months (document as many as apply); document the names (or descriptions) of the places the patient 

had sex with partners. Document ‘did not ask’ or ‘refused to answer’ if applicable. If additional space is needed, 

document within the Interview/Investigation Comments. 

Place an “X” in the appropriate box, Y - Yes, N - No, U - Unknown. If incidental antibiotic treatment occurred (that being 

an antibiotic that the patient did not receive to specifically treat this condition), document the date (MM/YYYY) the 

treatment began and the drug, dosage and duration used, and for what condition the treatment was prescribed, if known. 

If the date the treatment began is unknown, document “99/9999”. 

22 

Interview, Internet, and Investigation Comments 

Interview/Investigation Comments: This section is provided to record, in a narrative fashion, any additional information 

not included in the interview record, any relevant information discovered in the course of the investigation (such as 

attitude of the patient, if he or she was high/intoxicated, etc.), or to note any inconsistencies during the interview or DIS 

analysis of interview information. Also use this space to document any related internet use information, including 

alternate email addresses, instant messenger usernames, chat sites, etc. Also, note whether there were STD Clinic or 

provider accessability or availability issues that affected service to the patient. 

Incidental Antibiotic Treatment in Last 12 Months 23