The pattern of reported gonorrhea in Upstate New York (exclusive of New York City) in the years 1975–1980 is one of intense central urban concentration, with concentric circles of diminishing incidence. The relative risk for gonorrhea in these central core areas, compared to background state rates, is 19.8 for men and 15.9 for women, but as high as 40 in selected census tracts. Prevalence appears to approach 20% in some areas, the level postulated by current epidemiologic models for continuing endemic transmission. These core areas are characterized by high population density, low socioeconomic status and a male to female case ratio of one or lower. Contact investigation data suggest that sexual contact tends to exhibit geographic clustering as well. These observations provide support for narrow focusing of epidemiologic resources as a major disease control strategy.