Risk factors for and trends in gonorrhea incidence among persons infected with HIV in the United States.

Objective: To determine the risk factors for and trends in gonorrhea infections among HIV-infected persons. Design: Longitudinal review of medical records of HIV-infected patients. Methods: We analyzed data about HIV-infected patients obtained from 1991 to 1998 in over 100 facilities participating in the Adult/Adolescent Spectrum of HIV Disease Project. Results: The overall incidence of gonorrhea was 9.5 cases per 1000 person-years. Factors associated with higher gonorrhea incidence (P < 0.01) included younger age, male-male sex, black race, HIV infection without AIDS (namely AIDS-defining opportunistic illness or CD4 cell count < 200 × 10 6 cells/l), and recent recreational use of injection or non-injection drugs. There was an increase in the trend among men who have sex with men (P < 0.01) and a decrease in the trend among patients with heterosexual contact as their HIV exposure risk (P < 0.01). Among injection drug users there was no significant trend from 1991 to 1996, but there was an increase in gonorrhea incidence from 6.6 cases/1000 person-years in 1997 to 16.3 cases/1000 person-years in 1998. Conclusions: Following HIV diagnosis, some individuals continue to practice risky sexual behaviors which result in gonorrhea and may transmit HIV. The increase in the trend in gonorrhea incidence among HIV-infected men who have sex with men is of particular concern because it suggests an increase in risky sexual behaviors. These findings indicate a need for effective HIV prevention strategies that involve reducing risky sexual behaviors in HIV-infected persons.