High HIV seroprevalence associated with gonorrhea: New York City Department of Health, sexually transmitted disease clinics, 1990-1997.

Abstract

To measure trends in HIV seroprevalence associated with gonorrhea in patients presenting to New York City Department of Health sexually transmitted disease (STD) clinics, 1990-1997 (n = 94 577). Unlinked HIV-1 serosurvey using remnant serum originally drawn for routine serologic tests for syphilis (STS). Demographic, risk factor, clinical and laboratory data were abstracted from clinic charts. No other data sources were used. Patients were not interviewed. During 1990-1997 HIV seroprevalence declined from 9 to 6% (P for trend < 0.01) in the STD clinic sample. Gonorrhea incidence city-wide declined from 481 per 100 000 to 194 per 100 000. HIV seroprevalence in patients with a diagnosis of gonorrhea (n = 11 914) remained stable at 10-11% during the period, whereas HIV seroprevalence associated with all other STDs combined declined from 8 to 5% (P for trend < 0.01). Seroprevalence in women with gonorrhea (n = 2243) declined from 8 to 4% (P for trend < 0.001), whereas seroprevalence in men with gonorrhea was stable at 11-12%. Seroprevalence in men aged less than 25 years and diagnosed with gonorrhea declined from 5 to 3% (P for trend = 0.02). In contrast, in men aged 25 years and older and diagnosed with gonorrhea, seroprevalence remained at 14-16% throughout the period 1990-1997. Among men with gonorrhea, seroprevalence was associated with same gender or bisexual contact [odds ratio (OR), 9.2; 95% confidence interval (CI), 8.1-10.4], age > 25 years (OR, 5.1; 95% CI, 4.6-5.7), and white race/ethnicity (OR, 1.3; 95% CI, 1.2-1.4). In this 9-year serosurvey the association between HIV and gonorrhea remained strong during a period when HIV seroprevalence and gonorrhea incidence declined. The data suggest that a gonorrhea diagnosis is an important risk marker in this era of 'safe sex' and that behavior patterns of patients with gonorrhea warrant further study.