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Risk Factors for Rectal Gonococcal Infection Amidst Resurgence in HIV Transmission

KIM, ANDREA A. MPH*†; KENT, CHARLOTTE K. MPH*; KLAUSNER, JEFFREY D. MD, MPH*

doi: 10.1097/01.OLQ.0000086603.55760.54
Articles

Background Rectal gonorrhea in men has been increasing in San Francisco since 1995.

Goal The goal was to determine behavioral risk factors associated with rectal gonorrhea (RGC) among men who have sex with men (MSM) by HIV serostatus.

Study Design All men reporting receptive anal sex in the last 6 months are screened for RGC, regardless of reported condom use, at San Francisco's municipal sexually transmitted disease (STD) clinic. We surveyed a convenience sample of men screened for RGC at the clinic.

Results Among 564 MSM surveyed, 7.1% had RGC. HIV-positive MSM were significantly more likely (relative risk, 3.5, 95% confidence interval, 1.9–5.8) to have RGC. Behavioral risks for RGC infection varied significantly by HIV serostatus. HIV-positive MSM engaging in anonymous sex were at highest risk for RGC infection. Drug use during anal sex was the strongest risk factor for RGC infection among HIV-negative or unknown HIV status MSM.

Conclusion Our data suggest that STD and HIV prevention efforts among MSM in San Francisco must consider the role that HIV serostatus plays in acquisition of new infections.

Significant risk factors for rectal gonorrhea in men varied by HIV status: anonymous partners at bathhouses among HIV-positive men and high on drugs while having anal sex among HIV-negative men.

*San Francisco Department of Public Health, and the Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California

The authors acknowledge Ms. Toni Butler, the clinicians, and the clinic registration staff at the San Francisco City Clinic for their invaluable efforts with the implementation of this survey. They also thank all the participants of this survey who have contributed their time and personal experiences in helping to identify important factors contributing to rectal gonococcal infection among men who have sex with men in San Francisco.

Supported by the San Francisco Department of Public Health.

Correspondence: Charlotte Kent, MPH, STD Prevention and Control Services, 1360 Mission St., Suite 401, San Francisco, CA 94103. E-mail: charlotte.kent@sfdph.org

Received for publication January 27, 2003,

revised June 11, 2003, and accepted June 18, 2003.

© Copyright 2003 American Sexually Transmitted Diseases Association