Lv. Torian et al., High HIV seroprevalence associated with gonorrhea: New York City Department of Health, sexually transmitted disease clinics, 1990-1997, AIDS, 14(2), 2000, pp. 189-195
Objective: To measure trends in HIV seroprevalence associated with gonorrhe
a in patients presenting to New York City Department of Health sexually tra
nsmitted disease (STD) clinics, 1990-1997 (n = 94 577).
Method: Unlinked HIV-1 serosurvey using remnant serum originally drawn for
routine serologic tests for syphilis (STS). Demographic, risk factor, clini
cal and laboratory data were abstracted from clinic charts. No other data s
ources were used. Patients were not interviewed.
Results: During 1990-1997 HIV seroprevalence declined from 9 to 6% (P for t
rend < 0.01) in the STD clinic sample. Gonorrhea incidence city-wide declin
ed from 481 per 100 000 to 194 per 100 000. HIV seroprevalence in patients
with a diagnosis of gonorrhea (n = 11914) remained stable at 10-11% during
the period, whereas HIV seroprevalence associated with all other STDs combi
ned declined from 8 to 5% (P for trend < 0.01). Seroprevalence in women wit
h 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 an
d diagnosed with gonorrhea, seroprevalence remained at 14-16% throughout th
e 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 wh
ite race/ethnicity (OR, 1.3; 95% CI, 1.2-1.4).
Conclusions: In this 9-year serosurvey the association between HIV and gono
rrhea remained strong during a period when HIV seroprevalence and gonorrhea
incidence declined. The data suggest that a gonorrhea diagnosis is an impo
rtant risk marker in this era of 'safe sex' and that behavior patterns of p
atients with gonorrhea warrant further study. (C) 2000 Lippincott Williams
& Wilkins.