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

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.