Characteristics of homosexually-active men with gonorrhoea during an epidemic in Sydney, Australia

Our objective was to investigate an epidemic of gonorrhoea among homosexual ly-active men in Sydney. Demographic and behavioural data on all homosexual ly-active men diagnosed with gonorrhoea (any site) at the Sydney Sexual Hea lth Centre (SSHC) from 1992 through 1998 were reviewed. The men diagnosed w ith anal gonorrhoea were then compared with all homosexually-active men who tested negative for anal gonorrhoea or who were not tested for anal gonorr hoea at the SSHC between 1996 and 1998. Data on HIV status and country of b irth of men diagnosed with anal gonorrhoea during 1998 at the Taylor Square Private Clinic were also reviewed. Over the period 1992 to 1998, homosexua lly active men diagnosed with gonorrhoea at SSHC tended to become older at the time of diagnosis (median age 26.5 years in 1992 up to 31.0 years in 19 98), indicating a cohort effect in the clinic population due to service red uctions. When compared with men who tested negative for anal gonorrhoea at SSHC between 1996 and 1998, those with anal gonorrhoea were more likely to have anogenital symptoms (adjusted odds ratio [OR] 2.3), to have had a past history of gonorrhoea (OR 3.1), to present as a contact of gonorrhoea (OR 8.6), to have used condoms less consistently (OR 2.3), to be HIV positive o r of unknown HIV status (OR 3.2), and to have been born in an English-speak ing country other than Australia (OR 2.9). The last feature was not observe d at the private clinic. In conclusion, the gonorrhoea epidemic was linked to public health service reductions, though it seems unlikely to be the onl y factor. Homosexually-active men with anal gonorrhoea had well established behavioural risk factors while men with concurrent HIV infection were over represented. Given the role of gonorrhoea in promoting the spread of HIV in fection, a National Sexual Health Strategy-closely linked to the National H IV/AIDS Strategy-is due.