High rates of gonorrhoea among people living with HIV in the US

Combining HIV and gonorrhoea surveillance databases has revealed a high prevalence of gonorrhoea among people living with HIV in four US settings. Published in the online edition of the Journal of Acquired Immune Deficiency Syndromes, the research showed that between 2000 and 2008, approximately 5% of gonorrhoea cases involved people with HIV. Rates of gonorrhoea fell among the general population, but incidence of the infection increased among people with HIV. The investigators believe that combining databases “could allow for enhanced prevention among persons with HIV infection and acute STDs [sexually transmitted infections]”.

There are approximately 50,000 new HIV infections in the US each year. Prevention efforts are more likely to succeed if they are targeted to those with the highest risk. The presence of an untreated sexually transmitted infection can increase the risk of HIV transmission. Investigators therefore wanted to see if combining HIV and gonorrhoea surveillance databases allowed for the identification of people with HIV who had been diagnosed with gonorrhoea.

Surveillance data were obtained from four health jurisdictions: New York City, Washington DC, Miami/Dade County and Arizona.

Approximately 206,000 cases of gonorrhoea were diagnosed in these four areas between 2000 and 2008. The rate of diagnoses fell significantly over the course of the study in three sites: by 14% in New York City; by 21% in Arizona and by 10% in Washington DC. However, Miami experienced a 10% increase in gonorrhoea incidence.

A total of 9471 (4.6%) gonorrhoea cases involved people diagnosed with HIV. The rate differed between the four jurisdictions (New York City, 5.5%; Washington DC, 7.3%; Miami, 4%; Arizona, 2%).

In contrast to the overall fall seen in three study sites, the proportion of gonorrhoea diagnoses involving people with HIV increased significantly in all jurisdictions over the period of the study: from 3% in 2000 to 7% in 2008 in New York City; from 6.4 to 6.7% in Washington DC; from 2 to 4% in Miami; and from 0.7 to 3% in Arizona.

In each jurisdiction, the majority of people co-infected with HIV and gonorrhoea were men. The rate was 87% in New York City; 76% in both Washington DC and Miami; and 97% in Arizona. The investigators believe these findings indicate “many gonorrhoea-HIV co-infections are occurring in MSM [men who have sex with men] populations”. Despite their high risk, the authors note that the proportion of HIV-positive MSM having an annual gonorrhoea screen is low, “ranging from 14-18% for urethral screening and from 2-8.5% for oral/rectal screening”.

“Matching STD and HIV surveillance registries allowed us to identify and describe persons who acquired gonorrhoea subsequent to HIV diagnosis in 4 diverse jurisdictions”, comment the authors. “HIV care providers should prioritize HIV-infected patients with STDs for prevention strategies such as: initiation of antiretroviral therapy and adherence support; behavioural counselling; partner testing and referral; routine STD screening; and possibly pre-exposure prophylaxis (PrEP) for HIV for their uninfected sex partners.”

They conclude, “public health programmes with interest in prioritizing high-risk HIV-infected persons should consider the use of real-time data integration and analysis to identify STD/HIV co-infected persons and consider re-structuring priorities for partner service delivery for those who might not otherwise receive public health interventions”.