Trends in HIV prevalence by self-report among MSM diagnosed and reported with gonorrhea in six United States jurisdictions from 2010 to 2019

Abstract

Background: HIV co-infection among persons diagnosed with gonorrhea is not well characterized. Trends in HIV prevalence among persons diagnosed with gonorrhea may have significant implications for HIV prevention interventions, especially for MSM. MSM are increasingly and disproportionately represented among incident gonorrhea cases reported in a multistate sentinel surveillance network. Using data from this network, we estimated HIV prevalence among MSM by self-report and explored trends in co-infection by key demographics.Design: Observational study using enhanced surveillance data.Methods: Six geographically diverse jurisdictions in the STD Surveillance Network (SSuN) 2010-2019 randomly sampled laboratory-confirmed gonorrhea cases. Enhanced investigations on sampled cases included patient interviews eliciting demographic, behavioral and HIV testing history. These data were weighted to adjust for study design and nonresponse to estimate trends in HIV prevalence.Results: Of 653 522 reported cases, 28 979 were sampled and investigated. The proportion of cases reporting living with diagnosed HIV at the time of their gonorrhea diagnosis increased 61% across the study period from 6.6% in 2010 to 10.8% in 2019. The observed increase in HIV prevalence is concurrent with an increase in the proportion of gonorrhea cases attributable to MSM. HIV prevalence among MSM decreased in two jurisdictions and increasing trends were observed among non-Hispanic Black and Hispanic MSM. HIV prevalence decreased among non-Hispanic white MSM, MSM under 20 and those 40 years of age or older. Conclusion:Diagnosis with gonorrhea, especially among MSM, should be a sentinel event triggering screening for HIV, referral to high-impact HIV prevention interventions or to HIV primary care.

Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August 2022

“…However, ascertaining the relative roles that exposure and biologic risks play in this disproportionality is challenging. Sexual behavior that confers risk for HIV acquisition also increases risk for acquiring other sexually transmitted infections (STIs) leading to a similar disproportionate overrepresentation of ** https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html † † https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html § § https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypoxvaccination.html MSM with HIV among STI cases (20); risk for monkeypox through sexual contact is likely similarly increased. Although it is possible that poorly controlled HIV would increase risk for monkeypox after exposure, evidence from other diseases suggests that persons with HIV infection who are receiving ART and have robust CD4 counts are not at increased risk for most infections, including opportunistic infections, and therefore might not be at increased risk for monkeypox after exposure.…”

Characteristics of Reported Gonorrhea Diagnoses During The COVID-19 Pandemic Compared With Pre–COVID-19 Pandemic, Baltimore City, Maryland

“…Prior work has shown that over 60% of persons living with HIV are insured, and among MSM, PrEP users were more frequently insured compared with non-PrEP users 22,23 . Among MSM, gonorrhea incidence has increased for years, particularly among MSM living with HIV and PrEP users 24–26 . Prior work also suggests that one-third of 2020 gonorrhea cases occurred among MSM 27 .…”

Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis

“…1 A recent report found that gonorrhea diagnoses among men living with diagnosed HIV increased by 61% from 2010 to 2019. 5 Urogenital gonorrhea is more prevalent among MSM with HIV compared with MSM without HIV; no differences were observed in urogenital chlamydia prevalence based on HIV status. 1 Screening programs designed to detect and treat NG/CT are a critical component of the public health response to these infections.…”

“…Among men, from 2015 to 2019, rates of chlamydia diagnoses increased by 32% and gonorrhea diagnoses increased by 61% 1 . A recent report found that gonorrhea diagnoses among men living with diagnosed HIV increased by 61% from 2010 to 2019 5 . Urogenital gonorrhea is more prevalent among MSM with HIV compared with MSM without HIV; no differences were observed in urogenital chlamydia prevalence based on HIV status 1…”