CDC Shows Gonorrhea Threat Among Gay and Bisexual Men

In mid-September, scientists from the CDC and other major researchers from around the world gathered in Australia at the 21st Meeting of the International Society of STD Researchers. One study in particular that was presented by CDC looks at a troubling increase in gonorrhea among gay and bisexual men (GBMSM).
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"There is no clear single answer for the increase, but is likely a mix of social as well as individual factors,"�Dr. Mark Stenger, the lead author on the study, told EDGE. "Re-infection through having sex again with an untreated partner may contribute to increased incidence, as can exposure to new partners who may not know they are infected (gonorrhea can also infect their throats or rectums without showing symptoms)."

Stenger noted that barriers to accessing health care may also contribute in that people may not seek care quickly when they suspect they are infected, or even seek care at all if they perceive homophobia, or if they cannot afford care for any reason.

"While CDC recommendations strongly encourage routine screening for GBMSM at all sites on their body where they are at risk for gonorrhea infection, this study underlines the urgent need to better understand the factors contributing to observed increases and to effectively tailor interventions to reach this important population," he said.

Utilizing data from the STD Surveillance Network (SSuN) between 2010 and 2013, this is the first study to examine trends of gonorrhea among gay and bisexual men across multiple areas and offers new insight into the burden of disease among this population.

Data were collected in 11 states across six geographically diverse regions of the U.S. The states and cities in our project represent approximately 20 percent of the U.S. population and include large metropolitan areas on both the East and West coasts, as well as more rural settings.

Estimates of the size of the GBMSM population and the proportion of cases attributable to GBMSM did vary across areas. The analysis wasn't specifically focused on differences between areas, but on the overall trend across all areas included in our project.

Based on patient interviews, all areas saw a significant proportion of gonorrhea cases among GBMSM, and this increased throughout the study period. Although the rate of increase is by Stenger's own estimation modest and did not affect women or men who have sex with only women in the study area, an increase in cases of gonorrhea among GBMSM is troubling for a number of reasons.

"First, GBMSM appear to be significantly and disproportionately affected by gonorrhea and the toll of this preventable STD in terms of pain and reduced quality of life is important for CDC and our many state and local public health partners to address," said Stenger. "Secondly, gonorrhea among GBMSM may be a bellwether of emerging trends nationwide because many GBMSM also have female partners; the possibility of a more generalized increase in gonorrhea is a real concern. And lastly, the threat of antibiotic resistant gonorrhea makes preventing all new cases of gonorrhea extremely important. This is of particular concern for gay and bisexual men as data indicates decreases in drug susceptibility have often been seen first among GBMSM."

Though great strides have been made by the public health community in reducing gonorrhea to historically low levels over the last three decades, gonorrhea is still one of the most common STDs in the United States. Because many infections may have no, or very mild symptoms, many may not realize they have it. If untreated, gonorrhea can cause serious health problems and increases the risk of contracting or transmitting HIV.

Because gonorrhea often has no symptoms, getting screened regularly is the best way for someone to know their status and prevent the spread of the disease. CDC recommends sexually active MSM get tested for gonorrhea, as well as syphilis and chlamydia, at least once a year.

If you are sexually active, using condoms consistently and correctly, as well as limiting the number of partners are effective strategies for disease prevention. And finally, if infected, it's critical to get treated with ceftriaxone and azithromycin right away to fully cure the infection and prevent transmission.

Many GBMSM infected with gonorrhea are also infected with HIV. Gonorrhea infections may make HIV medications in some people less effective and could increase the level of virus in their bodies. This is important in that people with higher viral loads or more virus circulating in their bodies may be more likely to transmit HIV.

"For GBMSM who are not infected with HIV, their risk of becoming infected if exposed can be increased by having gonorrhea," said Stenger. "Regardless of whether someone is infected with HIV, or otherwise immune compromised, getting screened frequently in all exposed body areas, and if infected, getting prompt treatment is strongly encouraged to help reduce the spread of gonorrhea among GBMSM."

For more information, visit http://www.cdc.gov/std/stats12/gonorrhea.htm