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BACKGROUND: The reported number of gonorrhea cases in Florida increased 7.8% from 2012-2013, while the number of individuals with Human Immunodeficiency Virus (HIV) and gonorrhea increased by 17%. Prior studies indicate that 4.6% of new gonorrhea infections are already infected with HIV, but the temporal dynamics of gonorrhea and HIV diagnoses have not yet been documented properly (Taylor et al., 2013, JAIDS 64:115). Ideally, multiyear data should be used to analyze long term infection risks after a prior or concurrent gonorrhea or HIV diagnosis and surveillance databases are very suited for this. Seven years of surveillance data of Florida were analyzed to examine 1) the temporal dynamics between gonorrhea and HIV diagnoses, and 2) how those patterns changed over time.
METHODS: Reported gonorrhea and HIV cases from 2007 to 2013 were extracted from PRISM and eHARS, sequentially matched on the eHARS ID stored in PRISM, then social security number if eHARS ID was missing, or finally on full name and date of birth. The first reported gonorrhea and HIV diagnoses were used to determine the number of months between them. Monthly rates for the second diagnosis were estimated for each month since the first diagnosis and cumulative incidence rates of second diagnoses were estimated for each month. A concurrent diagnosis is defined as a gonorrhea infection within 60 days after the HIV diagnosis or a HIV diagnosis within six months after a gonorrhea diagnosis.
RESULTS: Of the 2871 individuals identified with gonorrhea and HIV, 1022, 805 and 1044 individuals acquired HIV prior to, concurrent, or subsequent to a gonorrhea diagnosis, respectively. Compared to the general population, clients with gonorrhea initially have a 14 times greater risk to acquire HIV, which decreases to about 6 times greater after 7 years. For individuals with HIV, the risks of subsequently being diagnosed with gonorrhea are 30 and 15 times greater, respectively.
CONCLUSIONS: The data suggests that individuals with a prior reported gonorrhea or HIV infection remain at an elevated risk to acquire HIV or gonorrhea even seven years after their initial diagnosis. This suggests that unsafe sexual practices continue long after the initial diagnosis with gonorrhea or HIV. Consequently, counselling of clients on the risk of STDs should not be limited to the immediate time after the last diagnosis, but should be extended to all people with a prior STD or HIV diagnosis regardless of time elapsed since the last diagnosis.