Increases in Syphilis and Gonorrhea Among Men Who Have Sex with Men in the United States

BACKGROUND:  Increases in primary and secondary syphilis among gay, bisexual, and other men who have sex with men (MSM) have been well documented in the United States since 2001. Because most jurisdictions do not collect information on sex of sex partners for men reported with gonorrhea in the National Notifiable Disease Surveillance System (NNDSS), trends in gonorrhea for MSM have been difficult to assess. As the second most commonly notifiable disease in the U.S. with over 169,000 cases reported in men in 2013, gonorrhea not only causes proctitis and epididymitis in men, it is also associated with HIV transmission and acquisition.

METHODS:  To better understand gonorrhea trends during 2009-2013, we examined data from several sources: NNDSS, which receives case reports from all 50 states; the STD Surveillance Network (SSuN), a sentinel network of 12 collaborating state and local health departments that collect demographic and behavioral information from interviews on a random sample of persons reported with gonorrhea; the Gonococcal Isolate Surveillance Project (GISP), a sentinel system of 25-30 selected STD clinics located throughout the U.S., established to monitor antimicrobial susceptibility in symptomatic men with urethral gonorrhea.

RESULTS:  During 2009-2013, the rate of gonorrhea based on notifiable disease surveillance data among men increased 20% while the rate among women decreased 2%. Increased rates among men were observed in whites (96%) and Hispanics (68%), but rates decreased 6% among blacks. Rates among men have increased in all regions of the country with the largest increases occurring in the West (69%) and Northeast (41%). In SSuN, during 2010-2013, the proportion of all reportable gonorrhea cases attributable to MSM increased in 10 of 12 jurisdictions and 14% overall (23.7% to 27.0%); at the same time, the proportion of cases attributable to men who have sex only with women remained relatively stable, while the proportion of cases among women declined 13%. In GISP, the proportion of urethral isolates obtained from MSM in selected STD clinics increased from 25% of men with gonorrhea consecutively attending these clinics in 2009 to 35% in 2013.

CONCLUSIONS:  Data from several sources suggest that, like syphilis, gonorrhea is increasing among MSM in the U.S.