Risk factors for gonorrhea among heterosexuals--San Francisco, 2006

In San Francisco, coinciding with increases in the western United States, we observed substantial gonorrhea increases among young heterosexuals during 2003-2005. We conducted a case-control study to identify intervention strategies for prevention and control.

We interviewed case patients with gonorrhea during February-July, 2006 and control subjects at the local Department of Motor Vehicles. We included sexually active heterosexuals aged 15 to 35 years in sex-stratified analyses.

We interviewed 225 persons: 24 male and 28 female case patients and 98 male and 75 female control subjects. In multivariable analysis adjusting for black race and multiple partners among men, black race [adjusted odds ratio (AOR), 5.1; 95% confidence interval (CI), 1.7-15.0], having had multiple partners (AOR, 3.1; 95% CI, 1.1-8.5), having had an anonymous partner (AOR, 6.4; 95% CI, 1.9-21.4), and a long-term partnership (AOR, 0.3; 95% CI, 0.1-0.9) were associated with gonococcal infection. Among women, after adjustment for age, multiple partners, and black race (subject or partner), being black or having a black partner (AOR, 6.9; 95% CI, 2.2-21.8), having had a recently incarcerated partner (AOR, 6.2; 95% CI, 1.0-38.4), or meeting partners on the street (AOR, 19.0; 95% CI, 2.0-179.0) were associated with gonococcal infection.

Demographic and behavioral factors increase risk for gonorrhea among heterosexuals in San Francisco with partner characteristics being particularly important. Prevention and control efforts are focusing on blacks and incarcerated populations using street-based outreach and expanded screening and treatment.