Repeat Gonorrhea Diagnosis Rates and Associated Characteristics, STI Surveillance Network, 2016-2022

Individuals with multiple gonorrhea diagnoses (repeat GC) may be a key group for sexually transmitted infection (STI) prevention. We determined repeat- GC rates and associated characteristics by sexual orientation/gender identity within 7 jurisdictions in the STI Surveillance Network.

We constructed a retrospective cohort of randomly sampled, interviewed GC patients using enhanced surveillance data (January 1, 2016-December 31, 2021) and followed cases until the first repeat GC date (diagnosis ≥30 days after the interview-associated diagnosis) or December 31, 2022. We applied design weights with poststratification adjustment for nonresponse by sex and age and calculated repeat GC rates. We performed Poisson regression adjusted for follow-up time accrued during the COVID-19 pandemic to assess differences across characteristics.

Among 21,746 interviewed individuals representing 577,718 gonorrhea diagnoses, 46.8% were men who have sex with men (MSM), 21.6% were men not reporting male partners, 30.9% were women, and 0.7% were transgender/gender-diverse persons. Repeat GC rates per 1000 person-years were the following: MSM, 182.3 (95% confidence interval [CI], 173.8-191.0); men not reporting male partners, 64.5 (95% CI, 58.2-71.7); women, 47.7 (95% CI, 43.4-52.6); and transgender/gender-diverse persons, 73.3 (95% CI, 46.3-115.8). Repeat GC was associated with prior gonorrhea diagnosis (past 12 months; adjusted incidence rate ratio [aIRR]: 1.58 [95% CI, 1.42-1.75] for MSM, 1.37 [95% CI, 1.01-1.84] for men not reporting male partners, 1.59 [1.24-2.02] for women). Among MSM, repeat GC was associated with an initial rectal (aIRR, 1.24 [95% CI, 1.12-1.36]) or pharyngeal (aIRR, 1.14 [95% CI, 1.04-1.25]) infection (vs. other infection sites). Men not reporting male partners (aIRR, 1.57 [95% CI, 1.18-2.12]) and women (aIRR, 1.92 [95% CI, 1.11-3.30]) living with HIV (vs. not) had higher rates.

Characteristics associated with repeat GC (prior gonorrhea diagnosis, HIV status, anatomic site of infection) are available through routine STI surveillance and could be used to prioritize individuals for routine follow-up services and/or novel interventions to prevent repeat GC.