Gonorrhea and Chlamydia — Proportion of MSM* Attending STD Clinics Testing Positive for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2013
Neisseria gonorrhoeae — Percentage of Urethral Isolates Obtained from MSM* Attending STD Clinics, by Site, Gonococcal Isolate Surveillance Project (GISP), 1990–2013
Compared to women and men who have sex with women only, gay, bisexual, and other men who have sex with men (collectively known as MSM) are at increased risk for STDs and antimicrobial resistance:
Gonorrhea and Chlamydial Infection
In 2013, the proportion of MSM who tested positive for gonorrhea and chlamydia at STD clinics varied by site. A larger proportion of MSM who visited STD clinics tested positive for gonorrhea than tested positive for chlamydia in all cities except Birmingham, Denver, and Hartford/New Haven (where the proportion for chlamydia was higher).
Across the participating sites, 20,955 MSM were tested for gonorrhea and 20,710 MSM were tested for chlamydia. The median site-specific gonorrhea prevalence was 16.9% (range by site: 10.4%–28.1%). The median site-specific chlamydia prevalence was 15.2% (range by site: 7.4%–30.7%). For this report, a person who tested positive for gonorrhea or chlamydia more than one time in a year was counted only once for each infection.
Co-infection of Primary and Secondary (P&S) Syphilis and HIV
Among MSM who presented to seven clinics with P&S syphilis infection in 2013, the proportion who were also infected with HIV ranged from 15.8% in Los Angeles to 47.4% in Philadelphia. The median site-specific proportion of MSM co-infected with HIV (45.5%) was comparable to the proportion of co-infection in MSM observed in 2013 case report data (51.6%)
HIV status and STDs
Among MSM visiting STD clinics, prevalence of STDs was higher among HIV-positive MSM than among HIV-negative MSM. The prevalence of P&S syphilis was 9.0% among HIV-positive MSM and 2.6% among HIV-negative MSM. Among HIV-positive MSM, urethral gonorrhea positivity was 15.0%, pharyngeal gonorrhea positivity was 10.0%, and rectal gonorrhea positivity was 16.4% (compared to 10.1%, 7.4%, and 8.9%, respectively, among HIV-negative MSM). Among HIV-positive MSM, urethral chlamydia positivity was 7.6% and rectal chlamydia positivity was 22.2% (compared to 7.1% and 11.4%, respectively, among HIV-negative MSM).
Nationally Notifiable Syphilis Surveillance Data
P&S syphilis among MSM has been increasing since at least 2000. In 33 areas reporting sex of partner data for 70% or more of cases of P&S syphilis each year during 2007–2013, cases among MSM increased 7% during 2012–2013. In 2013, MSM accounted for 75% of all P&S syphilis cases in 49 states and the District of Columbia that provided information about sex of sex partners. MSM accounted for more cases than MSW or women in all racial and ethnic groups.
Gonococcal Isolate Surveillance Project
GISP is a national sentinel surveillance system designed to monitor trends in antimicrobial susceptibilities of N. gonorrhoeae strains in the United States. Overall, the proportion of isolates from MSM in selected STD clinics from GISP sentinel sites has increased steadily, from 4.6% in 1990 to 35.1% in 2013. GISP has demonstrated that gonococcal isolates from MSM are more likely to exhibit antimicrobial resistance than isolates from MSW.
Author’s note: Despite these alarming findings, the gay media (and the highly gay-supportive main-stream news outlets) almost unanimously refuse to report on the CDC study; instead, they parade such well-scrubbed, athletic, and healthy looking gay specimens as Robbie Rogers (just recently, GQ grilled Rogers about his first homosexual experience – all amid laughter and joviality) before the cameras of the world; but, like when pop-culture was obsessed with uninhibited dancing homosexuals at Studio 54, The Village People, and Billy Crystal’s nonsensical gay character on “Soap,” at the advent of the AIDS crisis, this avoidance will come back to haunt us all.
And, the truth is shocking: in some cities as high as 28% of the gay population tested positive for gonorrhea and as much as 30% tested positive for chlamydia. Almost half of those gay men who tested positive for HIV also tested positive for syphilis; in fact, gay men (who make up between 2-4% of the total US population) accounted for 75% of all syphilis infections. Lastly, the statistic which horrifies me the most: the percentage of gay men who tested positive for drug-resistant gonorrhea increased from 4.6% in 1990 to 35.1% in 2013; Antibiotic-resistant gonorrhea has been noted by epidemiologists; beginning in the 1940s, gonorrhea was treated with penicillin, but doses had to be continually increased in order to remain effective, and, by the ’70s, penicillin- and tetracycline-resistant gonorrhea emerged in the Pacific Basin. These resistant strains then spread to Hawaii, California, the rest of the United States, and Europe. Fluoroquinolones were the next line of defense, but soon resistance to this antibiotic emerged as well. Since 2007, standard treatment has been third-generation cephalosporins, such as ceftriaxone, which are considered to be our “last line of defense;” when they stop working – they will all die. And the band played on…and on.