Background The diagnosis of a new bacterial STD in a person with documented HIV- infection suggests ongoing high-risk sexual behaviours. While high rates of syphilis among HIV-positive MSM have been repeatedly noted in South Florida, little attention has been given to the incidence of gonorrhoea (GC) and chlamydia (CT) among HIV-positive individuals, due to use of separate surveillance systems, differing security requirements, and limited partner services staff available to investigate GC and CT cases.
Methods We reviewed STD surveillance data from 2000 to 2009 after linking it to the HIV/AIDS surveillance data base. We analysed cases of GC and CT diagnosed >60 days after an HIV diagnosis.
Results Overall 3.7% of GC (1504 of 40 214) and 1.2% of CT (1149/99 265) cases were in persons known to be HIV- positive. The percentage of cases diagnosed in HIV- positive persons increased steadily over the time period; GC coinfections increased from 2.3% in 2000 to 5.0% in 2009 and CT coinfections increased from 0.8% to 1.3%. Most of the GC coinfected cases were among males; 1144/21 360 (5.4%) of males with GC were coinfected with HIV while 360/18 854 (1.9%) of females with GC were coinfected with HIV. For CT, 559/22 735 (2.5%) of males with CT were coinfected with HIV while 590/76 530 (0.8%) of females with CT were coinfected with HIV. Most coinfections were among HIV positive males, 73.5% of whom were men who have sex with men (MSM). Coinfections among men increased over the time period, while among women the number peaked in 2006 and has declined thereafter. HIV- positive men accounted for over 10% of GC infections among men 35–59 years of age and over 10% of CT infections among males 40–59. HIV coinfection was present for over 5% of GC infections among women 30–44 years of age and 50–54 years of age.
Conclusions While males with GC or CT who are coinfected with HIV constitute a small fraction of the cases in South Florida, the proportion is increasing steadily. HIV+ MSM account for a high percentage of cases among males over 35 years of age. Timely, accessible linkage between HIV and STD databases is essential to direct partner services and risk reduction counselling to this high-risk population.