Objectives: The objectives of this study were to analyze the spread of gonorrhea in men who have sex with men (MSM) in Stockholm regarding serovars, HIV status, and site of infection and to compare the distribution of serovars among HIV-positive and HIV-negative MSM.
Study design: Clinical and epidemiologic data were collected for all MSM diagnosed with gonorrhea in 1990 to 2004 at a clinic primarily serving MSM. Neisseria gonorrhoeae strains were serotyped.
Results: A total of 1,039 isolates from 840 gonorrhea episodes in 721 patients were included. A sharp increase was seen during the 2000s. Ten percent of the cases were HIV-positive. The proportion of pharyngeal infections increased significantly (P <0.001) from 15% to 38% during the last 7 years. A great variation of serovars (n = 66) was observed, but only 5 were present >10 years. There was a significant difference (P = 0.001) in distribution of serovars correlated to HIV status.
Conclusion: Gonorrhea is a marker for HIV infection in MSM, but the increase in gonorrhea may be associated with genital-oral sexual practice rather than with high-risk sexual practice.