Background:
Although gonorrhea is the second most commonly reported notifiable disease in the United States, data on the epidemiology of repeat gonorrhea infections (RI) is limited. In addition, evidence to identify populations for retesting is needed.

Objective:
To examine the incidence and time to repeat gonorrhea infection among a large representative population and to assess factors associated with repeat gonorrhea infections.

Method:
A retrospective study was conducted by constructing a cohort of patients with an initial case of treated gonorrhea reported to the Los Angeles County reportable STD disease registry between 1999 and 2000. Study participants were followed for a maximum of 4-years.

Result:
Among 9,120 patients treated for gonorrhea infection, 1,300 (14%) experienced at least one RI (range: 1-7). The median time to RI was 13 months (range: 1-48 months), with an overall incidence rate of 4.8 per 100 person years. In multivariate analyses, age was the strongest predictor of RI, with those <15 being 2.5 times more likely to experience a RI as compared to those 35 years and older [adjusted hazard ratio (aHR) = 2.47; 95% confidence interval (CI) 1.77 – 3.44]. In addition, men were 76% more likely to have a reported RI as compared to women (aHR = 1.76; 95% CI 1.58 – 1.95). Race/ethnicity was also associated with RI, with African Americans and Whites being twice as likely to experience a RI as compared to Hispanics (aHR=2.03; 95% CI 1.70 – 2.42; aHR = 1.96; 95% CI 1.71 – 2.25 respectively).

Conclusion:
Repeat infections are very common among this representative study population. Furthermore, repeat infections are more common among certain sub-populations, including those in the youngest age groups.

Implications:
Improved strategies are needed to treat sex partners particularly among adolescents. Retesting and other prevention efforts should not overlook men.