Factors Associated with HIV Seroconversion Among Men Diagnosed with Gonorrhea in Washington State: An Evidence Base for Targeting Integrated Partner Services

Background:Among men diagnosed with HIV in Washington State (WA) between 2000 and 2008, 11% had a previous diagnosis of gonorrhea (GC) representing potentially missed HIV prevention opportunities.

Objectives:To assess characteristics of males diagnosed with GC associated with subsequent HIV diagnosis and predictors of time to seroconversion following GC infection.

Methods:Males diagnosed with GC between 1992 and 2008 and not known to be HIV positive prior to their first GC episode were selected from the statewide STD surveillance registry. HIV-status and date of HIV diagnosis was obtained from matched HIV/STD registries. For seroconverters with multiple GC episodes, the episode closest to HIV diagnosis was selected. For other patients, the most recently reported case was included. Factors associated with subsequent HIV infection were determined through multiple regression modeling. Survival time from GC to HIV diagnosis was calculated for seroconverters and Cox proportional hazard model used to identify factors associated with interval to seroconversion.

Results:Of 22,312 men diagnosed with GC, 698 (3.1%) were subsequently diagnosed with HIV. Factors associated with HIV seroconversion include white race, non-Hispanic ethnicity, age 30 – 40 years, MSM behavior, metropolitan area residence, rectal site of infection and STD clinic for GC diagnosis (all p values <0.001). Among seroconverters, factors associated with shorter interval to seroconversion included MSM risk, Hispanic ethnicity, increasing age, non-metro area and non-urethral site of infection (all p values <0.05).

Conclusions:Among GC cases, those who are older, white, MSM, metropolitan area residents and diagnosed with GC in STD clinic settings are at increased risk for HIV infection. Prioritizing these cases for public health interventions such as partner services serves both STD and HIV prevention goals.

Implications for Programs, Policy, and/or Research:In an era of decreasing resources, evidence-based priorities should be developed to guide integration of HIV and STD interventions, especially partner services.