Characteristics of Men with Repeat Gonorrhea and Early Syphilis Case Reports

Background: Since 2010, early syphilis (ES) and gonorrhea rates among men have increased in New York State, excluding NY City (NYS). Characteristics of men with repeat STD infections have not been well defined in NYS.

Methods: A retrospective cohort of men with a gonorrhea or ES case reported between January 1, 2006 and December 31, 2012 was identified using NYS surveillance data.  Gonorrhea re-infection was defined as an additional infection, reported >14 days after an initial infection.  Syphilis re-infection was defined as an additional infection that met the ES surveillance case definition. Surveillance information on sexual orientation is required for ES but not gonorrhea and was excluded from this analysis given the high proportion of gonorrhea cases with unknown status (67%). Descriptive analysis, relative risks (RR) and 95% confidence intervals (CI) were calculated using SAS v9.3.

Results: A total of 21,709 gonorrhea and 1,853 ES cases were reported among 19,440 men during the study period. Among these men, 15,125 (78%) were mono-infected with gonorrhea, 1,434 (7%) were mono-infected with ES; 2,579 (13%) had at least one gonorrhea re-infection (range 2- 17); 220 (1%) had at least one gonorrhea and ES infection; and, 82 (<1%) had at least one ES re-infection only (range 2-5). Compared to men mono-infected with gonorrhea, the risk of gonorrhea re-infection only was greatest among men 10-19 (RR=1.9, CI: 1.7, 2.2) and 20-29 years old (RR=1.4, CI: 1.2, 1.6) and black non-Hispanics (RR=1.9, CI: 1.7, 2.1).  Men with at least one gonorrhea and ES infection were less likely to be 10-19 years old (RR=0.6, CI: 0.3, 0.9) or black non-Hispanic (RR=0.3, CI: 0.2, 0.4).

Conclusions: The characteristics of gonorrhea-infected men in NYS differed based on disease of diagnosis at re-infection. Recent statutory changes permitting HIV-STD data sharing will strengthen surveillance assessment of men with syndemic infections.