Gonorrhea Reinfections in Women from Florida 2000-2011

Background: Gonorrhea is the second most common bacterial sexually transmitted infection reported in the U.S. We wanted to describe how reinfections were impacting this epidemic in women.

Methods: The Florida state STD/HIV matched surveillance database containing all reports of STD from 2000-2011 was used for analysis.  Reports of repeat gonorrhea infection within 30 days were not included in the analysis.

Results: 127,081 gonococcal infections were reported among 103,156 females over age 13 in Florida between 2000 and 2011. The number of infections reported by year ranged from 9,345 to 11,970. 17,500 females had subsequent infections reported.  4,459 females had more than two gonococcal infections reported.  Of 9,923 women with gonorrhea reported in 2000, 27% had an additional infection reported between 2000 and 2011. Of 9,617 women with gonorrhea reported in 2011, 23% had a previous infection reported between 2000 and 2011. Life Table analyses indicated the following 12-year cumulative risks of repeat infection among women with gonorrhea: 17% for all women, 22% for African-American females aged 13 to 24 years, and 14% for white females aged 13-24 years. The highest number of additional infections was 10. The mean time to second recorded infection was 2.01 years with a median of 1.28 years. 21% of the repeaters were African-American and  25% were aged 13-19 at time of first diagnosis. Of 1,059 females that acquired their first gonococcal infection while they were HIV-infected, 16% were repeaters indicating possible risks of continued transmission of HIV to their partners.

Conclusions:   Many of the women who were diagnosed with gonorrhea in Florida became re-infected, some repeatedly. This supports the recommendation to rescreen persons with gonorrhea after their diagnosis. Partner services (including EPT) and high-intensity behavioral counseling have been shown to reduce reinfection.