Background: In 2012, the North Carolina Electronic Disease Surveillance System (NCEDSS) became fully integrated and includes named HIV cases to 1985, Gc cases to 2005. Co-infection of HIV with Gonorrhea is of concern due to increased susceptibility to HIV and the possibility of Gc treatment resistance.
Data from NCEDSS were cleaned and matched for co-infection. HIV cases diagnosed prior to March 2005 were retained only if matched to a Gc case. Co-infected persons were classified according to the timing of the HIV and GC infections and diagnoses occurring within 30 days were classified as occurring at the same time. Descriptive and bivariate analyses were performed using SAS 9.3.
Case reports for 115,986 individuals included 100,148 persons with Gc only; 13,810 with HIV only; and 2,028 co-infected persons. Men represented 74.5% of all HIV cases, 44.6% of GC cases, and 82.4% of co-infected persons. Men were more likely than women to be co-infected among both HIV cases (OR 1.7, 95% CI 1.5-1.9) and GC cases (OR 6.0, 95% CI 5.3-6.7). The majority (n=1,671, 72.7%) of co-infected men had a single GC case reported but 27.3% had repeat GC infections. Taken together, a high proportion were already HIV infected when they acquired Gc (n=1101, 65.9%) and 29.9% (n=352) were Gc repeaters. A third (n=550, 32.9%) of co-infected men had at least one Gc case more than 30 days prior to their HIV diagnosis.
Co-infection with HIV and Gonorrhea disproportionately affects men in NC. The 550 men with Gc prior to HIV represent a very small proportion of the 55,671 cases reported in NC and the utility for targeted prevention is limited. The high proportion of co-infected men with Gc infections subsequent to HIV diagnosis both stress the importance of STD testing among HIV-infected persons and indicate an opportunity for enhanced prevention efforts.