SAN FRANCISCO — As the incidence of gonorrhea continues to increase, physicians need to be doing more testing for the venereal disease in the anus and the throat, particularly in gay men, said Dr. Gail Bolan, chief of the sexually transmitted diseases control branch for California.
Gonorrhea incidence in the United States as a whole and in California specifically had been declining for 3 decades before starting to climb in about the year 2000, Dr. Bolan said at a meeting on HIV management sponsored by the University of California, San Francisco.
A recent study in San Francisco of men who have sex with men reported that if only urine and urethral screening were performed in those men, about 65% of gonorrhea cases would be missed, she noted.
The study found that 85% of the rectal infections were asymptomatic, indicating the possibility that these infections may be an important factor fueling the incidence increase (Clin. Infect. Dis. 2005;41:67–74).
In addition, the study also reported that 53% of chlamydial infections were at nonurethral sites.
Partly because of these concerns, the Centers for Disease Control and Prevention recently updated its sexually transmitted diseases guidelines to include what to ask when taking a sexual history to screen for disease.
The new guidelines suggest that the sexual history taking must include specific questions regarding what is known as the “5 P's”: partners, pregnancy protection, protection from sexually transmitted diseases, practices, and past history of sexually transmitted diseases. “You need to do appropriate sexual history, identify sites of exposure, and then, depending on those sites, do appropriate testing,” she said.
Dr. Bolan also said that fluoroquinolone-resistant gonorrhea continues to be a problem. The CDC guidelines recommend that fluoroquinolones not be used in men who have sex with men or in areas where fluoroquinolone resistance is high.