Prevalence and Incidence of Pharyngeal Gonorrhea in a Longitudinal Sample of Men Who Have Sex with Men: The EXPLORE Study

• Published in: Clinical infectious diseases 2006-11, Vol.43 (10), p.1284-1289
• Main Authors: Morris, Sheldon R., Klausner, Jeffrey D., Buchbinder, Susan P., Wheeler, Sarah L., Koblin, Beryl, Coates, Thomas, Chesney, Margaret, Colfax, Grant N.
• Format: Article
• Language: English
• Subjects: Articles and Commentaries; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Ejaculation; Epidemiology. Vaccinations; Gays & lesbians; General aspects; Gonorrhea; Gonorrhea - epidemiology; HIV; Homosexuality, Male; Human bacterial diseases; Human immunodeficiency virus; Humans; Incidence; Infections; Infectious diseases; Male; Medical sciences; Men; Neisseria gonorrhoeae; Oral sex; Pharyngeal Diseases - epidemiology; Pharyngeal Diseases - microbiology; Pharyngitis; Prevalence; Prospective Studies; Public health; Referents; Sex; Sexual Behavior; Sexually transmitted diseases; Sexually Transmitted Diseases - complications; Sexually Transmitted Diseases - epidemiology; Studies
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/508460

Background. The prevalence of gonorrhea of the pharynx among select samples of men who have sex with men (MSM) ranges from 9% to 15%. To our knowledge, there have been no longitudinal studies in a prospective MSM cohort to estimate pharyngeal gonorrhea incidence or predictors of infection. We examined the prevalence, incidence, and sociodemographic and behavioral predictors of pharyngeal gonorrhea in a cohort of sexually active, human immunodeficiency virus—negative MSM. Methods. We conducted a prospective study of pharyngeal gonorrhea among MSM who were enrolled in a behavioral intervention study to prevent human immunodeficiency virus infection (Project EXPLORE). Participants were enrolled in this ancillary study from March 2001 through July 2003. At baseline and every 6 months thereafter until 31 July 2003, participants were tested for pharyngeal gonorrhea and were administered a questionnaire regarding their oral sex practices. Rectal and urethral gonorrhea testing were also performed. Results. Prevalence of pharyngeal gonorrhea was 5.5% (136 cases diagnosed from 2475 tests). The incidence rate was 11.2 cases per 100 person-years. Pharyngeal gonorrhea was positively associated with younger age and the number of insertive oral sex partners in the past 3 months. Ejaculation did not increase the risk of pharyngeal gonorrhea. Gonorrhea of the pharynx was asymptomatic in 92% of cases. Conclusions. The pharynx is a common, asymptomatic reservoir for gonorrhea in sexually active MSM.