Narrative Review: Assessment of Neisseria gonorrhoeae Infections Among Men Who Have Sex With Men in National and Sentinel Surveillance Systems in the United States

Abstract

To assess trends in Neisseria gonorrhoeae among gay, bisexual, and other men who have sex with men (MSM), we reviewed existing and published gonorrhea surveillance data in the United States. Data identified in this review include the following: national gonorrhea case report data and data from 3 other surveillance programs, the Gonococcal Isolate Surveillance Project (GISP), the STD Surveillance Network (SSuN), and National HIV Behavioral Surveillance.Rates of reported cases of gonorrhea among men increased 54.8% in 2006 to 2015 compared with a 2.6% increase among women. Since 2012, the rate of reported gonorrhea cases among men surpassed the rate among women; the male-to-female case rate ratio increased from 0.97 in 2012 to 1.31 in 2015. The proportion of gonococcal urethral isolates collected in the Gonococcal Isolate Surveillance Project that were collected from MSM increased from 21.5% to 38.1% in 2006 to 2015. In 2009 to 2015, the percent of MSM who tested positive for rectal and oropharyngeal gonorrhea in sexually transmitted disease (STD) clinics increased by 73.4% and 12.6%, respectively. Estimated rates of gonorrhea among MSM increased by 151% in 2010 to 2015 in jurisdictions participating in the STD Surveillance Network. Data from the National HIV Behavioral Surveillance demonstrate that testing for gonorrhea among MSM increased by 23.1% between 2011 and 2014.Together, surveillance data suggest a disproportionate burden of gonorrhea among MSM in the United States and suggest increases in both screening and disease in recent years. Because each data source has inherent limitations and biases, examining these data from different systems together strengthens this conclusion.

Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men

“…In Australia, the US, and the United Kingdom, increasing trends in notifications of STI diagnoses were observed over several years before PrEP being broadly available, including in MSM populations. [8][9][10][11][12][13] Furthermore, increased frequency of STI testing, particularly that associated with PrEP, may also lead to an increase in STI diagnoses even if incidence is not increasing. 14 In New South Wales, Australia, between 2016 and 2018, a large-scale PrEP access program (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]) rapidly rolled out PrEP to almost 10 000 MSM at high risk of HIV infection.…”

“…In Australia, the US, and the United Kingdom, increasing trends in notifications of STI diagnoses were observed over several years before PrEP being broadly available, including in MSM populations. 8 , 9 , 10 , 11 , 12 , 13 Furthermore, increased frequency of STI testing, particularly that associated with PrEP, may also lead to an increase in STI diagnoses even if incidence is not increasing. 14 …”

The Laboratory Diagnosis of Neisseria gonorrhoeae: Current Testing and Future Demands

“…NAATs are also the most sensitive tests to diagnose extragenital Ng infection [14,68,69] and are therefore recommended for laboratory diagnosis of rectal or pharyngeal infection [13,70]. The relevance of testing extragenital sites is mainly based on two findings: (i) additional testing of pharyngeal and rectal swabs was shown to increase the number of infected individuals [5,16]; (ii) patients can be infected at multiple sites [71], and pharyngeal infections are more difficult to treat [72].…”

“…Since rectal and pharyngeal infections, as well as cervical infections in women, are frequently asymptomatic and will be missed by symptom-based examinations, laboratory testing should consider inclusion of both urogenital, anorectal, and pharyngeal samples, depending on sexual behavior, to identify infected individuals with higher sensitivity [5,15,16].…”

Pathogenic Interplay Between Chlamydia trachomatis and Neisseria gonorrhoeae that Influences Management and Control Efforts—More Questions than Answers?

“…Antiretroviral drugs, given as treatment for HIV infection and as pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV, have been associated with increases in NG in MSM [50]. If drugs, rather than condoms, are the main method that MSM use to prevent HIV, HIV and STI prevention have been decoupled.…”