Risk factors for and trends in gonorrhea incidence among persons infected with HIV in the United States Ann N. Do, Debra L. Hanson, Mark S. Dworkin  , Jeffrey L. Jones y , and the Adult and Adolescent Spectrum of HIV Disease Project Objective: To determine the risk factors for and trends in gonorrhea infections among HIV-infected persons. Design: Longitudinal review of medical records of HIV-infected patients. Methods: We analyzed data about HIV-infected patients obtained from 1991 to 1998 in over 100 facilities participating in the Adult/Adolescent Spectrum of HIV Disease Project. Results: The overall incidence of gonorrhea was 9.5 cases per 1000 person±years. Factors associated with higher gonorrhea incidence ( P , 0.01) included younger age, male±male sex, black race, HIV infection without AIDS (namely AIDS-de®ning opportunistic illness or CD4 cell count , 200 3 10 6 cells/l), and recent recreational use of injection or non-injection drugs. There was an increase in the trend among men who have sex with men ( P , 0.01) and a decrease in the trend among patients with heterosexual contact as their HIV exposure risk ( P , 0.01). Among injection drug users there was no signi®cant trend from 1991 to 1996, but there was an increase in gonorrhea incidence from 6.6 cases/1000 person±years in 1997 to 16.3 cases/1000 person±years in 1998. Conclusions: Following HIV diagnosis, some individuals continue to practice risky sexual behaviors which result in gonorrhea and may transmit HIV. The increase in the trend in gonorrhea incidence among HIV-infected men who have sex with men is of particular concern because it suggests an increase in risky sexual behaviors. These ®ndings indicate a need for effective HIV prevention strategies that involve reducing risky sexual behaviors in HIV-infected persons. & 2001 Lippincott Williams & Wilkins AIDS 2001, 15:1149±1155 Keywords: Gonorrhea incidence, Gonorrhea trend, Gonorrhea among HIV- infected persons, Risk factors for gonorrhea, risky sexual behaviors Introduction In the United States, the incidence of gonorrhea increased dramatically from the mid-1960s until the mid-1970s, plateaued, then declined following the implementation of a national control program [1,2]. The decline in gonorrhea incidence also coincided with the beginning of the human immunode®ciency virus (HIV) epidemic in the United States and may re¯ect changes in behaviors as a result of prevention efforts [3,4] as well as in response to the fear of AIDS [5]. With the development of highly effective antiretroviral From the Surveillance Branch, Division of HIV/AIDS Prevention ± Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Note:  Current af®liation with the Illinois Department of Public Health, Chicago, Illinois, USA. y Current af®liation with the Epidemiology Branch, Division of Parasitic Diseases, National Center for Infectious Diseases; Centers for Disease Control and Prevention, Atlanta, GA, USA. Correspondence to Ann N. Do, MD, Centers for Disease Control and Prevention, Surveillance Branch, Division of HIV/AIDS Prevention, 1600 Clifton Road, MS E-47, Atlanta, GA 30333, USA. Tel: 1 404 639 2050; e-mail: aad9@cdc.gov Received: 29 September 2000; revised: 15 February 2001; accepted: 8 March 2001. ISSN 0269-9370 & 2001 Lippincott Williams & Wilkins 1149