Prevalence of Neisseria gonorrhoeae Among Men Screened for Chlamydia trachomatis in Four United States Cities, 1999 –2003 CHARLOTTE ANN GAYDOS, DRPH,* CHARLOTTE KATHLEEN KENT, PHD,† CORNELIS ARTHUR RIETMEIJER, MD,‡ NANCY JO WILLARD, BA,* JEANNE MARISA MARRAZZO, MD,§ JOHANNA BEACH CHAPIN, MPH, EILEEN FRANCES DUNNE, MD, MPH, LAURI ELLEN MARKOWITZ, MD, JEFFREY DAVID KLAUSNER, MD,† JONATHAN MARK ELLEN, MD,* AND JULIA ANN SCHILLINGER, MD Objectives: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle. Methods: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non–sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests. Results: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P  0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P <0.01). Conclusions: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups. ALTHOUGH NATIONAL GONORRHEA RATES have declined steadily over most of the last half century, disease rates leveled off during the late 1990s and dramatic racial disparities persist. Cur- rently, infections resulting from gonorrhea are the second most commonly reported notifiable disease in the United States, with 335,104 cases reported in 2003 (116.2 cases per 100,000 popula- tion), 1 and national rates remain well above the Healthy People 2010 objective of 19 per 100,000 population. Increases in gonor- rhea case rates are being observed in certain population subgroups, including American Indian/Alaska Natives, Hispanics, and non- Hispanic whites, particularly white men aged 30 to 44 years, 1 yet there is a lack of updated evidence-based data for asymptomatic males. Data from a variety of sources suggest that gonorrhea rates are increasing among men who have sex with men (MSM). 1,2 Neisseria gonorrhoeae, along with Chlamydia trachomatis, is a leading cause of pelvic inflammatory disease (PID), which can result in sequelae such as tubal factor infertility, chronic pelvic pain, and ectopic pregnancy female partners of infected men. 3 Epidemiologic data also indicate that gonococcal infections can lead to a threefold to fivefold increase in risk for human immuno- deficiency virus transmission or acquisition. 4,5 This report pro- vides current data for gonorrhea prevalence in asymptomatic men. Because male gonococcal infections are largely symptomatic, 3 diagnostic testing, rather than routine screening, has been the recommended disease control strategy, and national disease rates in men reflect mainly symptomatic infection. Although there is evidence that asymptomatic gonococcal infections in heterosexual men may contribute disproportionately to disease transmission to women, 6 relatively few studies have measured the prevalence of N. gonorrhoeae infection among asymptomatic men, 7–9 and in June 2005, the United States Preventive Services Task Force concluded that there was insufficient evidence to recommend for or against routine screening in men, even those men who are at increased risk for infection. 10 We tested men for gonococcal infection as part of a large project aimed at measuring the prevalence of C. tracho- matis infection among asymptomatic heterosexual men attending clinical and nonclinical venues other than STD clinics in 4 met- ropolitan areas in the United States. 11 We describe the prevalence of N. gonorrhoeae infection and N. gonorrhoeae and C. tracho- matis coinfection among both asymptomatic and symptomatic men tested for chlamydia in 4 geographically diverse cities in non-STD clinic venues with substantial variation from nationally reported disease rates of both gonorrhea and chlamydia. Methods Study Design Urine-based nucleic acid amplification testing for N. gonor- rhoeae and C. trachomatis was offered to men attending adult and adolescent primary care clinics, high school– based health clinics and health fairs, college clinics, street-based outreach venues, community-based organizations, drug treatment centers, and juve- nile and adult detention centers in Baltimore, Denver, San Fran- cisco, and Seattle between October 1999 and April 2003 (39 months). At all detention facilities except those in Baltimore, men Source of support: The project was funded by Centers for Disease Control and Prevention award number U30/CCV317876. Correspondence: Charlotte Ann Gaydos, MS, MPH, DrPH, 1159 Ross Building, 720 Rutland Ave., Baltimore, MS 21205. E-mail: cgaydos@ jhmi.edu. Received for publication July 26, 2005, and accepted September 26, 2005. From the *Johns Hopkins University School of Medicine, Baltimore, Maryland; †San Francisco Department of Public Health, San Francisco, California; ‡Denver Public Health, Denver, Colorado; §University of Washington, Seattle, Washington; and the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Sexually Transmitted Diseases, February 2006, Vol. 33, No. 2, p.000 – 000 DOI: 10.1097/01.olq.0000194572.51186.96 Copyright © 2006, American Sexually Transmitted Diseases Association All rights reserved. 1