![]() Īs part of the EXPLORE study, willing participants were tested for rectal and urethral gonorrhea. ![]() ![]() Details on the EXPLORE study have been published elsewhere. All San Francisco study visits occurred at the AIDS Office of the San Francisco Department of Public Health. Eligible men were randomized to the intervention (10 counseling sessions delivered over a 6-month period, followed by quarterly booster sessions with HIV testing and counseling every 6 months) or to the control arm (standard HIV testing and counseling every 6 months). Eligibility requirements included being HIV antibody-negative at baseline, being at least 18 years of age, reporting anal sex in the past year with at least 1 man, and not being currently in a mutually monogamous relationship for ⩾2 years with a known HIV antibody-negative man. Recruitment occurred through outreach in neighborhoods with significant populations of MSM other venues frequented by MSM, including bathhouses and health and sex clubs STD clinics with advertisements and through referrals from other participants. From January 1999 to February 2001, a total of 736 MSM from San Francisco were enrolled in the study. The EXPLORE study was a multicity, randomized, controlled trial of a behavioral intervention for the prevention of HIV infection among MSM. We also determined the behavioral, clinical, and sociodemographic predictors of pharyngeal gonorrhea infection. Whereas previous research provides only cross-sectional data on pharyngeal gonorrhea, this longitudinal cohort study enabled us to measure both prevalence and incidence of pharyngeal gonorrhea among sexually active, HIV-negative MSM, and to compare rectal and urethral gonorrhea incidence rates with pharyngeal gonorrhea rates during the same period. This, however, does not eliminate the importance of pharyngeal gonorrhea as a source of genital infection, because oral sex has been shown to be an independent risk factor for urethral gonorrhea and, in some cases, may be the only identified risk factor for infection. Pharyngeal gonorrhea may be self limiting, with up to 50% of cases detected by culture spontaneously remitting within a week and all cases spontaneously remitting within 3 months. In San Francisco, where more than one-half of reported cases of gonorrhea are attributed to MSM, the pharynx accounts for an increasing number of total gonorrhea cases among this population, possibly because of increased screening. Rates of pharyngeal gonorrhea among MSM tested in HIV clinics, STD clinics, anonymous testing sites, and bathhouses range from 3% to 15%. The pharynx is the most common site of gonococcal infection among MSM. In the 2003 Centers for Disease Control and Prevention Sexually Transmitted Disease (STD) Surveillance Report, men who have sex with men (MSM) presenting to STD clinics in 2003 had a median prevalence of 15.3% for gonorrhea at any anatomic site. The pharynx is a common, asymptomatic reservoir for gonorrhea in sexually active MSM. Gonorrhea of the pharynx was asymptomatic in 92% of cases.Ĭonclusions. Ejaculation did not increase the risk of pharyngeal gonorrhea. Pharyngeal gonorrhea was positively associated with younger age and the number of insertive oral sex partners in the past 3 months. The incidence rate was 11.2 cases per 100 person-years. ![]() Prevalence of pharyngeal gonorrhea was 5.5% (136 cases diagnosed from 2475 tests). Rectal and urethral gonorrhea testing were also performed. 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. Participants were enrolled in this ancillary study from March 2001 through July 2003. 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). We examined the prevalence, incidence, and sociodemographic and behavioral predictors of pharyngeal gonorrhea in a cohort of sexually active, human immunodeficiency virus-negative MSM. To our knowledge, there have been no longitudinal studies in a prospective MSM cohort to estimate pharyngeal gonorrhea incidence or predictors of infection. The prevalence of gonorrhea of the pharynx among select samples of men who have sex with men (MSM) ranges from 9% to 15%. ![]()
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