(P97) Incidence of repeat gonorrhea diagnoses and associated characteristics, SSuN Network, 2016-2019

Background:

Individuals with repeat gonorrhea (re-GC) may be in high-prevalence sexual networks and are an important group for prioritizing prevention strategies. Prior studies of re-GC have limited generalizability, and/or defined re-GC as evidence of a previous diagnosis. We determined the incidence and characteristics associated with a future GC diagnosis within jurisdictions participating in the STD Surveillance Network (SSuN).



Methods:

We combined routine surveillance with demographic and behavioral data from interviews conducted among a representative sample of GC diagnoses reported from eight SSuN jurisdictions between January 2016-September 2018. Re-GC was defined as any subsequently reported GC diagnosis occurring > 30 days after the diagnosis and for which SSuN interview data were available. Person-time was calculated as time from the initial diagnosis to date of re-GC or September 30, 2019. We applied design weights and adjusted for non-response by sex and age. Poisson regression was used to assess differences across groups.



Results

We included 10,466 SSuN-interviewed individuals contributing 21,778.5 person-years of follow-up (median: 2.1 person-years) representing 245,827 reported GC diagnoses. Re-GC was reported among 27.7% (95% confidence interval [CI]: 24.3%-31.4%); 60.7% of re-GC diagnoses occurred ≤12 months. Overall incidence was 132.3/1000 person-years (124.7-140.5). Re-GC was strongly associated with gender/sexuality: men-who-have-sex-with-men (MSM; incidence rate ratio [IRR]: 3.22; 95% CI: 2.60-3.99), transgender persons (IRR: 2.14; 95% CI:1.03-4.44), and cisgender women (IRR: 0.71; 95% CI: 0.60-0.83) vs. cisgender non-MSM; infection at extragenital sites compared to urogenital-only infections, particularly rectal infections (IRR: 3.11; 95% CI: 2.51-3.84) and infections at multiple sites (IRR: 3.30; 95% CI: 2.60-4.18); recent history of gonorrhea (≤12 months; IRR: 3.05; 95% CI: 2.61-3.56) vs. those with no history; and HIV-negative individuals on pre-exposure prophylaxis (PrEP; IRR: 3.86; 95% CI: 3.16-4.72) vs. non-PrEP patients.



Conclusions:

Re-GC was common, and frequently occurred ≤12 months of initial diagnosis. Sexual minorities, those with extragenital infections, recent gonorrhea history, and PrEP users had highest observed rates of re-GC. Our results could reflect more frequent screenings among sexual minorities and those on PrEP rather than increased transmission. Future work to identify subgroups of MSM, non-MSM and women at highest risk of re-GC will help to inform targeted interventions.