Foreboding a possible return of unsafe sex practices, the
number of gay men diagnosed with gonorrhea has increased in San
Francisco and several other U.S. cities, raising concerns that
HIV may also be on the rise.
Between 1994 to 1995, the number of gay men with gonorrhea in a
sampled San Francisco clinic increased 24 percent, from 271 to
336, according to a new study by the federal Centers for
Disease Control and Prevention.
In Seattle, cases increased 125 percent between 1994 and '96,
from 51 to 115 cases. In Portland between '95 and '96, the
number of cases increased 124 percent, from 33 to 74 cases.
Cases also climbed in Honolulu, San Diego, Denver and Long
Despite a continuing overall decline in rates of gonorrhea
among all Americans, the trend among gay men may be reversing,
federal health officials conclude.
However, rates of disease are nowhere near those seen in the
early 1980s, when thousands of gay men were diagnosed annually.
"This new information should serve as a wake-up call to all
populations at risk, that high-risk sexual behaviors continue
to have very real consequences," said Dr. Helene Gayle,
director of the CDC.
"Some gay men may not be taking the threat of AIDS as seriously
as they once did," she said.
Signal of HIV rise?
The CDC study linked rising gonorrhea rates with attendance at
specific sex clubs and other places frequented by gay men in
San Francisco, Portland and Seattle.
Gonorrhea infections are considered a sentinel of the spread of
the human immunodeficiency virus (HIV), which causes AIDS.
Rates of HIV are less easily monitored than rates of gonorrhea,
due to confidentiality concerns. But it is known that the same
unsafe sex practices that transmit gonorrhea also spread HIV.
Several other studies have documented relapses in unprotected
anal sex among gay men.
Researchers once presumed that AIDS would wipe out an entire
generation of men, but that the younger generation of gay men,
educated about the peril, would be spared.
Now it seems that some young gay men may have missed earlier
prevention messages, say AIDS experts. Or they fail to take the
warning personally, neglecting to make life-saving changes in
Cases inching upward
There is also concern that life-prolonging HIV drugs may give
the mistaken message that HIV is no longer something to be
The number of gonorrhea cases has been inching upward in recent
years, said Dr. Mitch Katz, director of the San Francisco
Department of Health. But the cases seemed to have leveled off
in 1997 - and are a far cry from levels seen before the onset
of the AIDS epidemic.
A total of only 70 cases of rectal gonorrhea were reported in
1993 in San Francisco, according to Katz. By 1995, 100 cases
were reported; by 1996, the number had climbed to 136.
So far in 1997, 84 cases have been reported. Katz estimates a
year-end total of 110 to 120.
By comparison, in 1980, a total of 5,100 cases of rectal
gonorrhea were reported. In recent years, new HIV infections
have plateaued. In 1996, San Francisco had roughly 500 new HIV
infections, down from about 950 annually 5 years ago.
"Any increase in rectal gonorrhea is disturbing, because it
indicates high-risk sexual behavior that can also transmit
HIV," said Katz.