title: Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006-2010: differences by sex and transmission route.
abstract: BACKGROUND
  Gonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006-2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection.
  
  
  METHODS
  All gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model.
  
  
  RESULTS
  2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups.Most MSM cases were Spaniards (72%), aged 25-34 years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%.HIV co-infection was highest in MSM (20.9%). Co-infection was associated with age > 35 years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with female sex.
  
  
  CONCLUSIONS
  Differences by sex, transmission route and origin should be considered when implementing care and preventive programmes for gonorrhoea, and MSM are a priority group for intervention, in particular HIV-infected MSM.
authors.affiliation: Instituto de Salud Carlos III, Área de Epidemiología del VIH y comportamientos de riesgo, Centro Nacional de Epidemiologia, C/ Monforte de Lemos, 5, 28029 Madrid, Spain. adiaz@isciii.es.
authors.forename: Asuncion
authors.initials: A
authors.lastname: Diaz
authors.forename: Cesar
authors.initials: C
authors.lastname: Garriga
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Varela
authors.forename: Elisa
authors.initials: E
authors.lastname: Fernández
authors.forename: Isabel
authors.initials: I
authors.lastname: Sanz
authors.forename: Josep
authors.initials: J
authors.lastname: Boronat
authors.forename: Fuensanta
authors.initials: F
authors.lastname: Gual
authors.forename: Concepcion
authors.initials: C
authors.lastname: Colomo
authors.forename: Josefina
authors.initials: J
authors.lastname: López de Munain
authors.forename: Valentin
authors.initials: V
authors.lastname: Esteban
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Junquera
authors.forename: Blanca
authors.initials: B
authors.lastname: Martínez
authors.forename: Isabel
authors.initials: I
authors.lastname: Pueyo
authors.forename: Justo
authors.initials: J
authors.lastname: Suárez
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Barberá
authors.forename: Maider
authors.initials: M
authors.lastname: Arando
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Ureña
authors.forename: Mercedes
authors.initials: M
authors.lastname: Diez
mesh_terms: D000328:Adult; D060085:Coinfection; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000635:transmission; D015658:HIV Infections / Q000150:complications; D006268:Health Facilities / Q000706:statistics & numerical data*; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D055815:Young Adult