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Clin Infect Dis. 2020 Jan 22. pii: ciaa066. doi: 10.1093/cid/ciaa066. [Epub ahead of print]

More Screening or More Disease? Gonorrhea Testing and Positivity Patterns among Men in Three Large Clinical Practices in Massachusetts, 2010-2017.

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Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA.
Commonwealth Informatics, Waltham, MA.
Atrius Health, Boston, MA.
Cambridge Health Alliance, Cambridge, MA.
Massachusetts League of Community Health Centers, Boston, MA.
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA.



Gonorrhea diagnosis rates in the U.S. increased by 75% during 2009-2017, predominantly in men. It is unclear whether the increase among men is being driven by more screening, an increase in the prevalence of disease, or both. We sought to evaluate changes in gonorrhea testing patterns and positivity among men in Massachusetts.


The analysis included men ≥15 years who received care during 2010-2017 in three clinical practice groups. We calculated annual percentages of men who received a gonorrhea test and men with at least one positive result, among men tested. Log-binomial regression models were used to examine trends in these outcomes. We adjusted for clinical and demographic characteristics that may influence predilection to test and probability of gonorrhea disease.


On average 306,348 men had encounters each year. There was a significant increase in men with at least one gonorrhea test from 2010 (3.1%) to 2017 (6.4%; adjusted annual RR: 1.12, 95% CI 1.12,1.13). There was a significant, albeit lesser, increase in the percentage of tested men with at least one positive result (1.0% in 2010 to 1.5% in 2017; adjusted annual RR: 1.07, 95% CI 1.04,1.09).


We estimated significant increases in the proportion of men tested at least once in a year for gonorrhea and the proportion of tested men with at least one positive gonorrhea result between 2010 and 2017. These results suggest that observed increases in gonorrhea rates could be explained by both increases in screening and the prevalence of gonorrhea.


electronic medical records; gonorrhea; gonorrhea screening


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