Open Access Research article

Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006–2010: differences by sex and transmission route

Asuncion Diaz117*, Cesar Garriga1, Jose Antonio Varela2, Elisa Fernández3, Isabel Sanz4, Josep Boronat5, Fuensanta Gual6, Concepcion Colomo7, Josefina López de Munain8, Valentin Esteban9, Maria Luisa Junquera10, Blanca Martínez11, Isabel Pueyo12, Justo Suárez13, Maria Jesus Barberá14, Maider Arando14, Jose Manuel Ureña15, Mercedes Diez1617 and on behalf of STI Study Group

Author Affiliations

1 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

2 Centro ETS, Gijón, Spain

3 Centro de Información y Prevención del Sida, Alicante, Spain

4 Plan del Sida del País Vasco, San Sebastián, Spain

5 Unidad ITS, CAP Tarragonès, Tarragona, Spain

6 Comité de Apoyo a las Trabajadoras del sexo (CATS), Murcia, Spain

7 Programa de Prevención del Sida y ETS, Madrid, Spain

8 Unidad ETS, Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Spain

9 Servicio Microbiología Clínica, Hospital Basurto, Bilbao, Spain

10 Unidad de ETS, Hospital Monte Naranco, Oviedo, Spain

11 Unidad de Promoción y Apoyo a la Salud (UPAS), Málaga, Spain

12 Centro ETS, Sevilla, Spain

13 Centro ETS, Algeciras, Spain

14 Unidad de ITS. Programa especial de enfermedades infecciosas Vall d’Hebron-Drassanes, Hospital Universitario Vall d’Hebron, Barcelona, Spain

15 Centro de ETS y Orientación Sexual, Granada, Spain

16 Plan Nacional sobre el Sida. S.G. de Promoción de la Salud y Epidemiología. Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain

17 CIBER de Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III, Madrid, Spain

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BMC Public Health 2013, 13:1093  doi:10.1186/1471-2458-13-1093

Published: 25 November 2013



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.


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.


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.


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.

Gonorrhoea; Genitourinary medicine services; STI; HIV; Core populations