Saunas and drugs linked with rectal gonorrhoea in gay men in San Francisco study

Michael Carter
Published: 28 January 2004

For HIV-positive gay men in San Francisco, having anonymous sex in a sauna is associated with an increased risk of rectal gonorrhoea, according to a study published in the November 2003 edition of Sexually Transmitted Diseases. The study also found that rectal gonorrhoea in HIV-negative men was associated with the use of recreational drugs, particularly stimulants in the amphetamine class. Earlier published research from the same investigators found that the recent resurgence of syphilis amongst gay men in San Francisco was associated with meeting sexual partners on-line (see link below).

For six months in 2000 doctors at a sexual health clinic in San Francisco screened all men reporting receptive anal sex for gonorrhoea, irrespective of reported condom usage. A total of 564 men were included in the study, which also involved self-completion of a questionnaire to provide demographic details, information on recent sexual encounters, drug use, and HIV status.

Of all the men in the study, a little over 7% tested positive for rectal gonorrhoea. However, the percentage of HIV-positive men with the sexually transmitted infection was over twice as high at 15.2%, a highly significant difference (p<0.01).

The men in the study had a median age of 33 years, were well educated, with 78% having a college degree, and almost two thirds (65%) were white. There were no demographic differences between the men with and without rectal gonorrhoea.

Symptoms were present in only 10.5% of cases of rectal gonorrhoea.

HIV-positive men reporting anonymous receptive anal sex in the past fortnight had a two-fold higher risk of rectal infection with gonorrhoea than positive men reporting no anonymous receptive anal sex, however this difference was not statistically significant (p=0.1). However, a significantly increased risk of gonorrhoea was found for HIV-infected men who met their partners at either saunas or over the internet (p=0.06 and p=0.04 respectively).

For HIV-negative men, or men of unknown HIV status, the investigators found a significant relationship between rectal gonorrhoea and the use of amphetamines (p=0.02) and poppers (p=0.08) during sex.

In multivariate analysis, meeting an anonymous partner at a sauna in the previous two weeks remained significantly associated with rectal gonorrhoea for HIV-positive men (OR, 3.39, 95% CI, 0.80 – 14.44, p<0.1). Sex whilst “high” on drugs remained significantly associated with a rectal gonorrhoea infection for HIV-negative or untested men (OR, 2.94; 95% CI, 1.03 – 8.34, p<0.05), as did, unsurprisingly, unprotected receptive anal sex (OR, 4.06; 95% CI, 1.31 – 12.53, p<0.05).

The investigators describe the prevalence of rectal gonorrhoea in their study as “high.” As infection with HIV and gonorrhoea have a “strong biological association”, the investigators suggest that the recent increase in new HIV infections in San Francisco could have been fuelled by rectal gonorrhoea.

In conclusion the investigators emphasise the need for doctors and clinics to promote regular sexual health check-ups and the integration of HIV and sexually transmitted infection efforts.


Kim AA et al. Risk factors for rectal gonoccal infection amidst resurgence in HIV transmission. Sexually Transmitted Diseases 30: 813 – 817, 2003.

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