THE GONORRHEA NON-SURGE

The sometimes crazy but often accurate AIDS activist Michael Petrelis emails to let me know that the one dark lining in my analysis of the San Francisco Health Dept HIV report may actually be a little lighter. I reported that the data shows a doubling of rectal gonorrhea among gay men in San Francisco in five years – a deeply worrying trend. The report didn’t show the size of the testing samples so I took it as a stable and reliable indicator. It turns out it isn’t. In their 1999 report, the San Francisco Department of Public Health explained the sampling background for gonorrhea testing: “In response to the city-wide increases seen in 1995, we began testing more MSM [men who have sex with men] seen at City Clinic for rectal gonorrhea (since infections may be asymptomatic): the number of tests increased from 542 in 1995 to 1285 in 1999 while the number of male visits per year remained approximately 11,000. This increase in screening could be expected to increase the number of reported cases. The number of cases with symptoms did not change between 1996 and 1999, which indicates that the increase in cases may be due to the increased number of tests.” So the doubling of gonorrhea cases, by any reasonable assessment, is completely explained by the more than doubling of the number of tests. Quite why that wasn’t made clear in the current report is beyond me.