Donnell D, Zewdie K, Ratna N, et al. - Researchers herein sought for empirical evidence of correlation between rectal gonorrhea (GC) and HIV incidence in order to assess whether high rectal GC rates reliably correlate with high risk of HIV.

• Between 2011 and 2018, a total of 541,056 HIV-negative men who have sex with men (MSM) attending SHCs in England were assessed for HIV and rectal GC incidence.

• A decline was observed in HIV incidence among MSM from 1.26/100 person-years (PYs) in 2011 to 0.28/100 PYs in 2018.

• Increase in rectal GC rates occurred from 3.5/100 PYs to 11.1/100 PYs.

• Decrease in the rate of HIV incidence occurred by 22.3% for each percent increase in rectal GC.

• Expanded HIV testing, prompt antiretroviral treatment (ART) initiation and increased viral suppression likely resulted in decreased HIV incidence; these interventions did not decrease rectal GC.

• Based on findings, researchers did not suggest rectal GC as an ideal proxy for HIV incidence in trials, as HIV exposure risk is complex and context dependent, given effective HIV prevention interventions in MSM.