{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:30Z","timestamp":1792787310772,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHMRC partnership grant","award":["GNT1092852"],"award-info":[{"award-number":["GNT1092852"]}]},{"name":"Australian Department of Health"},{"name":"Prevention Research Support Program funded by the New South Wales Ministry of Health"},{"name":"National Health and Medical Research Council","award":["APP1082336"],"award-info":[{"award-number":["APP1082336"]}],"id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Health and Medical Research Investigator Grant","award":["GNT2027235"],"award-info":[{"award-number":["GNT2027235"]}]},{"name":"Governments of Victoria and Western Australia"},{"name":"Blood Borne Viruses and Sexually Transmitted Infections Research, Intervention and Strategic Evaluation (BRISE) Program"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2026,8,21]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Gonorrhoea incidence is increasing globally, with gay and bisexual men (GBM) over-represented in notifications. Changes in behaviour, sexual networks and screening practices associated with HIV pre-exposure prophylaxis (PrEP) uptake and treatment-as-prevention may influence gonorrhoea transmission. We describe trends in gonorrhoea testing and incidence among GBM over 12 years spanning PrEP implementation in Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study using surveillance data from 67 sexual health and general practice clinics between 1 January 2012 and 31 December 2023. For testing analyses, we included GBM with \u22651 visit and calculated annual test uptake (proportion of attendees tested at least once). For incidence analyses, we included GBM with \u22652 tests and calculated annual gonorrhoea incidence per 100 person-years (py). Test uptake and incidence were stratified by HIV status and PrEP use (ever vs never prescribed PrEP). Poisson regression explored factors associated with incident gonorrhoea, adjusted for calendar year and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 193\u2009053 GBM attended a clinic during the study period, of which 176\u2009244 (91.3%) had \u22651\u2009test. Annual test uptake increased from 58.7% in 2012 to 75.2% in 2023, largely driven by increased testing among ever-PrEP-users. Among 119\u2009741 GBM in incidence analyses, there were 61\u2009896 gonorrhoea infections over 542\u2009949 py (incidence rate=11.4\/100 py). From 2012 to 2023, incidence among HIV-negative ever-PrEP users increased from 6.2 to 19.6\/100 py (p&lt;0.001), and among GBM with HIV increased from 8.6 to 18.8\/100 py (p&lt;0.001). GBM with recurrent infections (n=13\u2009620; 11.4%) accounted for 69.1% of all diagnoses. Ever being prescribed PrEP (adjusted incidence rate ratio (aIRR)=2.40, 95%\u2009CI: 2.35 to 2.45) and living with HIV (aIRR=3.05, 95%\u2009CI: 2.97 to 3.13) were associated with incident gonorrhoea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large cohort of GBM, gonorrhoea incidence significantly increased during PrEP implementation, although incidence was already rising before large-scale PrEP roll-out in 2016. GBM with HIV, PrEP users or those previously diagnosed with gonorrhoea should be prioritised for testing and prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2026-056909","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:20:26Z","timestamp":1790011226000},"page":"sextrans-2026-056909","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in gonorrhoea testing and incidence among gay and bisexual men in Australia during PrEP implementation: an analysis of surveillance data (2012\u20132023)"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7055-1243","authenticated-orcid":false,"given":"Hein Htet","family":"Aung","sequence":"first","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Guy","sequence":"additional","affiliation":[{"name":"UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Asselin","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8867-3220","authenticated-orcid":false,"given":"Htein Linn","family":"Aung","sequence":"additional","affiliation":[{"name":"UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0657","authenticated-orcid":false,"given":"Eric P F","family":"Chow","sequence":"additional","affiliation":[{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"},{"name":"Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia"},{"name":"School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason J","family":"Ong","sequence":"additional","affiliation":[{"name":"Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia"},{"name":"School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0402-0506","authenticated-orcid":false,"given":"Rick","family":"Varma","sequence":"additional","affiliation":[{"name":"UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"},{"name":"Sydney Sexual Health Centre, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Thng","sequence":"additional","affiliation":[{"name":"Gold Coast Sexual Health Service, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Shaw","sequence":"additional","affiliation":[{"name":"M Clinic, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick J","family":"Lee","sequence":"additional","affiliation":[{"name":"New South Wales Health Pathology, Newcastle, New South Wales, Australia"},{"name":"The University of Sydney Central Clinical School, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Templeton","sequence":"additional","affiliation":[{"name":"UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"},{"name":"The University of Sydney Central Clinical School, Sydney, New South Wales, Australia"},{"name":"Department of Sexual Health Medicine, Sydney Local Health District, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9349-3080","authenticated-orcid":false,"given":"Fabian Yuh Shiong","family":"Kong","sequence":"additional","affiliation":[{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyssa","family":"Watson","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicent J","family":"Cornelisse","sequence":"additional","affiliation":[{"name":"UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"},{"name":"School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia"},{"name":"North Coast HIV and Sexual Health Services, Sydney, New South Wales, Australia"},{"name":"Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dash","family":"Heath-Paynter","sequence":"additional","affiliation":[{"name":"Health Equity Matters, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret E","family":"Hellard","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia"},{"name":"Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A","family":"Stoove","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Centre of Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W","family":"Traeger","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 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