ObjectiveTo determine the risk factors for and trends in gonorrhea infections among HIV-infected persons.DesignLongitudinal review of medical records of HIV-infected patients.MethodsWe analyzed data about HIV-infected patients obtained from 1991 to 1998 in over 100 facilities participating in the Adult/Adolescent Spectrum of HIV Disease Project.ResultsThe overall incidence of gonorrhea was 9.5 cases per 1000 person–years. Factors associated with higher gonorrhea incidence (P< 0.01) included younger age, male–male sex, black race, HIV infection without AIDS (namely AIDS-defining opportunistic illness or CD4 cell count < 200 × 106cells/l), and recent recreational use of injection or non-injection drugs. There was an increase in the trend among men who have sex with men (P< 0.01) and a decrease in the trend among patients with heterosexual contact as their HIV exposure risk (P< 0.01). Among injection drug users there was no significant trend from 1991 to 1996, but there was an increase in gonorrhea incidence from 6.6 cases/1000 person–years in 1997 to 16.3 cases/1000 person–years in 1998.ConclusionsFollowing HIV diagnosis, some individuals continue to practice risky sexual behaviors which result in gonorrhea and may transmit HIV. The increase in the trend in gonorrhea incidence among HIV-infected men who have sex with men is of particular concern because it suggests an increase in risky sexual behaviors. These findings indicate a need for effective HIV prevention strategies that involve reducing risky sexual behaviors in HIV-infected persons.