Previous gonorrhea infection increased risk of bladder cancer in men

The association was especially strong for invasive and advanced bladder cancer.

Issue: February 2007

Men with a history of gonorrhea had an almost twofold increased risk of bladder cancer, according to a recent study.

Dominique Michaud, ScD, assistant professor at the Harvard School of Public Health, and colleagues conducted a prospective cohort study to examine the association between gonorrhea infection and bladder cancer. The results of the study were published in the British Journal of Cancer.

The researchers identified a link between gonorrhea, which is the second most common sexually transmitted disease in the United States, and bladder cancer, which is the fourth most common cancer in men. The association was stronger for invasive and advanced bladder cancer, and among current smokers. The study, however, does not establish a need for continuous bladder cancer screening in men with a history of gonorrhea.

“There is no direct implications for oncologists, as it is too early to recommend having all patients with a history of gonorrhea to be screened for bladder cancer,” Michaud said. “This study should be reproduced in other populations to confirm the findings.”

Twofold increased risk

Researchers collected data from 51,529 men aged 40 to 75 years who participated in the Health Professionals Follow-Up Study, which started in 1986. At baseline, and biennially thereafter, the participants filled out questionnaires with information such as smoking habits, medical conditions and other characteristics.

On the 1992 questionnaire, the participants were asked whether they had ever had gonorrhea. A total of 3,212 men did not respond to the question. The participants who answered were categorized according to history of gonorrhea.

Men with a history of gonorrhea had a twofold increase in bladder cancer risk, compared with men without a history. The association was stronger in men with advanced disease and men with invasive disease (RR=4.07; 95% CI, 1.35-12.3). There was no apparent association with superficial bladder cancer, and a weak association with less-advanced disease (RR=1.14; 95% CI, 0.50-2.59).

“We are interested in understanding the mechanism that explains this association, including inflammation and urinary tract symptoms,” Michaud said. “Also, we have to consider the possibility that gonorrhea was a marker for another sexually transmitted disease, and therefore not causally related to bladder cancer.”

Effect on screening

Previous case-control studies have also indicated an increased risk of bladder cancer associated with gonorrhea, the researchers wrote. Gonorrhea infection often presents as acute urethritis in men, which frequently recurs even after initial treatment. The inflammation caused by the infection may play a role in bladder carcinogenesis, the researchers wrote.

Gonorrhea infection was also associated with urinary tract infection symptoms in this cohort. Previous studies have proven an association between urinary tract infections and bladder cancers. Therefore, it is possible the inflammation that produces urinary symptoms such as incomplete bladder emptying, frequency, intermittency, urgency and hesitancy could be involved in the bladder carcinogenesis, the researchers wrote. – by Emily Shafer

For more information:

Michaud DS, Platz EA, Giovannucci E. Gonorrhoea and male bladder cancer in a prospective study. Br J Cancer. 2007;96:169-171.