Distribution and Factors Associated with Neisseria gonorrhoeae Cases in Kampala, Uganda, 2016–2020

<b>Background</b>: Gonorrhoea is a common sexually transmitted infection with serious health consequences if not well-treated. Resistance to common therapeutic agents and limited diagnostics further heighten its burden on sexual and reproductive health. This study determined the positivity level, spatial distribution and factors influencing test positivity for <i>Neisseria gonorrhoeae</i> in Kampala, Uganda. <b>Methods</b>: Clinical data and urethral swabs were primarily collected from men with urethritis at 10 high-volume surveillance facilities. Laboratory analysis followed conventional microbiology techniques. Statistical analysis was conducted using R 4.4.3. <b>Results:</b> Among 1663 participants, 923 (56%, 95% CI: 53-58%) tested positive for <i>N. gonorrhoeae</i>, with comparable levels in Kampala divisions. Co-positivity of HIV and <i>N. gonorrhoeae</i> ranged from 5-27%. At bivariable analysis, there was a lower risk of testing positive for <i>N. gonorrhoeae</i> among participants aged above 24 years. Individuals who never use condoms or infrequently use them were marginally at a higher risk for positivity compared to routine users. Only age was the independent predictor for positivity with <i>N. gonorrhoeae</i> (aPR = 0.93, 95% CI: 0.87-0.99, <i>p</i>-value = 0.017), with men aged above 24 years being less likely to test positive for <i>N. gonorrhoeae</i>. <b>Conclusions</b>: Spatial distribution of <i>N. gonorrhoeae</i> positivity in Kampala was found not to be significantly influenced by location in any of the five divisions. Public health interventions should be tailored to focus on the high-risk groups such as men aged below 25 years, incorporating targeted education and prevention programs, particularly emphasizing consistent condom use among sexually active individuals to improve sexual and reproductive health in Kampala and greater Uganda.