OBJECTIVES: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle. METHODS: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non-sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests. RESULTS: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P = 0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P <0.01). CONCLUSIONS: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups. Copyright © 2006, American Sexually Transmitted Diseases Association All rights reserved.