Prevalence of pharyngeal gonorrhoea in men who have sex with men human immunodeficiency virus-positive patients is not entirely known. We cultured the pharynx of 264 asymptomatic men who have sex with men human immunodeficiency virus-positive individuals in downtown Madrid. A questionnaire on sexual and drug use risk behaviours was taken. Gonococci were isolated in 25 (9.46%). Among the whole study population, 65% had a history of sexual intercourse with two or more partners on a single day and 26% were involved in group sex with other men. Only 29% regularly used condoms in all sexual encounters and 63% used condoms only in insertive anal intercourse. When asked on oral sex, 89% of patients engaged in insertive and/or receptive oral sex and 86% recognized that they did not regularly request the use of condoms when practising "fellatio" to a partner. Cocaine, crystal methamphetamine or alcohol use and a previous history of ≥1 STD were significantly more common among culture-positive patients. Gonococcal colonization of the pharynx was self-limited in patients that were not treated and re-cultured a mean 18.45 ± 5.18 days after diagnosis. Asymptomatic pharyngeal gonorrhoea is common among human immunodeficiency virus-infected men who have sex with men and may contribute to the increasing epidemic of gonorrhoea in Madrid.