It Takes 2

Swartzendruber, Andrea; Zenilman, Jonathan M.; Niccolai, Linda M.; Kershaw, Trace; Brown, Jennifer L.; DiClemente, Ralph J.; Sales, jessica

doi:10.1097/olq.0b013e318283d2c9

Cited by 27 publications

(15 citation statements)

References 69 publications

(215 reference statements)

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“…The CDC has long cited recent new partners as a key C trachomatis risk that should prompt more frequent screening, (2) and is supported by more recent prospective studies. (9, 10) Our finding of risk from partners who have other partners is consistent with cross-sectional studies of partners' concurrency being linked to more STIs,(14, 15) and with the concept of sexual networks, in which a woman's risk is influenced by her relationship position and STI rates in the greater network. (16) Similarly, frequent substance use as a risk may reflect the woman's involvement in a higher-risk sexual network or riskier partner and condom practices.…”

Section: Discussionsupporting

confidence: 86%

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

Hwang

Moscicki

2014

Obstetrics &Amp; Gynecology

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Objective To identify biological and behavioral risks for incident Chlamydia trachomatis among a prospective cohort of young women followed frequently. Methods Our cohort of 629 women from two outpatient sites was seen every 4 months (October 2000 through April 2012) for behavioral interviews and infection testing. C trachomatis was tested annually, and anytime patients reported symptoms or possible exposure using commercial nucleic acid amplification tests. Analyses excluded baseline prevalent C trachomatis infections. Risk factors for incident C trachomatis were assessed using Cox proportional hazards models. Significant risks (p<0.10) from bivariate models were entered in a multivariate model, adjusted for four covariates chosen a priori (age, race or ethnicity, condom use, study site). Backwards step-wise elimination produced a final parsimonious model retaining significant variables (p<0.05) and the four adjustment variables. Results The 629 women attended 9,594 total visits. Median follow-up time was 6.9 years (interquartile range 3.2-9.8), during which 97 (15%) women had incident C trachomatis . In the final multivariate model, incident C trachomatis was independently associated with HPV at the preceding visit (p<0.01), smoking (p=0.02), and weekly use of substances besides alcohol and marijuana (p<0.01) since prior visit. Among 207 women with available colpophotographs (1,742 visits), cervical ectopy was not a significant risk factor (p range=0.16-0.39 for ectopy as continuous and ordinal variables). Conclusion Novel risks for C trachomatis include preceding HPV, smoking, and substance use, which may reflect both biological and behavioral mechanisms of risk, such as immune modulation, higher-risk sexual networks, or both. Improved understanding of the biological bases for C trachomatis risk would inform our strategies for C trachomatis control.

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Section: Discussionsupporting

confidence: 86%

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

Hwang

Moscicki

2014

Obstetrics &Amp; Gynecology

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“…Further combined with evidence that partner risk is associated with STD acquisition, 5,6,9 our findings suggest partner risk may contribute to the well-established link between alcohol use and STDs. 1 Therefore, adolescent in-the-moment alcohol use may synergistically increases risk by enhancing the probability of choosing a partner with an STD and decreasing the probability of using a condom with that partner.…”

Section: Discussionsupporting

confidence: 65%

“…Second, while we analyzed four partner characteristics, we were unable to consider additional important partner characteristics because either they were not measured (e.g., time since last STD, concurrent partners, relationship length) or because participant and partner drinking were too strongly correlated to consider partner drinking as an independent predictor. 6,9 The consistency, however, between partners drinking status is commonly reported. 7,12 Third, because only 12% of participants reported in-the-moment alcohol use, we were limited to assessing alcohol use as a dichotomous variable and were unable to examine differential effects by amounts of alcohol consumed.…”

Section: Discussionmentioning

confidence: 99%

Increased Partner Risk Characteristic Among Adolescents Using Alcohol In the Moment

2016

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Background Alcohol is a recognized risk factor for sexually transmitted diseases (STD) acquisition, but the mechanism is unclear. Potentially, adolescents using alcohol in the two hours before sex (in-the-moment use) have riskier sexual partners. Methods We used multivariable logistic regression to examine the association between in-the-moment alcohol use and partner risk characteristics reported for the most recent sex among primarily 17-18 year old adolescents originally recruited from a representative sample of Chicago public elementary schools. We created three composite partner risk profiles: partner familiarity risk (casual and unexpected), partner context risk (age discordance and met in public), and overall risk using all measures except partner alcohol use. Results Teens who reported any in-the-moment alcohol use were more likely than non-drinking teens to report casual [Adjusted Odds Ratio (AOR)=3.2, 95% CI = 2.1 to 4.9)], unexpected (AOR=1.6, 95% CI = 1.0 to 2.5), age discordant (AOR=3.0, 95% CI=2.0 to 4.6), or met in public partners (AOR=1.4, 95% CI = 1.0 to 2.1). For each composite measure, the number of partner risk characteristics reported increased linearly with the percent of teens drinking in-the-moment (Cochran-Armitage trend P<0.0001). Compared to zero characteristics, in-the-moment alcohol use was associated with increased odds of reporting one (AOR=2.8, 95% CI=1.7, 4.5), two (AOR=4.6, 95% CI=2.7, 7.6), or three to four characteristics (AOR=7.1, 95% CI=3.3, 15.3). Conclusions Our findings expand the link between in-the-moment alcohol use and partner risk reported in prior studies to encompass adolescents’ general sexual experiences and additional partner characteristics including the highly associated composite characteristics. For primarily 17-18 year olds’ most recent sexual encounter, adolescents using any alcohol in-the-moment were two to three times more likely than non-users to have a risky sex partner.

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“…However, this finding is consistent with a recent systematic review which concluded that older partner age was associated with prevalent infection but largely unrelated to incident STIs among adolescents. 29 …”

Section: Discussionmentioning

confidence: 99%

Correlates of Incident Trichomonas vaginalis Infections Among African American Female Adolescents

Swartzendruber

Sales

Brown

et al. 2014

Sexually Transmitted Diseases

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Background Trichomonas vaginalis is the most common curable sexually transmitted infection (STI), associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident Trichomonas vaginalis infections among African American adolescent females. Methods Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American females (14–20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching and other STIs. Results Of 605 (86.3%) participants who completed ≥1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n=121). Factors associated with incident infection in adjusted analysis included: cigarette smoking (AOR: 1.66, 95% CI: 1.04, 2.64), using alcohol on an increasing number of days in the past 3 months (AOR: 1.02, 95% CI: 1.00, 1.04), acquisition of C. trachomatis (AOR: 2.27, 95% CI: 1.40, 3.69) or N. gonorrhoeae (AOR: 5.71, 95% CI: 2.97, 11.02) and T. vaginalis infection at the previous assessment (AOR: 3.16, 95% CI: 1.96, 5.07). Conclusions Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of re-screening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae and associations between substance use and T. vaginalis acquisition warrant further investigation.

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It Takes 2

Cited by 27 publications

References 69 publications

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

Increased Partner Risk Characteristic Among Adolescents Using Alcohol In the Moment

Correlates of Incident Trichomonas vaginalis Infections Among African American Female Adolescents

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