Risk Factors for Repeated Gonococcal Infections: San Francisco, 1990–1992

Klausner, Jeffrey D.; Barrett, Donald C.; Dithmer, Dwyn; Boyer, Cherrie B.; Brooks, George F.; Bolan, Gail

doi:10.1086/517442

Cited by 25 publications

(13 citation statements)

References 14 publications

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“…In our cohort, syphilis reinfection accounted for three quarters of incident syphilis cases as indicated by baseline reactive titers and appropriate increase of titers reflective of new infection. This supports the idea that there is a higher risk core group of “repeaters” who are reinfected with syphilis [11, 18]. This calls for focused prevention of syphilis beyond periodic testing among high-risk individuals.…”

Section: Discussionsupporting

confidence: 72%

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

Park¹,

Konda

Roberts³

et al. 2016

PLoS ONE

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BackgroundSyphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru.MethodsParticipants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02).ResultsOf 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1–1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated.ConclusionsWe report a high rate of syphilis reinfection among high-risk men who have evidence of previous syphilis infection. Our findings highlight the close relationship between HIV incidence with both incident syphilis and syphilis reinfection. Further studies on syphilis reinfection are needed to understand patterns of syphilis reinfection and new strategies beyond periodic testing of high-risk individuals based on HIV status are needed.

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Section: Discussionsupporting

confidence: 72%

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

Park¹,

Konda

Roberts³

et al. 2016

PLoS ONE

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“…6,7,18,21,28,31,51,52,56 In the 2 prospective studies, an African-American partner was associated with STI acquisition 6,7 In cross-sectional studies, Black or African-American race was positively associated with MG, 18,28 GC, 21 repeat GC 56 and composite STI measures. 31,52 One study reported an African-American partner was significantly associated with GC and CT among White and “Other” males and females, but not among African-Americans.…”

Section: Resultsmentioning

confidence: 98%

“…Ten 6,7,18,21,28,30,31,51,52,56 of 11 6,7,18,21,26,28,30,31,51,52,56 studies which investigated race/ethnicity were US-based; 9 of the 10 reported significant findings. 6,7,18,21,28,31,51,52,56 In the 2 prospective studies, an African-American partner was associated with STI acquisition 6,7 In cross-sectional studies, Black or African-American race was positively associated with MG, 18,28 GC, 21 repeat GC 56 and composite STI measures.…”

Section: Resultsmentioning

confidence: 99%

It Takes 2

Swartzendruber

Zenilman

Niccolai

et al. 2013

Sexually Transmitted Diseases

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Objectives To identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and summarize implications for research and prevention. Design Systematic review. Methods We identified peer-reviewed studies published 1990–2010 which assessed ≥1 partner attribute in relation to a biologically-confirmed STI among adolescents (15–24 years) by searching MEDLINE and included articles. Studies which included adolescents but >50% of the sample or with mean or median age ≥25 years were excluded. Results Sixty-four studies met eligibility criteria; 59% were conducted in high-income countries; 80% were cross-sectional; 91% enrolled females and 42% males. There was no standard “partner” definition. Partner attributes assessed most frequently included: age, race/ethnicity, multiple sex partners and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms appear to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for: other partner sociodemographics; sexual and other behaviors (sexual concurrency, sex worker, intimate partner violence, substance use, travel) and STI history. There were no apparent differences by STI. Conclusions Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard “partner” definition would facilitate interpretation of findings in future studies.

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“…Because the focus of the analysis was repeat infection rather than treatment failure, antibiotic efficacy studies, which generally have short-term follow-up, were not included in our analysis. Twenty-three studies were excluded because reinfection rates were not stratified by sex [11][12][13][14][15][16][17][18][19][20][21] or specific etiology (chlamydia or gonorrhea), 13,14,[21][22][23][24] the publication was a nonpeer-reviewed letter, 25 data were duplicative of already published material, 26 -28 reinfection rates could not be calculated using the data provided, 29 -32 or initial infection was not laboratory-confirmed. 33 Specific study design, proportion of females retested, diagnostic test type used, length of follow-up, geographic region, and population demographics were not considered in the inclusion and exclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Repeat Infection With Chlamydia and Gonorrhea Among Females: A Systematic Review of the Literature

Hosenfeld

Workowski²,

Berman³

et al. 2009

Sexually Transmitted Diseases

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279

207

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Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.

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Risk Factors for Repeated Gonococcal Infections: San Francisco, 1990–1992

Cited by 25 publications

References 14 publications

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

It Takes 2

Repeat Infection With Chlamydia and Gonorrhea Among Females: A Systematic Review of the Literature

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