Analysis of routine data describing morbidity from gonorrhea

Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting

This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.

Surveillance for Repeat Gonorrhea Infection, San Diego, California, 1995???2001

BACKGROUND

Persons with repeat gonorrhea (GC) infection often participate in sexual networks that maintain and spread GC throughout the community. However, there are no established methods for collecting repeat GC surveillance data that are needed to monitor trends and risk factors for repeat infection.

GOAL

The goal of this study was to evaluate definitions and methods for establishing surveillance for repeat gonorrhea infection.

STUDY DESIGN

During a 7-year period (1995-2001), all reported GC cases in San Diego County, California, were reviewed to identify persons with >2 GC infections that occurred >30 but <365 days apart. Various matching criteria and definitions of repeat infection were evaluated.

RESULTS

Overall, 12,287 GC infections were reported; 509 persons accounted for 551 episodes of repeat infection and 9.7% of all GC infections. The mean annual repeat GC case rate was 2.8 per 100,000 population (range, 1.5-4.1) and repeat cases were 4.5% of total GC (range, 2.7-5.5%). Temporal trends in both repeat measures mirrored the overall county reported GC case rate. Young, inner-city males were more likely to have reported repeat GC infection.

CONCLUSION

Simple, uniform repeat GC measures can be used to establish a surveillance system for monitoring trends, risk factors, and the impact of interventions directed toward preventing repeat GC infections.

Sexually transmitted disease clinic clients at risk for subsequent gonorrhea and chlamydia infections: possible 'core' transmitters

BACKGROUND

From an sexually transmitted disease (STD) intervention perspective, developing a practical way to identify persons in core transmitter groups has been difficult. However, persons who have repeated STD infections may be in such groups.

GOAL

To evaluate a self-administered risk assessment approach that would identify STD clinic clients who were at an increased risk of being involved in gonorrhea (GC) or chlamydia (CT) transmission in the subsequent year.

STUDY DESIGN

Prospective cohort of consecutive STD clinic clients with a 1-year follow-up period.

RESULTS

During a 6-month period in 1995, 2576 STD clinic clients in San Diego completed a risk assessment. Of those clients, 204 (7.9%) had a subsequent STD and 79 (3.1%) had a subsequent GC or CT infection during the 1-year follow-up period. The strongest predictor of a subsequent GC/CT was having a recent history or current clinic visit diagnosis of GC or CT (6.1% subsequent GC/CT rate). The more past episodes of GC or CT, the higher the subsequent GC/CT rate. Unsafe sexual behavior had little effect on further increasing subsequent GC/CT risk.

CONCLUSION

STD clinic clients with a recent history of GC or CT and a high risk of subsequent GC/CT may be core transmitters who could likely benefit from risk reduction, periodic screening for GC/CT, symptom recognition counseling, and preventive treatment-the essential elements of STD-prevention case management.

Features of urethritis in a cohort of male soldiers

Of 400 cases of urethritis in male soldiers enrolled in a behavioral intervention project, the etiology of 69% was defined at study enrollment, as well as the etiology of 72% of 25 repeated episodes involving 21 men during the first 78 days of active follow-up (5% of the cohort). Chlamydia trachomatis (36%), Neisseria gonorrhoeae (34%), and Ureaplasma urealyticum (19%) were the most common causes of infection identified at enrollment and during subsequent visits (44%, 28%, and 12%, respectively). By univariate analysis, patients with repeated infection ("repeaters") were significantly more likely to report a history of sexually transmitted disease (STD; relative risk [RR], 3) and sex with sex workers (RR, 4) than were nonrepeaters. By multivariate analysis, only STD history was significant (RR, 2.8). Characteristics of repeaters in this cohort suggest that specific patterns may be used to establish screening "profiles" of potential repeaters, by which such individuals might be targeted for aggressive intervention at the time of the initial diagnosis.