High Incidence of New Sexually Transmitted Infections in the Year following a Sexually Transmitted Infection: A Case for Rescreening

17 October 2006 | Volume 145 Issue 8 | Pages 564-572

Background: Studies show 11% to 15% of women treated for Chlamydia trachomatis are reinfected 3 to 4 months after treatment, suggesting the need for rescreening. There is little information on infections among men, infections with Neisseria gonorrhoeae or Trichomonas vaginalis, or long-term follow-up.

Objective: To determine the incidence of new sexually transmitted infections during the year after a visit to a sexually transmitted disease (STD) clinic and associated risk factors.

Design: Secondary analysis of data from a randomized, controlled trial (RESPECT-2).

Setting: 3 urban STD clinics.

Patients: Sexually active patients enrolled in an HIV prevention counseling trial.

Measurements: Patient characteristics at the initial visit; behaviors during follow-up; and new infections with C. trachomatis, N. gonorrhoeae, or T. vaginalis (women only) detected during 4 scheduled return visits and any other interim visits.

Results: 2419 persons had 8129 three-month follow-up intervals. Among 1236 women, 25.8% had 1 or more new infections (11.9% acquired C. trachomatis, 6.3% acquired N. gonorrhoeae, and 12.8% acquired T. vaginalis); among 1183 men, 14.7% had 1 or more new infections (9.4% acquired C. trachomatis, and 7.1% acquired N. gonorrhoeae). Black persons and those with sexually transmitted infections at baseline were at highest risk for recurrent infection (adjusted odds ratio, 2.5 and 2.4, respectively). For persons infected at baseline, the risk for infection was high at 3 and 6 months (16.3 per 100 three-month intervals) and remained high at 9 and 12 months (12.0 per 100 three-month intervals). Most (67.2%) infections were diagnosed during study-related visits, and 66.2% of these patients reported no symptoms.

Limitations: Because patients were recruited from STD clinics, results may not be generalizable.

Conclusions: Men and women who receive diagnoses of C. trachomatis, N. gonorrhoeae, or T. vaginalis infections should return in 3 months for rescreening because they are at high risk for new asymptomatic sexually transmitted infections. Although single-dose therapy may adequately treat the infection, it often does not adequately treat the patient.

*For members of the RESPECT-2 Study Group, see the Appendix.

Editors' Notes Context The Centers for Disease Control and Prevention recommends that women treated for Chlamydia trachomatis infection return in 3 months for evaluation of reinfection. Contribution When data from the RESPECT-2 trial were used, these investigators found that among patients treated for sexually transmitted infections, 25.8% of women and 14.7% of men acquired 1 or more new infections with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis during 1 year of follow-up. Approximately 66% of reinfections were asymptomatic. Implications Successful treatment of incident cases of sexually transmitted infections is unlikely to eliminate a reservoir of infection in the community. Physicians need to perform ongoing surveillance on men and women and encourage lifestyle changes in patients with reinfection. —The Editors

 

Author and Article Information

From Centers for Disease Control and Prevention, Atlanta, Georgia; Human Sciences Research Council, Pretoria, South Africa; California State University and Long Beach Department of Health and Human Services, Long Beach, California; New Jersey Department of Health and Senior Services, Trenton, New Jersey; and Denver Public Health Department and University of Colorado at Denver Health Sciences Center, Denver, Colorado.

Grant Support: None.

Potential Financial Conflicts of Interest:Grants received: C.K. Malotte (Centers for Disease Control and Prevention).

Requests for Single Reprints: Thomas A. Peterman, MD, MSc, Centers for Disease Control and Prevention, Mailstop E-02, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, tpeterman{at}cdc.gov.

Current Author Addresses: Drs. Peterman, Tian, and Douglas and Ms. Satterwhite: Centers for Disease Control and Prevention, Mailstop E-02, 1600 Clifton Road NE, Atlanta, GA 30333.

Dr. Metcalf: Human Sciences Research Council, 134 Pretorius Street, Pretoria, 0002 Private Bag X41, Pretoria 0001, South Africa.

Dr. Malotte: California State University, Long Beach, 5500 Atherton Street, Suite 400, Long Beach, CA 90815.

Ms. DeAugustine: City of Long Beach Department of Health, 2525 Grand Avenue, Long Beach, CA 90815.

Dr. Paul: New Jersey Department of Health and Senior Services, P.O. Box 363, Trenton, NJ 08625-0363.

Dr. Cross: New Jersey Department of Health and Senior Services, Box 363, Trenton, NJ 08625-0363.

Dr. Rietmeijer: Denver Public Health Department, 605 Bannock Street, Denver, CO 80204.

Author Contributions: Conception and design: T.A. Peterman, C.A. Metcalf, S.M. Paul, H. Cross, C.A. Rietmeijer, J.M. Douglas Jr.

Analysis and interpretation of the data: T.A. Peterman, L.H. Tian, C.A. Metcalf, C.L. Satterwhite, S.M. Paul, C.A. Rietmeijer.

Drafting of the article: T.A. Peterman, S.M. Paul, C.A. Rietmeijer.

Critical revision of the article for important intellectual content: T.A. Peterman, C.A. Metcalf, C.K. Malotte, S.M. Paul, C.A. Rietmeijer, J.M. Douglas Jr.

Final approval of the article: T.A. Peterman, L.H. Tian, C.A. Metcalf, C.L. Satterwhite, C.K. Malotte, N. DeAugustine, S.M. Paul, H. Cross, C.A. Rietmeijer, J.M. Douglas Jr.

Provision of study materials or patients: N. DeAugustine, S.M. Paul, C.A. Rietmeijer, J.M. Douglas Jr.

Statistical expertise: L.H. Tian.

Obtaining of funding: H. Cross, C.A. Rietmeijer.

Administrative, technical, or logistic support: J.M. Douglas, H. Cross.

Collection and assembly of data: C.A. Metcalf, C.L. Satterwhite, C.K. Malotte, S.M. Paul, H. Cross, C.A. Rietmeijer.