1. Repeat Chlamydia trachomatis: Rate and Predictors among Males Eileen F. Dunne M.D., M.P.H. JB Chapin, C Rietmeijer, CK Kent, J Ellen, C Gaydos, N Willard, L Lloyd, N Birkjukow, S Chung, JA Schillinger, LE Markowitz Division of STD Prevention Centers for Disease Control and Prevention

2. Acknowledgments Baltimore: Jon Ellen Charlotte Gaydos Nancy Willard Michelle Chung Denver: Kees Rietmeijer Laura Lloyd San Francisco: Charlotte Kent Nat Birkjukow CDC: Julie Schillinger Lauri Markowitz Maya Sternberg Johanna Chapin

3. Background Chlamydia trachomatis (Ct) infection in females is common and associated with serious sequelae –PID, ectopic pregnancy and infertility Ct infection in males –Limited resources to screen –Additional information needed to guide program activities

4. Background Male Chlamydia Screening Project: –Demonstration project: men ages 15-44 screened for Ct infection Baltimore Denver San Francisco Seattle –Longitudinal Study: men with Ct infection recruited for a study of repeat infection Baltimore Denver San Francisco

5. Venue Type Baltimore Denver San Francisco (N=10) (N=33) (N=11) Adolescent Primary CareXX X Adult Primary CareXX Juvenile DetentionXX Adult DetentionXXX School ClinicsXXX School Health FairsX College Clinics X Community Based OrganizationsX Drug TreatmentX STD ClinicsXX Street OutreachXX

6. Objectives To evaluate: Ct prevalence and predictors of infection Cost-effectiveness of screening for Ct infection Partner and network characteristics Rate and predictors of repeat Ct infection

7. Objectives Ct prevalence and predictors of infection Cost-effectiveness of screening for Ct infection Partner and network characteristics Rate and predictors of repeat Ct infection

8. Longitudinal Study Methods Men with Ct infection recruited from various venues in Baltimore, Denver, San Francisco –Study Design Baseline Visit –Questionnaire –Partner management Follow-up at 1 and 4 months –Screening for Ct using urine NAATs –Questionnaire –Partner management

9. Longitudinal Study Methods Analysis: –Men with at least one follow-up visit –Repeat infection: defined as Ct infection at the first or second follow-up visit

10. Longitudinal Study Methods Bivariate Characteristics of men at baseline visit Characteristics of partners –Baseline partners –New partners Cox Proportional Hazards Model

11. Longitudinal Study Enrollment 358 men enrolled 272 (76%) study population 98 (36%) 1 follow-up visit 174 (64%) 2 follow-up visits

12. Time in Study MedianRange Time to First Follow-up33 days21-215 days Time in Study102 days21-391 days

13. Partner Management 272 study population –403 partners named 74 (18%) partners locatable 65 (16%) partners treated Locatable Treated

14. Study Population CharacteristicN (%) Age (yrs) 15-17 18-19 20-24 >24 51 (19) 63 (23) 96 (35) 61 (23) Race/Ethnicity White Hispanic Black Other 49(18) 77(29) 108 (40) 37 (13) City Baltimore Denver San Francisco 58 (21) 138 (51) 75 (28)

15. Repeat Infection Overall: 31 (11%) men had repeat Ct infection –3 men ≥ 1 repeat infection

16. Repeat Infection by City CityNRepeat Infection n (%) Baltimore587 (12) Denver13816 (12) San Francisco758 (11)

17. Repeat Infection by City/Venue City/VenueNRepeat Infection n (%) Baltimore/Adolescent Clinics18 5 (28) Baltimore/School Clinics40 2 (5) Denver/Adolescent Clinics32 9 (28) Denver/STD Clinic67 5 (7) San Francisco/STD Clinic57 7 (12)

18. Repeat Infection by Age VariableNRepeat infection n (%) p value Age (yrs) 15-17 18-19 20-24 >24 51 63 96 61 9 (18) 6 (10) 10 (10) 6 (10).22

19. Repeat Infection by Partner Partner CharacteristicNRepeat infection n (%) # Partners last 2 months 0 1-2 ≥3 12 210 45 0 27(13) 4(9) New Partner during study Yes No 111 161 16 (14) 16(10)

20. Repeat Infection by Partner Type Partners during studyNRepeat infection n (%) No partners Only baseline partners Baseline and new partners Only new partners 5 155 104 8 0 15 (10) 16 (15) 0

21. Repeat Infection Significant findings VariableNRepeat infection n (%) p value Education level <HS Some HS College Graduate school 21 136 89 15 7 (33) 10 (7) 8 (9) 2 (13).003 History of STD Yes No 67 204 13 (19) 18 (9).01 Income No Yes 97 174 16 (16) 15 (9).05

22. Cox Proportional Hazards Model VariableHazard Ratio(95% CI)p value Education level <HS more than HS 5.1 1.0 (2.1, 12.5)<.001 History of STD Yes No 2.4 1.0 (1.1, 5.4).03 Income No Yes 1.8 1.0 (0.8, 3.9).14

23. Incidence of Repeat Infection Cumulative Incidence: 42.3 per 100 person years –Most infections occurred early

24. Cumulative Incidence Curve

25. Conclusions Repeat Ct infection among men from diverse geographic locations was 11% Partner characteristics were not significantly associated with repeat infection History of STD, and less than high school education were associated with repeat Ct infection

26. Future Directions Genotyping Evaluating partner characteristics and sexual behaviors during study

27. Contact Eileen F. Dunne (edunne@cdc.gov)edunne@cdc.gov –404-639-6184

28. Acknowledgments Baltimore: Jon Ellen Charlotte Gaydos Nancy Willard Michelle Chung Denver: Kees Rietmeijer Laura Lloyd Stewart Thomas San Francisco: Charlotte Kent Nat Birkjukow SeatleJeanne Marrazzo CDC: Julie Schillinger Lauri Markowitz Maya Sternberg Johanna Chapin John Papp Angelica Wendt

29. Survival Curve