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Concurrent STD Morbidity in Sexual Contacts to Persons with STD’s: Implications for Patient-Delivered Partner Therapy (PDPT) Joanne Stekler, Laura Bachmann,

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Presentation on theme: "Concurrent STD Morbidity in Sexual Contacts to Persons with STD’s: Implications for Patient-Delivered Partner Therapy (PDPT) Joanne Stekler, Laura Bachmann,"— Presentation transcript:

1 Concurrent STD Morbidity in Sexual Contacts to Persons with STD’s: Implications for Patient-Delivered Partner Therapy (PDPT) Joanne Stekler, Laura Bachmann, Rebecca Brotman, Emily Erbelding, Laura Lloyd, Kees Rietmeijer, H Hunter Handsfield, King K Holmes, Matthew R Golden

2 Background Public health partner notification programs affect <20% of cases of gonorrhea and chlamydia. Many patients become reinfected by untreated partners. A randomized, controlled trial that included PDPT reduced persistent or recurrent chlamydia or gonorrhea, compared to patient referral. Little is known about missed opportunities to diagnose HIV and other STD’s in contacts who might receive PDPT.

3 Objectives To describe STD morbidity in patients who present as contacts to bacterial STD’s and/or trichomoniasis. To compare the regional variability of this morbidity between four U.S public health STD clinics.

4 Methods Retrospective analysis Study sites: Baltimore, MD Birmingham, AL Denver, CO Seattle, WA Study period: Jan 1 2001-Dec 31 2002

5 Inclusion Criteria Patients who presented as contact to: chlamydia (ct) gonorrhea (gc) non-gonococcal urethritis (ngu) mucopurulent cervicitis (mpc) trichomoniasis (trich)

6 Exclusion Criteria Subsequent visit(s) during study period Contact to syphilis or HIV For men: unknown sexual orientation

7 Study Population: Contacts to STD’s Baltimore N=1080(%) Birm. N=822 (%) Denver N=3289(%) Seattle N=1287(%) Total n=6478(%) Fem MSW MSM 661 (39) 651 (60) 10 (1) 362 (44) 459 (56) 1 (0) 1332 (40) 1757 (53) 200 (6) 394 (31) 644 (50) 249 (19) 2507 (39) 3511 (54) 460 (7) White Hisp Black 12 (1) 0 1055 (98) 72 (9) 10 (1) 725 (88) 852 (26) 1286 (39) 1044 (32) 578 (45) 40 (3) 466 (36) 1514 (23) 1336 (21) 2235 (51)

8 Study Population: Contacts to STD’s Contact Baltimore n=1080(%) Birmingham N=822 (%) Denver N=3289(%) Seattle N=1287(%) Total N=6478(%) CT GC CT+GC NGU Trich 248 (23) 240 (22) 12 (1) 148 (14) 430 (40) 203 (25) 211 (26) - 108 (13) 296 (36) 1507 (46) 527 (16) 135 (4) 637 (19) 415 (13) 614 (48) 294 (23) 52 (4) 171 (13) 128 (10) 2572 (40) 1272 (20) 199 (3) 1064 (16) 1269 (20)

9 Results: Prevalence of HIV and Syphilis in Contacts to STD’s Women N=2507 (%) Hetero men N=3511 (%) MSM N=460 (%) HIV0/1404 (0)3/1928 (0.3)11/204 (5.4) Early syphilis 1/2507 (0)0/3511 (0)2/459 (0.4) Late/latent/ or other syphilis 18/2042 (.9)14/2923 (0.5)5/351 (1.4)

10 Results: Prevalence of STD Dx’s Concordant with Contact Women N=2088 (%) Hetero men N=2860 (%) MSM N=450 (%) CT dx in contact to CT 242/624 (38.8) 769/1602 (48.0) 14/98 (14.3) GC dx in contact to GC 221/470 (47.0) 78/263 (29.7) 101/299 (33.8) CT dx in contact to GC 105/470 (22.3) 42/263 (16.0) 26/299 (8.7)

11 Results: Prevalence of STD Dx’s Discordant with Contact Women N=2507 (%) Hetero men N=3511 (%) MSM N=460 (%) GC dx in contact to CT 29/737 (3.9) 56/1801 (3.1) 6/100 (6.0) CT or GC dx in contact to Trich 29/134 (21.6) 88/819 (10.7) - Trich dx in contact to CT, GC, or NGU 145/2334 (6.2) --

12 Prevalence of PID + STD Dx’s Discordant with Contact: Women by Site

13 Prevalence of STD Dx’s Discordant with Contact: Heterosexual Men by Site

14 Prevalence of STD Dx’s Discordant with Contact: MSM by Site

15 Summary Women and heterosexual male contacts had extremely low levels of HIV and syphilis. Diagnoses of CT and GC were common in contacts to trichomoniasis. Prevalence of trich in female contacts to bacterial STD’s varied by location. 5.4% of MSM were newly diagnosed with HIV during evaluation as contacts to bacterial STD’s. Syphilis was less common.

16 Conclusions Use of PDPT for chlamydia and gonorrhea would not be associated with major missed opportunities in heterosexual contacts. Overall, PDPT would likely result in a greater number of treated partners compared with patient referral. Approximately 90% of GC would be treated by antibiotics directed towards CT. The high prevalence of bacterial comorbidity in contacts to trich must be noted when evaluating the potential benefits of PDPT for this disease.

17 Conclusions The relatively high prevalence of HIV and syphilis suggests that further studies should be done before PDPT for chlamydia and gonorrhea is routinely used in MSM.

18 Acknowledgements Baltimore, MDDenver, CO R BrotmanL Lloyd E ErbeldingK Rietmeijer Birmingham, ALSeattle, WA L BachmannA Collier S YuM Golden HH Handsfield K Holmes F Koch

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