Repeat Infections among Adolescents and Young Adults:

1. Repeat Infections among Adolescents and Young Adults: Findings From Philadelphia STD Clinics Nicole Liddon, PhD1 Michael Eberhart, BS2 Jami Leichliter, PhD1 Martin Goldberg, BS2 Lenore Asbel, MD2 1 National Centers for Disease Control and Prevention, NCHSTP, DSTP, BIRB 2 City of Philadelphia Health Department

2. Background:Repeat Infections • Studies estimate between 5%-20% of STD clinic clients reinfected within the following 2 years. • As much as 40% of annual chlamydia and gonorrhea incidence occurs in previously infected patients. • Health and financial consequences.

3. Objective To use clinic intake records and morbidity reports to identify factors associated with repeat infection among Philadelphia STD clinic clients. • Can observations commonly used by clinics be used to recognize individuals at risk of returning with reinfection? • Are there any clinic-level protective factors (e.g. didactic messages)?

4. Methods • Retrospective study of records: • City of Philadelphia morbidity files 1994-2000 (n=79,989) • Matched clinic patient records (n=17,929) • Lab diagnosed gc and/or ct infection

5. Preliminary inquiry(Eberhart et al., 2002) • 16.3% reinfected with gc and/or ct (within 30 days to 2 years) • Relatively little of the difference in risk of repeat infections explained by demographics or behavior. • Repeaters more likely to be African-American, younger, present initially with dual infection. • History of Gonorrhea and/or Chlamydia strongest predictors of repeat infections.

6. Methods • Age 14-19, no previous dx (n=1,909) • To identify risks of re-infection at initial dx for patients by using demographics, behaviors, and provider actions. • Chi-square, difference of means tests, univariate logistic regression • Separate analyses by gender

7. Methods • Demographics (race, age) • Sexual Risk Behaviors • Condom use last sexual encounter • Condom use regular partners • (never, some/always) • Condom use other partners • (never, some/always) • New sex partner last 90 days • # of sex partners last 90 days • (none, one, two, three or more)

8. Provider Actions • Self reported message delivery (yes or no) re: • Partner notification • Risk reduction • Future Disease Suspicion • Medication • Follow-up • Patient Handouts • Contraception

9. Patients

10. Significant correlates of repeat infection--females

11. Significant correlates of repeat infection—males

12. Limitations-- • Use of morbidity data • Unclear if there are other dx outside of reported cases. • Use of clinic files • Not designed for in-depth behavior measurement • Self-report • Retrospective design • Behaviors occurred before initial dx • Individuals not randomly assigned to receive message from provider or not.

13. Conclusions • Current clinic-level observation does little to identify individuals at risk of reinfection, and new methods of assessing this risk may need to be developed. • However, some specific factors clinics currently measure that do associate with increased risk of re-infection and suggest possibilities for focused prevention at the first diagnosis.

14. Conclusions • For both males and females, individuals presenting with multiple diagnoses may benefit from increased follow-up and case management techniques. • Provider-delivered risk reduction messages may protect patients from repeat infection, but should be explored further.