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The burden of repeat Chlamydia trachomatis infection in young women in New York City

The burden of repeat Chlamydia trachomatis infection in young women in New York City. Klingler E 1 , Pathela P 1 , Cordova D 1,2 , Blank S 1,2 , Schillinger J 1,2 1. New York City Department of Health and Mental Hygiene (NYC DOHMH), USA

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The burden of repeat Chlamydia trachomatis infection in young women in New York City

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  1. The burden of repeat Chlamydia trachomatis infection in young women in New York City Klingler E1, Pathela P1, Cordova D1,2, Blank S1,2, Schillinger J1,2 1. New York City Department of Health and Mental Hygiene (NYC DOHMH), USA 2. Centers for Disease Control and Prevention (CDC), USA

  2. OBJECTIVE To quantify the burden of repeat chlamydial infection in young women in New York City

  3. BACKGROUND • Repeat C. trachomatis (Ct) infections in women increase the risk for adverse sequelae • CDC recommends re-screening women three to four months after treatment for a Ct infection • Large numbers of Ct reportedin adolescents and young adult women in NYC • ~27,000 cases in females reported to NYC Department of Health and Mental Hygiene (DOHMH) in 2005 • 17,887 (67%) among women age 15 to 25 years

  4. METHODS • Data source: NYC DOHMH Bureau of STD Control (BSTDC) surveillance registry • Analytic sample: Women aged 10 to 29 years for whom a case of Ct was reported between January 2000 and June 2005

  5. METHODS-DEFINITIONS- • Initial infection: The first infection for a given woman in a year • Repeat infection: A Ct infection > 30 days after a woman’s initial Ct report and within a 12 month follow-up (f/u) period

  6. METHODS-DEFINITIONS- • Gonorrhea (GC) co-infection: Gonorrhea infection reported for a woman within ten days of her initial Ct report • Private Provider: Any provider working outside the NYC DOHMH BSTDC clinic system

  7. METHODS-COHORT DESCRIPTION- • We created cohorts of women diagnosed with Ct in a calendar year • 4 years: 2000-2003 • We allowed each woman 1 year of f/u time from her initial infection • We created a separate cohort of women reported July 2003- June 2004, permitting a full year of f/u

  8. METHODS-ANALYSIS- • Calculate rates of repeat infection by year • Bivariate analyses to determine predictors of repeat infection • Covariates investigated: neighborhood of residence, age, provider type, gonorrhea co-infection, and race/ethnicity • Multivariate analysis to identify independent predictors of repeat infection • Included all covariates examined +/- neighborhood

  9. RESULTS • Overall, 117,792 cases of Ct in females aged 10-29 years were reported to the NYC DOHMH BSTDC during the 5 ½ year interval • These cases were among 91,979 women • ~ 21% of these women experienced at least one repeat infection

  10. Proportion of women with a repeat infection, by age and year of initial Ct diagnosis

  11. Median time to repeat infection and % re-infected by three months

  12. Number of Ct cases reportedby year and provider type and proportion of cases with repeat infection 14% 13% 15% 15% 14% 22% 12% 13% 12% 12%

  13. Rates of GC co-infection at the initial Ct infection among women with and without repeat infection, by age

  14. Bivariate Analysis of Repeat Ct Infections, Race/ethnicity

  15. Bivariate Analysis of Repeat Ct Infections, Age

  16. Bivariate Analysis of Repeat Ct Infections, GC co-infection

  17. Multi-variate Analysis of Repeat Ct Infections, Race/ethnicity

  18. Multi-variate Analysis of Repeat Ct Infections

  19. LIMITATIONS • We may have classified some persistent infections as repeat infections • We assumed treatment was given for an initial infection • Possible bias in who providers decide to re-screen

  20. CONCLUSIONS • Repeat infection rates are high among young women in NYC • Age and GC co-infection at time of initial infection may be used to target women at greatest risk for re-infection • A larger proportion of re-infected women have their initial infection reported by a private provider

  21. THANKS to our entire BSTDC staff for their work in getting this data collected, entered, and analyzed. The findings and conclusions of this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy

  22. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

  23. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

  24. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

  25. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

  26. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

  27. METHODS-COHORT DESCRIPTION- A A B A B 2000 2001 2002

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