The Relationship Between The Relationship Between Repeat Infections and Behavioral Repeat Infections and Behavioral

Risk Factors and Clinician Risk Factors and Clinician Counseling: Findings from a Counseling: Findings from a

Philadelphia STD ClinicPhiladelphia STD Clinic

M. EberhartM. Eberhart11, N. Liddon, N. Liddon22, M. Goldberg, M. Goldberg11, ,

J.S. LeichliterJ.S. Leichliter22, L. Asbel, L. Asbel11

1Philadelphia Department of Public Health, Philadelphia, PA

2Centers for Disease Control and Prevention, Atlanta, GA

BackgroundBackground

Repeat infections with bacterial STDs Repeat infections with bacterial STDs are relatively commonare relatively common

Repeat infections account for a Repeat infections account for a substantial proportion of morbiditysubstantial proportion of morbidity

Adverse sequelae are associated with Adverse sequelae are associated with untreated bacterial STDsuntreated bacterial STDs

ObjectivesObjectives

Identify behavioral/demographic Identify behavioral/demographic predictors of repeat infectionpredictors of repeat infection

Explore the relationship between Explore the relationship between clinician counseling and repeat infectionclinician counseling and repeat infection

Repeat InfectionRepeat Infection

Lab-confirmed diagnosis of CT, GC, or Lab-confirmed diagnosis of CT, GC, or both at index infectionboth at index infection

Subsequent lab-confirmed diagnosis of Subsequent lab-confirmed diagnosis of CT, GC, or both – 31 days to 2 years CT, GC, or both – 31 days to 2 years after index infectionafter index infection

Disease Control Management Disease Control Management System (DCMS)System (DCMS)

A comprehensive database of all A comprehensive database of all reported STDs in Philadelphiareported STDs in Philadelphia

Patients are assigned a unique identifier Patients are assigned a unique identifier that can be used to track subsequent that can be used to track subsequent infections infections

Used to collect and store information on Used to collect and store information on STD cases reported to the health STD cases reported to the health department since 1994department since 1994

Includes demographic data, as well as Includes demographic data, as well as testing, treatment and diagnosis data testing, treatment and diagnosis data

MethodsMethods

Morbidity data from 1994 to 2000 were Morbidity data from 1994 to 2000 were reviewed to identify repeat infectionsreviewed to identify repeat infections

n = 79,989n = 79,989– GC and/or CT at index visitGC and/or CT at index visit– Age 12 and upAge 12 and up

Clinic DataClinic Data

Patient data is collected and stored Patient data is collected and stored using a scannable medical recordusing a scannable medical record

Data include the following clinic servicesData include the following clinic services– Intake/RegistrationIntake/Registration– Lab testsLab tests– Clinician evaluation/diagnosisClinician evaluation/diagnosis– TreatmentTreatment– Counseling/ReferralCounseling/Referral

MethodsMethods

Morbidity data were matched with clinic Morbidity data were matched with clinic visit datavisit data

n = 17,929n = 17,929– Sexual Risk Behaviors (e.g. condom use, Sexual Risk Behaviors (e.g. condom use,

number of partnersnumber of partners– Clinician Counseling (e.g. partner Clinician Counseling (e.g. partner

notification, contraception, drug use)notification, contraception, drug use)

MethodsMethods

SPSS 10.1 for WindowsSPSS 10.1 for Windows®®– FrequenciesFrequencies

– Chi-squaresChi-squares

– Logistic RegressionLogistic Regression

MethodsMethods

Males:Males:– Never using a condom, increased number Never using a condom, increased number

of partners, and dual diagnosis associated of partners, and dual diagnosis associated with repeat infectionwith repeat infection

Females:Females:– Never using a condom and dual diagnosis Never using a condom and dual diagnosis

associated with repeat infectionassociated with repeat infection

ResultsResults

14.5% of patients contracted repeat 14.5% of patients contracted repeat infectionsinfections– 17.8% of females (1,338/7,498)17.8% of females (1,338/7,498)– 12.1% of males (1,266/10,431)12.1% of males (1,266/10,431)

Women under 25 years of age are more Women under 25 years of age are more likely to have a repeat infectionlikely to have a repeat infection

ResultsResults

The strongest predictors of repeat The strongest predictors of repeat infection for both males and females infection for both males and females are:are:– Self-reported history of GC or CTSelf-reported history of GC or CT– Dual diagnosis at index infectionDual diagnosis at index infection

ConclusionsConclusions

Self-reports of known behavioral risk Self-reports of known behavioral risk factors did not predict repeat infectionsfactors did not predict repeat infections

More analysis is needed to accurately More analysis is needed to accurately identify patients at risk of repeat identify patients at risk of repeat infectioninfection

Next StepsNext Steps

Evaluation of the content and Evaluation of the content and consistency of counseling messages consistency of counseling messages should be consideredshould be considered

Research on intervention strategies Research on intervention strategies targeted specifically at repeat infectors targeted specifically at repeat infectors is neededis needed