Risk factors for gonorrhea among heterosexuals--San Francisco, 2006

Neisseria gonorrhoeae Infection in Women Increases With Rising Gonococcal Burdens in Partners: Chlamydia Coinfection in Women Increases Gonococcal Burden

BACKGROUND

Likelihood of Neisseria gonorrhoeae infection in women exposed to male sex partners with increasing N. gonorrhoeae burdens and enhancement by Chlamydia trachomatis is not defined.

METHODS

We identified men with urethritis and their regular female sex partners. Exposure to N. gonorrhoeae burdens in men was compared in N. gonorrhoeae-infected versus -uninfected partners. Association of N. gonorrhoeae infection in women with burdens in male partners was estimated using logistic regression. Association of C. trachomatis coinfection and N. gonorrhoeae burdens in women adjusted for burdens in male partners was estimated by linear regression.

RESULTS

In total, 1816 men were enrolled; 202 had ≥2 partners, 91 who confirmed monogamy and were enrolled; 77% were married. Seventy were partners of N. gonorrhoeae-infected men; 58 (83%) were N. gonorrhoeae infected, 26 (45%) C. trachomatis coinfected. Infected women had partners with 9.3-fold higher N. gonorrhoeae burdens than partners of uninfected women (P = .0041). Association of N. gonorrhoeae infection in women with upper quartiles of N. gonorrhoeae burdens in partners increased (odds ratios ≥ 2.97)compared to the first quartile (P = .032). N. gonorrhoeae burdens in C. trachomatis-coinfected women were 2.82-fold higher than in C. trachomatis-uninfected women (P = .036).

CONCLUSIONS

N. gonorrhoeae infections increased in women whose partners were infected with higher N. gonorrhoeae burdens. C. trachomatis coinfection was associated with increased N. gonorrhoeae burdens in women.

Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia

Background

Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action.

Methods

Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed.

Results

Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk.

Conclusion

The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.

Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression

Objective

To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations.

Methods

A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains.

Findings

A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99).

Conclusions

Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission.

PROSPERO registration number

CRD42018102934.

Racial/Ethnic Differences in Young Women's Health-Promoting Strategies to Reduce Vulnerability to Sexually Transmitted Infections

PURPOSE

Young women of color in the United States are disproportionately affected by sexually transmitted infections (STIs). We characterize the protective behaviors used by young women to reduce their vulnerability to STI acquisition and examine how STI prevention strategies differ by race/ethnicity.

METHODS

From 2015 to 2016, women aged 13-24 years presenting to five Northern California family planning clinics were surveyed about their STI prevention strategies. The chi-squared tests and multivariable logistic regression identified associations between race/ethnicity and use of sexual health-promoting strategies.

RESULTS

Among 790 women, the most common strategies included condom use (67%), asking partners about STIs (47%), limiting sexual partners (35%), frequent STI screening (35%), and asking partners about other sexual partners (33%). Black, Hispanic, and Asian women had decreased odds of utilizing strategies before intercourse compared with white women (adjusted odds ratio [aOR]black: .25, confidence interval [.14-.47]; aORHispanic: .36, CI [.20-.65]; aORAsian: .44, CI [.23-.84]). Black women had decreased odds of using strategies requiring partner involvement (aORblack: .35, CI [.13-.92]). White women were more likely to report that providers discussed condoms (aOR: 2.53, CI [1.04-6.15]) and talked to partners about STIs (aOR: 2.56, CI [1.52-4.32]) compared with nonwhite women. Black and Hispanic women were more likely to feel very uncomfortable discussing lifetime sexual partners (aORblack: 4.26, CI [1.36-13.30] and aORHispanic: 5.35, CI [1.79-15.99]) and condom use (aORblack: 3.05, CI [1.14-8.15] and aORHispanic: 2.86, CI [1.11-7.35]) with providers.

CONCLUSIONS

Young women use diverse strategies to prevent STIs that vary by race/ethnicity. Providers can use these findings to improve sexual health counseling and promote equitable education and services.

Impact of methamphetamine on infection and immunity

The prevalence of methamphetamine (METH) use is estimated at ~35 million people worldwide, with over 10 million users in the United States. METH use elicits a myriad of social consequences and the behavioral impact of the drug is well understood. However, new information has recently emerged detailing the devastating effects of METH on host immunity, increasing the acquisition of diverse pathogens and exacerbating the severity of disease. These outcomes manifest as modifications in protective physical and chemical defenses, pro-inflammatory responses, and the induction of oxidative stress pathways. Through these processes, significant neurotoxicities arise, and, as such, chronic abusers with these conditions are at a higher risk for heightened consequences. METH use also influences the adaptive immune response, permitting the unrestrained development of opportunistic diseases. In this review, we discuss recent literature addressing the impact of METH on infection and immunity, and identify areas ripe for future investigation.

Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines

SummarySexually transmitted diseases (STDs) are leading causes of substantial morbidity worldwide. Identification of risk factors for estimating STD risk provides opportunities for optimising service delivery in clinical settings, including improving case finding accuracy and increasing cost-efficiency by limiting the testing of low-risk individuals. The current study was undertaken to synthesise the evidence supporting commonly cited chlamydia and gonorrhoea risk factors. The level of empirical support for the following predictors was strong/moderate: age, race/ethnicity, multiple lifetime sexual partners, sex with symptomatic partners and concurrent STD diagnosis. The following predictors had weak evidence: socio-economic status, transactional sex, drug/alcohol use, condom use and history of STD diagnosis. The most frequently listed predictors among nine clinical guidelines were younger age and multiple sexual partners; the least consistently listed predictor was inconsistent condom use. We found reasonably good concordance between risk factors consistently listed in the recommendations and predictors found to have strong empirical support in the literature. There is a need to continue building the evidence base to explicate the mechanisms and pathways of STD acquisition. We recommend periodic reviews of the level of support of predictors included in clinical guidelines to ensure that they are in accordance with empirical evidence.

It takes 2: partner attributes associated with sexually transmitted infections among adolescents

OBJECTIVES

The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention.

DESIGN

The design of this study was systematic review.

METHODS

We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded.

RESULTS

Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI.

CONCLUSIONS

Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.

Association between sex partner meeting venues and sexual risk taking among urban adolescents

PURPOSE

To increase understanding of the association between sexual partner meeting venue types (school, through friends or family, organized groups, public places, or on the street) and sexual risk taking among urban youths.

METHODS

Data were from 17- to 18-year-old youths who reported having had sex (n = 1,656) by the time they participated in the 2008-2009 follow-up of a multicomponent alcohol preventive intervention, Project Northland Chicago. We used logistic regression to assess the association between partner meeting venue and sexual risk taking.

RESULTS

Approximately 20% of Chicago adolescents met their most recent sex partner on the street or in public places. Adolescents who met their partner in a public place, rather than in school, were more likely to report having ≥ 3 years age-discordant partner (women: odds ratio [OR] = 7.7, 95% confidence interval [CI] = 3.3-17.7; men: OR = 2.7, 95% CI = 1.1-6.6], alcohol use before sex (women: OR = 3.4, 95% CI = 1.8-6.5; men: OR = 2.4, 95% CI = 1.3-4.4), casual partner (women: OR = not significant; men: OR = 2.4, 95% CI = 1.3-4.5), anal sex (women: OR = not significant; men: OR = 2.4, 95% CI = 1.2-4.9), and unprotected sex (women: OR = 1.7, 95% CI = 1.0-2.7; men: OR = 1.9, 95% CI = 1.1-3.4). Meeting partners on the street was associated with increased probability of alcohol use before sex (women: OR = 2.2, 95% CI = 1.1-4.3; men: OR = 2.1, 95% CI = 1.0-4.6), age-discordant partnerships among women (OR = 14.2, 95% CI = 6.4-31.4), and casual sex partners among men (OR = 2.5, 95% CI = 1.4-4.8).

CONCLUSIONS

Targeting sexual risk taking with partners selected from public places or the street may improve adolescent HIV preventive interventions.

Sexually transmitted infections, sexual risk behavior, and intimate partner violence among African American adolescent females with a male sex partner recently released from incarceration

PURPOSE

Social networks directly and indirectly influence sexually transmitted infections (STIs) risk. The objective was to explore associations between sex with a male recently released from incarceration and sexual risk and intimate partner violence (IPV) among African American adolescent females.

METHODS

Sociodemographic, psychosocial, and sexual behavior data were collected at baseline, 6, and 12 months from African American females, aged 15-21 years, participating in an HIV/STI prevention trial. Among 653 participants with ≥1 follow-up assessments, generalized estimating equations tested associations during follow-up between having a recently released partner and STI acquisition, sexual risk behaviors, and IPV, adjusting for age, treatment assignment, and corresponding baseline measure.

RESULTS

Eighty-three (13.6%) participants had a recently released partner at 6 months and 56 (9.3%) at 12 months. Participants with a recently released partner were more likely to have the following: vaginal (adjusted odds ratio [AOR]: 5.48), anal (AOR: 2.43), and oral (AOR: 1.51) sex, a casual partner (AOR: 1.66), sex while high/drunk (AOR: 1.57) or with a high/drunk partner (AOR: 2.27); use condoms inconsistently (AOR: .58); acquire Chlamydia (AOR: 1.80), and experience emotional (AOR: 4.09), physical (AOR: 2.59), or sexual abuse (AOR: 4.10) by a boyfriend. They had a greater number of sex partners, lower partner communication and refusal self-efficacy, were high/drunk during sex more frequently, and used condoms during oral sex less frequently.

CONCLUSIONS

A recently released sex partner is associated with sexual risk and IPV among African American adolescent females. Prevention programs should inform adolescents about potential risks associated with recently released partners as well as provide adolescents with skills to establish and maintain healthy sexual relationships.

Examining the association between neighbourhood characteristics and gonorrhea rates among women aged 15 to 24 years in Montreal, Canada

OBJECTIVE

The reported incidence rate of gonorrhea has more than doubled from 2000 to 2010 in Montréal, increasing in both sexes and all age groups; however, the increase was particularly high in females aged 15 to 24 years. As the reasons for this increase among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates in this group, to help target intervention strategies.

METHODS

Incident gonorrhea cases were female residents of Montréal aged 15 to 24 years who met Québec's gonorrhea surveillance definition, with a notification date from 2002 to 2009. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression and show the change in the incidence of gonorrhea for each unit increase in neighbourhood-level independent variables, which included material and social deprivation indices (plus the latter's combination and components) and ethnic origin. In the final model, independent variables were normalized to facilitate comparison of their respective IRRs.

RESULTS

A total of 837 cases were reported (cumulative incidence rate 5.6 per 100,000). Higher proportions of persons of African, Aboriginal and Caribbean ethnicity were associated with higher rates of gonorrhea, even after adjustment for deprivation indices.

CONCLUSION

Customary methods for gonorrhea surveillance consider individual characteristics of cases as risk factors for disease. However, our results show that gonorrhea is clustered in neighbourhoods that have high proportions of three ethnic origin groups. Findings from this ecological approach suggest that although ethnicity may be strongly correlated with socio-economic status, there are factors in ethnicity that transcend poverty.

Riskier sexual partners contribute to the increased rate of sexually transmitted diseases among youth with substance use disorders

BACKGROUND

Youth with alcohol or marijuana dependence or disorders (substance use disorders [SUDs]) are at increased risk of acquiring sexually transmitted diseases (STDs). Sexual partner characteristics may explain the relationship between SUD and STD.

METHODS

Clinical criteria for SUD, clinical STD diagnosis, and sexual partner characteristics were assessed among 15- to 24-year-old STD clinic attendees between 1999 and 2002 (n = 412). We used exact logistic regression and path analysis to examine the mediation effect of sexual partner characteristics (age discordance, incarceration, STD diagnosis, other partners, perceived alcohol problem, perceived marijuana problem, and a calculated composite measure) on the relationship between SUD and STD, adjusting for important demographics and condom use.

RESULTS

We found evidence of mediation by partner characteristics on the relationship between SUD and STD. For the logistic regression analysis, adding the partner characteristic composite reduced the strength of the association between SUD and STD from a statistically significant odds ratio of 1.7 (95% confidence interval = 1.0-2.7) to a statistically nonsignificant odds ratio of 1.5 (95% confidence interval = 0.9-2.5). In the path analysis, adding the partner characteristic composite reduced the significant direct effect of SUD on STD (β = 0.5, P = 0.04) to statistically nonsignificant effect (β = 0.1, P = 0.2). We estimated that 31% of the total effect of SUD on STD was attributable to the indirect path through the composite partner characteristic measure.

CONCLUSIONS

Even when controlling for demographics and condom use, partner characteristics partially explained the association between SUD and STD.

Sexual partner characteristics and sexually transmitted diseases among adolescents and young adults

BACKGROUND

Among adolescents and young adults, the extent that partner characteristics account for sexually transmitted diseases (STDs) in context of individual sexual activities and demographic characteristics is unclear.

METHODS

Sexual partner characteristics, individual sexual activities, and STD diagnosis were assessed among 15 to 24-year-old STD clinic attendees from 1999 to 2002 (n = 412). We used exact logistic regression to calculate odds ratios (OR) for several sexual partner characteristics (age discordance, incarceration, STD diagnosis, other partners, alcohol problem, marijuana problem, and a calculated composite variable) adjusting for demographics and individual sexual activities, including condom use.

RESULTS

Sexual partner characteristics associated with STD diagnosis were >or=5 years age discordance [OR = 2.6 (95% confidence interval (CI) = 1.6, 4.5)] and STD in the past year [OR = 3.4 (95% CI = 2.0, 5.7)]. Even when considering individual sexual activities, composite partner risk was associated with STD diagnosis [intermediate to low OR = 2.1 (95% CI = 1.0, 4.2) and high to low OR = 3.4 (95% CI = 1.6, 7.0)]. Composite individual sexual activities was associated with STD diagnosis when considering demographics [intermediate to low OR = 1.8 (95% CI = 1.0, 3.2), high to low OR = 2.3 (95% CI = 1.2, 4.5)], but not when also considering partner characteristics [intermediate to low OR = 1.6 (95% CI = 0.9, 2.8), high to low OR = 1.8 (95% CI = 0.8, 3.9)].

CONCLUSIONS

Among this sample of 15 to 24-year-olds, sexual partner characteristics identified individuals at increased risk of prevalent STDs and were more predictive of STDs than an individual's sexual activities.