Screening for Gonorrhea: Update of the Evidence: Evidence Table 2

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Evidence Table 2. Studies of Population Level Risk Factors in Adults and Adolescents

Author, Year	Purpose	Study Design	N	Population/ Setting	Demographics	Inclusion/ Exclusion Criteria	Instruments Used	Results
Holtgrave, 2003⁵¹	Determine association between social capital, poverty, income inequality and 4 infectious diseases (including gonorrhea)	State-level correlation analysis	NA	U.S. State level analysis	NA	U.S., State level	Federal surveillance of STDs from 1999; social capital= community organizational life, involvement in public affairs; volunteerism, informal sociability and social trust, poverty defined by percentage of state population living below poverty line; income inequality.	Social capital was significantly correlated to all outcome measures including GC; poverty was significantly correlated with chlamydia, and income inequality was significantly correlated with chlamydia and AIDS case rates.
Cohen, 2000⁵²	Examine the relationship between neighborhood conditions and gonorrhea	Cross sectional block design	55 block groups, population 26,600	City blocks in New Orleans, LA	Average size of block was .04 square miles; average population of 507; 91% African American, 21% unemployed; 34.47% gonorrhea rate	If information was available on the block groups, from the College of Urban and Public Affairs (CUPA) at the University of New Orleans, LA	Sociodemographic information: age, sex, income level, education, work status; CUPA rated neighborhood deterioration index; sum of annual reported case rates of gonorrhea per 1000 persons for each block group between 1944 and 1996.	Multiple regression analysis included broken window index, poverty, race, unemployment, and marital status. Results showed that the broken window index was the only variable that remained significantly related to gonorrhea rates (p=0.005).
Becker, 1998⁵³	To evaluate the geographic epidemiology of gonorrhea using a GIS (geographic information system) technology	Space-time clustering, data system	7,330 reported cases	Baltimore, MD, 1994 central disease registry	7,330 cases; 3,417 females	NA	Reported cases of gonorrhea from STD clinic and non-STD clinic sources following CDC reporting guidelines; medical records with addresses and other demographic information.	7,330 cases of gonorrhea were reported by Baltimore, MD (city) residents in 1994; 6,410 (87%) of the cases were aged 15-39 yrs. When ethnicity was reported, 97% were African American. Consensus tracks were created for core cases, as well as adjacent areas.
Ellen, 1997⁵⁰	Determine whether there are core groups of transmitters of gonorrhea and chlamydia and sociodemographic factors for repeat risk factors	Retrospective analysis of gonorrhea and chlamydia cases	12,506 cases; 9,461 in 5 years	San Francisco, CA	NA	14-35 years of age at initial infection; examined for subsequent infection	Sociodemographic information: age, sex, provider, date of visit, address for initial visit and date of visit for repeat visit.	During 5 years, 8,613 recurrent cases of gonorrhea among males (17%) and 3,893 among females (19%) were identified. Geographically defined populations were at increased risk for repeat infection with gonorrhea in San Francisco, CA, independent of race and ethnicity, with likely core transmitters per region of the city.

Notes: CDC, Centers for Disease Control and Prevention; CT, Chlamydia trachomatis; ED, emergency department; GC, gonorrhea; IVDU, intravenous drug user; MSM, men who have sex with men; PID, pelvic inflammatory disease; PPV, positive predictive value; STD, sexually transmitted disease.

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