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High incidence of new sexually transmitted infections in the year
following a sexually transmitted infection: A case for rescreening.
Annals of Internal Medicine 2006; 145(8):564-572.
Peterman TA, Tian LH, Metcalf CA, Satterwhite CL, Malotte CK, DeAugustine
N, Paul SM, Cross H, Rietmeijer CA, Douglas JM, for the RESPECT-2 Study Group.
Abstract
BACKGROUND: Studies show 11% to 15% of women treated for Chlamydia trachomatis
are reinfected 3 to 4 months after treatment, suggesting the need for rescreening.
There is little information on infections among men, infections with Neisseria
gonorrhoeae or Trichomonas vaginalis, or long-term follow-up. OBJECTIVE:
To determine the incidence of new sexually transmitted infections during
the year after a visit to a sexually transmitted disease (STD) clinic and
associated risk factors. DESIGN: Secondary analysis of data from a randomized,
controlled trial (RESPECT-2). SETTING: 3 urban STD clinics. PATIENTS: Sexually
active patients enrolled in an HIV prevention counseling trial. MEASUREMENTS:
Patient characteristics at the initial visit; behaviors during follow-up;
and new infections with C. trachomatis, N. gonorrhoeae, or T. vaginalis (women
only) detected during 4 scheduled return visits and any other interim visits.
RESULTS: 2419 persons had 8129 three-month follow-up intervals. Among 1236
women, 25.8% had 1 or more new infections (11.9% acquired C. trachomatis,
6.3% acquired N. gonorrhoeae, and 12.8% acquired T. vaginalis); among 1183
men, 14.7% had 1 or more new infections (9.4% acquired C. trachomatis, and
7.1% acquired N. gonorrhoeae). Black persons and those with sexually transmitted
infections at baseline were at highest risk for recurrent infection (adjusted
odds ratio, 2.5 and 2.4, respectively). For persons infected at baseline,
the risk for infection was high at 3 and 6 months (16.3 per 100 three-month
intervals) and remained high at 9 and 12 months (12.0 per 100 three-month
intervals). Most (67.2%) infections were diagnosed during study-related visits,
and 66.2% of these patients reported no symptoms. LIMITATIONS: Because patients
were recruited from STD clinics, results may not be generalizable. CONCLUSIONS:
Men and women who receive diagnoses of C. trachomatis, N. gonorrhoeae, or
T. vaginalis infections should return in 3 months for rescreening because
they are at high risk for new asymptomatic sexually transmitted infections.
Although single-dose therapy may adequately treat the infection, it often
does not adequately treat the patient.