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Sexually transmitted disease clinic clients at risk for subsequent
gonorrhea and chlamydia infections: possible 'core' transmitters.
Sexually Transmitted Diseases 2000;27(6):343-349.
RA Gunn, S Fitzgerald, SO Aral.
Abstract
BACKGROUND: From an sexually transmitted disease (STD) intervention perspective,
developing a practical way to identify persons in core transmitter groups
has been difficult. However, persons who have repeated STD infections may
be in such groups. GOAL: To evaluate a self-administered risk assessment
approach that would identify STD clinic clients who were at an increased
risk of being involved in gonorrhea (GC) or chlamydia (CT) transmission in
the subsequent year. STUDY DESIGN: Prospective cohort of consecutive STD
clinic clients with a 1-year follow-up period. RESULTS: During a 6-month
period in 1995, 2576 STD clinic clients in San Diego completed a risk assessment.
Of those clients, 204 (7.9%) had a subsequent STD and 79 (3.1%) had a subsequent
GC or CT infection during the 1-year follow-up period. The strongest predictor
of a subsequent GC/CT was having a recent history or current clinic visit
diagnosis of GC or CT (6.1% subsequent GC/CT rate). The more past episodes
of GC or CT, the higher the subsequent GC/CT rate. Unsafe sexual behavior
had little effect on further increasing subsequent GC/CT risk. CONCLUSION:
STD clinic clients with a recent history of GC or CT and a high risk of subsequent
GC/CT may be core transmitters who could likely benefit from risk reduction,
periodic screening for GC/CT, symptom recognition counseling, and preventive
treatment-the essential elements of STD-prevention case management.