| Author, Year |
Purpose |
Study Design |
N |
Population/ Setting |
Demographics |
Inclusion/ Exclusion Criteria |
Instruments Used |
Results |
| Bachman,
20035 |
Evaluate prevalence of chlamydia
and gonorrhea in women presented to an
urban ED with genitourinary symptoms or pregnancy related complaints and
frequency of effective treatment |
Cross-sectional interview and
urine specimen screen of randomly sampled shifts |
403 |
U.S. urban ED |
Women
aged 15-35 years; Mean age 23; 81% African American, 44% insured on Medicaid;
33% uninsured; 41% confirmed pregnancy at time of visit. Greater than 50%
reported history of STD. |
Sexually active females aged
15-35 years presenting to ED with symptoms including dysuria, hematuria,
vaginal discharge, vaginal bleeding, abdominal pain, or any pregnancy related
complaint |
Demographic and behavioral
questions, LCR testing (LCx, Abbott Lab). Positive was repeated for
confirmation |
Gonorrhea and chlamydia
prevalence 16.4% (62). Associated risk included younger age, African
American, greater number of sex partners in last 30 days; antibiotic use in
past 4 weeks, drug use in past 30 days; genitourinary symptoms at
presentation (vaginal bleeding, dysuria, lower abdominal pain). Women with an
STD were just as likely to have a pelvic exam as women without an STD, no
significant difference between pelvic exam findings for women with positive
test and women without positive test. Women discharged with diagnosis of PID
were more likely to test positive for gonorrhea; Women with positive tests
were not significantly more likely to have received ED based screening that
women without positive tests. |
| Boyer,
199936 |
Determine sociodemographic
markers and behavioral risk factors associated with STDs in sexually active
youth seeking care at a HMO teen clinic |
Cross-sectional consecutive
sample of racially and ethnically diverse youth |
285 |
U.S. urban HMO teen clinic |
Mean age 16.7 years; 58.6%
female; 43% African American, 15% white, 14% Latino, 13% Asian |
Excluded if not sexually active,
not between 13-21 years old, or used antibiotics in past 2 weeks |
Self-report questionnaire on
sociodemographic risk markers and behavioral factors; endocervical or
urethral swab for gonorrhea culture |
28.8% reported a history of STD
infection; 11.6% of sample had one or more STDs after testing. Regression
analysis indicated that youth who are African American (OR=3.34), had sex
partners 2 or more years older (OR=2.63), and used marijuana (OR=2.27) were
more likely to have STD at screening. |
| Cecil,
200118 |
Characteristics of infection in
army recruits |
Cross-sectional screening and
survey |
2,245 (76.5% accepted) |
Male army recruits in South
Carolina |
Mean age 20.6 years (range
17-35); 89% <25 years old; 60% white |
All new male army recruits |
Behavioral risk assessment
survey and urine specimen tested with LCR |
Prevalence of gonorrhea=0.6%,
chlamydia=5.3%, co-infection=7.5%. Of those testing positive for gonorrhea,
40% reported having symptoms of any kind, and 60% were co-infected with
chlamydia. Young age was a predictor of
both gonorrhea and chlamydia. |
| Ellen,
199637 |
Determine whether personal or
partner use of crack cocaine is associated with syphilis or gonorrhea and if
the relationship is similar for adults and adolescents |
Cross-sectional behavioral
survey |
1,442 |
Heterosexual males and females
attending public STD clinics in 3 cities (Tampa, Philadelphia, San Diego) |
Majority African American (72.5%
of males and 67% of females) |
Past 3 months they had sex with
multiple partners or in the past year they had sex with a partner who uses IV
drugs, they had sex with a partner who uses crack cocaine or they received
money or drugs for sex, or they ever used IV drugs or crack cocaine |
Behavioral survey |
35%
of males and 12.8% of females had gonorrhea.
Independent risk factors for gonorrhea for men: sex in last year with
a crack cocaine user, failure to use condoms, younger age; for women: younger
age. |
| Gunn,
200045 |
To evaluate a self-administered
risk assessment approach that identifies STD clinic patients who are at
increased risk of gonorrhea and chlamydia transmission in the subsequent year |
Prospective cohort of consecutive
patients with one-year followup |
2,576 |
STD clinic patients in San Diego |
Not provided |
Men and women attending the San
Diego County STD clinic |
Risk assessment form: number and
types of sex partners, condom use, STD history, and questions about perceived
risk. Medical record abstraction for diagnosis. One year after initial
enrollment, the medical record was reviewed for evidence of a return visit. |
Of the 2,576 enrolled, 204
(7.9%) had a subsequent infection during the 1 year followup. Non-gonococcal
urethritis was the most common subsequent diagnosis. Subsequent GC/CT
occurred in 79 (3.1%) including 32 with gonorrhea and 4 with both. MSM as a group had a 5.2% subsequent GC/CT
rate. The strongest predictor of subsequent infection with GC/CT was a recent
history of GC/CT or current visit diagnosis of GC/CT infection. Unsafe sex behaviors had little impact on
subsequent risk. |
| Klausner,
199846 |
Risk factors for repeat
infection with gonorrhea |
Case-control comparison among a
high risk population |
185 (94 cases; 91 controls) |
San Francisco City and County
control database |
Mean age 20 years; 80% African
American; 76% with repeated infections had one previous infection (maximum
28) |
Case=new case of repeated
gonorrhea infection; enrollment defined as heterosexual, age 15-24 years,
identified in database with current gonorrhea infection or infection in past
2 years, history of PID. Control =current diagnosis of gonorrhea within 2 weeks
of the date of diagnosis of the case patient and who had no known history of
gonorrhea. |
Patient demographics, health,
sexual behavior, and illicit substance use recorded during a private
face-to-face interview |
Patients with repeated gonorrhea
did not differ from patients with first diagnosis in number of medical visits
in past 5 years, if they could identify a regular doctor, having a partner
with STD, being told by health department they had been exposed to an STD,
smoking, douching, number of years of sexual activity, number of lifetime sex
partners, frequency of having a new partner in past 2 months, frequency of
condom use by any partner type, reporting intoxication by sex partner in past
2 months, or receiving money for sex in previous 2 months. Patients with
gonorrhea were more likely to be African American, less likely to be employed
or have a high school education, more likely to report a history of STD
infection, and more likely to have received drugs for sex. Regression
identified factors associated with repeated gonorrhea as more likely to be
African American and have a previous history of STD (CT infection), less
likely to have completed high school. |
| Liau,
200228 |
Investigate associations between
biologically confirmed marijuana use and laboratory-confirmed STD and condom
use |
Cross-sectional survey (face-to
face and self-administered), urine sample for marijuana screen, self-obtained
vaginal swab |
522 |
2 adolescent clinics, 4 public
health department clinics, 5 health classes; African American females |
Average
age 16 years; 81% full-time students; 18% had jobs |
African American female, 14-18
years old, unmarried, sexually active in previous 6 months |
Urine sample for marijuana
screen using EMIT® II assay to detect use of marijuana for up to 30 days
prior to testing, self-obtained vaginal swab for gonorrhea, and chlamydia
testing using LCR assay. |
28% of sample screened positive
for at least one of 3 STDs; 81.8% reported having sex with one steady partner
in the last 6 months; 58.1% reported consistent condom use in past 30 days;
53.9% reported consistent condom use in past 6 months. Lab testing confirmed
that 5.4% of adolescents had used marijuana in past 30 days; 41% reported a
lifetime history of use of marijuana. Females who used marijuana were 3.4
times more likely to test positive for gonorrhea and 3.9 times more likely to
test positive for chlamydia. Marijuana use was associated with never using a
condom in past 30 days (increased risk by 3 times) and in past 6 months
(increased risk 3.6 times). |
| Marrazzo,
200230 |
Utility
of age and cervical findings in predicting infection with gonorrhea and
chlamydia |
Retrospective chart review |
6,230 new problem visits with
pelvic exams |
Visits by women to Seattle STD
clinics |
Not provided |
Women with pelvic exams |
Demographic data in medical
records, and results from pelvic exams with gram stain smear of endocervical
secretions and quantified polymorphonuclear cells per 1000 using standardized
procedures. |
133
(2.1%) had gonorrhea detected by culture of cervix. Cervical findings (30 or more PMH/HPF on
gram stain, easily induced endocervical bleeding, mucopurulent endocervical
discharge) and a diagnosis of mucopurulent cervicitis were independently
associated with an increased likelihood of infection with either gonorrhea or
chlamydia. The stronger association
between age and infection was independent of the presence of any cervical
finding. Non-white race was associated with a 2-fold increase in detection of
infection, and 2 or more sex partners in the last 2 months was associated
with a small increase in risk of infection, reporting of a new partner in the
same time was not associated with infection. The PPV of all cervical findings
and of gram stain smear of endocervical secretions for cervical infection
were significantly higher in women younger than 25 years old than in women 25
years and older. 40% of all women 19 or younger with cervical findings were
infected with either gonorrhea or chlamydia. |
| Mehta,
200135 |
Prevalence
of and risk factors for gonorrhea in patients presenting to the Emergency
Department |
Cross-sectional; consecutive
patients treated at randomized shifts,
outcomes included positive gonorrhea and/or chlamydia screen on LCR |
2,118 eligible; 981 approached;
700 consented to study (71%) |
Male and females aged 18-44 years
presenting to urban ED for any medical reason over 2-week period |
77%
were 18-31 years of age; those enrolled were more likely to be younger,
African Americans, and more likely to be treated for STD by ED. |
Psychiatric and critically ill
patients excluded; patients treated in common areas where confidentiality
could not be maintained were excluded |
Survey with demographic and
behavior questions, urine specimens tested with LCR |
13.6%
prevalence of gonorrhea and chlamydia, 5.3% with GC alone, in younger age
group (18-31), and 1.8% GC/CT in older age group (32-44). The majority of both female and male
participants did not report symptoms.
Significant predictors for women included history of STD, new sex
partner in past 90 days, number of sex partners in past 90 days. Significant
predictors for men included age <24, marijuana use in the past 90 days,
positive response on the CAGE alcohol screen, new sex partner in past 90
days, more than one sex partner in past 90 days, and penile discharge.
Regression models: having a new sex
partner in past 90 days was a significant predictor for women (OR=2.23); in
men, age <24, having been criticized for drinking, and penile discharge
were significant predictors. |
| Mertz,
200014 |
Determine factors associated
with acquisition of gonorrhea by men in Newark, NJ |
Case-control |
214 |
STD clinics in Newark, comparing
15-29 year old males with culture confirmed gonorrhea to controls with no STD |
15-29 year old men |
Males 15-29 years with gonorrhea |
Behavioral survey with case and
control groups |
Cases
more likely than controls to be African American, 15-19 years old, or to ever
spend a night in jail. Previous
diagnosis of gonorrhea was reported by 41% of cases and 29% of controls.
History of another STD was reported by 17% of cases and 25% of controls. 2/3
of both cases and controls had a main partner during the month before the
clinic visit. Compared with controls, cases with gonorrhea more frequently
reported a least 1 casual sex partner within the preceding month (OR=3.2),
sex after using marijuana during the preceding month (OR=2.4), and a history
of incarceration (OR=2.1). Having a new causal sex partner increased risk for
gonorrhea infection (OR=3.9). |
| Mertz,
200215 |
Feasibility and acceptability of
urine based screening for women entering jail and prevalence of treatment
rates |
Cross sectional |
5,364 |
Women ages 16-75 years
entering 3 urban jails |
In all cities the majority of
women entering jail were young (< 30 years), and African American |
Consenting women at jails in
Baltimore, MD, Chicago, IL, and Birmingham, AL; age range exclusions varied
by location |
Urine specimens transported to
university labs in each city and tested using LCR assay for chlamydia and
gonorrhea |
High prevalence of gonorrhea
(8.2%-9.2%) depending on city; highest rates found among youngest women
(<25 years of age), the majority of women were treated in jail or outside
(61%-85%). Treatment limited by length of test result and release of woman from
jail; women more likely to be treated in prison were tested at intake. |
| Orr,
200111 |
To compare rates of subsequent
infection with chlamydia, trichomonas, and gonorrhea in a group of high risk
adolescents and adults |
Prospective cohort; multiple
testing of women and men attending clinic for treatment who had previous
infection or partner with infection |
444 |
Urban clinic population |
70% female; 77% African
American; 25% of participants were enrolled as uninfected sexual partner;
half of participants attended school and were unemployed |
Excluded if did not intend to
stay in area for next 3 months or were pregnant |
Diagnostic criteria based on
culture of endocervical or urethral swabs.
Screening on return visit at 1, 3, 5 and 7 months was urine based
using PCR |
97
(22%) were positive for gonorrhea and 7% were co-infected with gonorrhea and
chlamydia. At enrollment, women and African Americans were more likely to be
infected. Compared with uninfected contacts, adolescents and young adults
with an STD were younger, more likely to be enrolled in school, reported
fewer sex partners in the prior 2 months, and more likely to report use of
condom at last intercourse. No difference between infected and uninfected
contacts. Overall 80% (355) had at
least one followup visit, compared to those who did not return; returners
were younger, female, enrolled in school, infected at enrollment, reported
more sexual partners in prior 2 months. Subsequent infections were common,
irrespective of enrollment status. By
7 months, an estimated 53% of contacts and 73% with an STD at enrollment had
subsequent STD. Regression analysis
demonstrated that being female and having at least one new sexual partner
independently increased likelihood of subsequent infection. |
| Peters,
200029 |
Association of behaviors and STD
risk among adolescents |
Descriptive survey |
515 with chlamydia results |
Adolescent clinics in Georgia |
94% African American; mean age
17 (range 13-20); 40% reported symptoms |
Female aged <21 years; needed
pelvic exam |
Questionnaire
on behaviors; cervical PCR test for chlamydia using PCR assay (Roche),
gonorrhea was presumptively diagnosed by culture of cervical specimen on
Thayer Martin media |
76% reported using a condom in
past 6 months; 75% of women reported only one partner (74.6%). Prevalence of
gonorrhea was 9.9% (43/433), 3.9% tested positive for both gonorrhea and
chlamydia. Women with gonorrhea had a
lower mean age (16), young women who did not report oral contraception were
significantly more likely to have gonorrhea than older women. Consistent
condom use was associated with lower risk of gonorrhea, but not
significantly. Number of sex partners in last 6 months was not associated
with infections; however, majority of women reported only one sex partner in
past 6 months. |
| Shain,
200231 |
To determine behaviors
associated with infections |
Followup data (6 and 12 months)
from an intervention trial |
477 |
Women seen in public health
clinics in Texas |
70% of sample was <25 years
of age (range 14-45); most had low income and low educational level |
Consenting
women receiving project SAFE interventions |
DNA probe testing of
endocervical samples; interview on sexual behaviors (sex with untreated
partner, not mutually monogamous, unsafe sex, rapid partner turnover, douches
after sex) |
Reduction in risk of 5
modifiable factors in study group. The 0-12 month regression model
demonstrated that behaviors correctly predicted infection rates in 75.3% of
participants. Infection rates: study
group 12% vs. 16.7% control at 0-6 months; 8.8% for study vs. 16.7% at 6-12
months; and 17.7% vs. 25.9% at 0-12 months.
Unprotected sex with an untreated/incompletely treated partner had the
strongest association with infection (cumulative adjusted OR=5.6, 0-12
months). Mutual monogamy was significantly associated with decreased
infection at 6-12 months and 0-12 months. Unsafe sex (condom use) was
significant across all time periods; rapid partner turnover was significantly
associated with infection at all time points; douching after sex was
significantly associated with infection at 0-6 months but not at 6-12 months. |
| Todd,
200147 |
Determine prevalence and
correlates of asymptomatic genital tract infection with gonorrhea and
chlamydia among ED patients |
Cross-sectional screening of
consecutive patients presenting for evaluation of non-genitourinary
complaints |
359 (87% acceptance=312) |
ED at urban
tertiary care facility in St. Louis, Mo. |
56% female, 44% male; 78%
African Americans; mean age 23.9 years: 30% unemployed; 36% received public
assistance |
Age 18-30 years; patients
excluded if symptoms attributed to possible STD (dysuria, discharge, pelvic
pain) or sexual assault |
Urine sample LCR test performed
within 24 hours of collection at hospital lab |
Prevalence of asymptomatic
gonorrhea and chlamydia was 9.7%; 1% gonorrhea, 0.7% with both gonorrhea and
chlamydia, 8.0% with chlamydia, highest prevalence in youngest age group (18
years). Correlates of chlamydia infection were younger age, residence in high
morbidity zip code, previous history of gonorrhea and chlamydia, and number
of sex partners. |
540 Gaither Road Rockville, MD 20850