The Relationship Between Repeat Infections and Behavioral Risk Factors and Clinician Counseling: Findings from a Philadelphia STD Clinic M. Eberhart 1, N. Liddon 2, M. Goldberg 1, J.S. Leichliter 2, L. Asbel 1 1 Philadelphia Department of Public Health, Philadelphia, PA 2 Centers for Disease Control and Prevention, Atlanta, GA

Background Repeat infections with bacterial STDs are relatively common Repeat infections with bacterial STDs are relatively common Repeat infections account for a substantial proportion of morbidity Repeat infections account for a substantial proportion of morbidity Adverse sequelae are associated with untreated bacterial STDs Adverse sequelae are associated with untreated bacterial STDs

Objectives Identify behavioral/demographic predictors of repeat infection Identify behavioral/demographic predictors of repeat infection Explore the relationship between clinician counseling and repeat infection Explore the relationship between clinician counseling and repeat infection

Repeat Infection Lab-confirmed diagnosis of CT, GC, or both at index infection Lab-confirmed diagnosis of CT, GC, or both at index infection Subsequent lab-confirmed diagnosis of CT, GC, or both – 31 days to 2 years after index infection Subsequent lab-confirmed diagnosis of CT, GC, or both – 31 days to 2 years after index infection

Disease Control Management System (DCMS) A comprehensive database of all reported STDs in Philadelphia A comprehensive database of all reported STDs in Philadelphia Patients are assigned a unique identifier that can be used to track subsequent infections Patients are assigned a unique identifier that can be used to track subsequent infections Used to collect and store information on STD cases reported to the health department since 1994 Used to collect and store information on STD cases reported to the health department since 1994 Includes demographic data, as well as testing, treatment and diagnosis data Includes demographic data, as well as testing, treatment and diagnosis data

Methods Morbidity data from 1994 to 2000 were reviewed to identify repeat infections Morbidity data from 1994 to 2000 were reviewed to identify repeat infections n = 79,989 n = 79,989 –GC and/or CT at index visit –Age 12 and up

Clinic Data Patient data is collected and stored using a scannable medical record Patient data is collected and stored using a scannable medical record Data include the following clinic services Data include the following clinic services –Intake/Registration –Lab tests –Clinician evaluation/diagnosis –Treatment –Counseling/Referral

Methods Morbidity data were matched with clinic visit data Morbidity data were matched with clinic visit data n = 17,929 n = 17,929 –Sexual Risk Behaviors (e.g. condom use, number of partners –Clinician Counseling (e.g. partner notification, contraception, drug use)

Methods SPSS 10.1 for Windows® SPSS 10.1 for Windows® –Frequencies –Chi-squares –Logistic Regression

Methods Males: Males: –Never using a condom, increased number of partners, and dual diagnosis associated with repeat infection Females: Females: –Never using a condom and dual diagnosis associated with repeat infection

Results 14.5% of patients contracted repeat infections 14.5% of patients contracted repeat infections –17.8% of females (1,338/7,498) –12.1% of males (1,266/10,431) Women under 25 years of age are more likely to have a repeat infection Women under 25 years of age are more likely to have a repeat infection

Results The strongest predictors of repeat infection for both males and females are: The strongest predictors of repeat infection for both males and females are: –Self-reported history of GC or CT –Dual diagnosis at index infection

Conclusions Self-reports of known behavioral risk factors did not predict repeat infections Self-reports of known behavioral risk factors did not predict repeat infections More analysis is needed to accurately identify patients at risk of repeat infection More analysis is needed to accurately identify patients at risk of repeat infection

Next Steps Evaluation of the content and consistency of counseling messages should be considered Evaluation of the content and consistency of counseling messages should be considered Research on intervention strategies targeted specifically at repeat infectors is needed Research on intervention strategies targeted specifically at repeat infectors is needed