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Background

Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates. Roxanne P. Kerani, Matthew R. Golden, William L.H. Whittington, Hunter H. Handsfield, King K. Holmes. Background. Bridges serve as links for subpopulations with differing prevalances of STD

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Background

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  1. Geographic Bridges for Importation of STD in the Seattle Metropolitan Area:Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H. Whittington, Hunter H. Handsfield, King K. Holmes

  2. Background • Bridges serve as links for subpopulations with differing prevalances of STD • Geographic bridges may import STD from high to low prevalence regions • Few studies have examined travel and STDs other than HIV

  3. Objectives • To describe geographic bridges residing in the Seattle Metropolitan Area (SMA) • To compare attributes of partnerships involving partners residing in and outside of the SMA

  4. Methods • Data collected as part of a study of expedited partner treatment • Study period: Oct, 1998 – Jan, 2002 • Population: Residents of King Co., WA • Heterosexual • 14+ years • Diagnosed & reported with gonorrhea or chlamydia • Contacted within 14 days of treatment

  5. Methods • Exclusions: • Current incarceration • No provider consent for contact • No sex partners (SP) in previous 60 days • Persons with unknown residence • N = 3,123 • Interviews included questions regarding up to nine SPs in previous 60 days

  6. Bridgers Participants with partners residing both in (local) and outside (distant) the SMA

  7. Methods • Analyses of individuals: • Bivariate: T-tests and chi-squares • Multivariate: Logistic regression • Analyses of partnerships • Bivariate: GEE models

  8. Study Population

  9. Bridgers • 310 (9.5%) of participants reported at least one distant partner • 140 (4.9%) of participants reported both local and distant partners (bridgers)

  10. Percent BridgersDemographics & STD Dx

  11. Education, Employment, and Residence

  12. Number of Sex Partners

  13. Concurrency and Reason for Visit

  14. Multivariate Results

  15. Results - Partnerships • Partnerships among bridgers: N=329 • Residence of partners: • 53% SMA • 14% Elsewhere in WA • 33% Within the US, outside WA

  16. Partner Type and Ability to Contact

  17. Partner Knowledge of Infectionand Perceived Future Sex with SP

  18. Partnerships: Perceived Transmission Direction

  19. Summary • 5% of patients were geographic bridges • Bridgers were more likely to be white, older, employed, and of higher SES, and to report more partners and concurrency • Distant partnerships were more likely to represent casual relationships with little potential for future contact

  20. Limitations • Study sample not representative of all gonorrhea and chlamydia cases in King Co. • Direction of transmission is unknown • We don’t know where sex took place • Anonymous partners may be underrepresented

  21. Conclusions • Factors associated with bridging are generally those associated with low rates of STD • Bridges may be important in maintaining GC/CT endemicity in low prevalence populations • Is business travel related to risky sex? • Control of disease in some populations may require enhanced collaboration between distant public health agencies

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