Concurrent STD Morbidity in Sexual Contacts to Persons with STD’s:

1. Concurrent STD Morbidity in Sexual Contacts to Persons with STD’s: • Implications for Patient-Delivered Partner Therapy (PDPT) • Joanne Stekler, Laura Bachmann, Rebecca Brotman, Emily Erbelding, Laura Lloyd, Kees Rietmeijer, H Hunter Handsfield, King K Holmes, Matthew R Golden

2. Background • • Public health partner notification programs affect <20% of cases of gonorrhea and chlamydia. • • Many patients become reinfected by untreated partners. • • A randomized, controlled trial that included PDPT reduced persistent or recurrent chlamydia or gonorrhea, compared to patient referral. • • Little is known about missed opportunities to diagnose HIV and other STD’s in contacts who might receive PDPT.

3. Objectives • • To describe STD morbidity in patients who present as contacts to bacterial STD’s and/or trichomoniasis. • • To compare the regional variability of this morbidity between four U.S public health STD clinics.

4. Methods • • Retrospective analysis • • Study sites: Baltimore, MD • Birmingham, AL • Denver, CO • Seattle, WA • • Study period: Jan 1 2001-Dec 31 2002

5. Inclusion Criteria • • Patients who presented as contact to: • chlamydia (ct) • gonorrhea (gc) • non-gonococcal urethritis (ngu) • mucopurulent cervicitis (mpc) • trichomoniasis (trich)

6. Exclusion Criteria • • Subsequent visit(s) during study period • • Contact to syphilis or HIV • • For men: unknown sexual orientation

7. Study Population:Contacts to STD’s

8. Study Population:Contacts to STD’s

9. Results: Prevalence of HIV and Syphilis in Contacts to STD’s

10. Results: Prevalence of STD Dx’s Concordant with Contact

11. Results: Prevalence of STD Dx’s Discordant with Contact

12. Prevalence of PID + STD Dx’s Discordant with Contact: Women by Site

13. Prevalence of STD Dx’s Discordant with Contact: Heterosexual Men by Site

14. Prevalence of STD Dx’s Discordant with Contact: MSM by Site

15. Summary • • Women and heterosexual male contacts had extremely low levels of HIV and syphilis. • • Diagnoses of CT and GC were common in contacts to trichomoniasis. • • Prevalence of trich in female contacts to bacterial STD’s varied by location. • • 5.4% of MSM were newly diagnosed with HIV during evaluation as contacts to bacterial STD’s. Syphilis was less common.

16. Conclusions • • Use of PDPT for chlamydia and gonorrhea would not be associated with major missed opportunities in heterosexual contacts. • • Overall, PDPT would likely result in a greater number of treated partners compared with patient referral. • • Approximately 90% of GC would be treated by antibiotics directed towards CT. • • The high prevalence of bacterial comorbidity in contacts to trich must be noted when evaluating the potential benefits of PDPT for this disease.

17. Conclusions • • The relatively high prevalence of HIV and syphilis suggests that further studies should be done before PDPT for chlamydia and gonorrhea is routinely used in MSM.

18. Acknowledgements • Baltimore, MDDenver, CO • R Brotman L Lloyd • E Erbelding K Rietmeijer • Birmingham, ALSeattle, WA • L Bachmann A Collier • S Yu M Golden • HH Handsfield • K Holmes • F Koch