Subsequent sexually transmitted infections among adolescent women with genital infection due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis

Abstract

Objective: To identify factors associated with subsequent sexually transmitted infection (STI) (within 1 year of initial infection) due to Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis.

Design: Prospective cohort study.

Setting: A sexually transmitted diseases clinic and four community-based primary care clinics for adolescents.

Participants: Female patients (ages 15 to 19 years) with initial diagnosis of chlamydia, gonorrhea, or trichomonas.

Main outcome measures: Subsequent infection by chlamydia, gonorrhea, or trichomonas.

Results: More than 40% of subjects were subsequently infected by at least one STI. Reinfection was common, but infections with sexually transmitted organisms other than the initial infecting organism were also common. Predictors of subsequent infection were black race, gonorrhea as the initial infection, two or more sex partners in the previous 3 months, and inconsistent condom use.

Conclusions: Subsequent STI frequently follow an initial STI, but there is substantial variation in the causal organism. These data suggest the importance of comprehensive STI prevention programs for adolescents rather than organism-specific interventions.

PIP: Factors associated with subsequent sexually transmitted infection due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis were investigated in a prospective study of 236 female adolescents 15-19 years of age who had presented to US sexually transmitted disease (STD) and adolescent health clinics with one of these infections within the previous 12 months. At the second visit, 58 (29.7%) of 195 initially infected women were again infected; 13 were infected with more than one organism. At the third visit, 59 (37.6%) of 157 subjects were reinfected, 20 with more than one organism. Overall, 97 (41.1%) of 236 subjects were again infected within 12 months of an initial STD. Many subsequent infections were due to a sexually transmitted pathogen other than the one causing the index STD. The risk of a subsequent infection was significantly elevated among Blacks, those with gonorrhea at enrollment, and women with 2 or more sex partners in the previous 3 months and significantly reduced among condom users. These findings suggest that organism-specific screening programs would fail to detect a substantial number of subsequent infections due to the presence of other organisms.