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Canadian Journal of Public Health

, Volume 106, Issue 2, pp e17–e21 | Cite as

Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed gonorrhea cases in a local health region from Saskatchewan, Canada

  • Molly A. Trecker
  • Jo-Anne R. Dillon
  • Kathy Lloyd
  • Maurice Hennink
  • Cheryl L. Waldner
Quantitative Research

Abstract

Objectives

We aimed to identify demographic and behavioural determinants associated with risk of repeat STI infection and coinfection with gonorrhea and chlamydia in the Regina Qu’Appelle Health Region, Saskatchewan.

Methods

We extracted data from a cross-sectional sample of laboratory-confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu’Appelle Health Region. Risk factors for repeater status were examined using logistic regression and for coinfection with gonorrhea and chlamydia using mixed-effects logistic regression to account for multiple diagnoses for individual clients.

Results

Data from 1,143 cases (representing 1,027 unique individuals) and 1,524 reported contacts (representing 1,383 unique individuals) were extracted from the 10-year period. Factors associated with repeat infection entries in the database included younger age at first visit (p = 0.01), coinfection (p = 0.01), and sex trade involvement (p < 0.01). Factors associated with coinfection at the time of diagnosis included younger age at diagnosis (p < 0.001) and reported alcohol or drug abuse (p = 0.04).

Conclusion

In one of the first epidemiologic studies on gonorrhea in Saskatchewan, we have identified age, engagement in the sex trade, and drug and alcohol abuse as potential markers to identify clients with a high risk of reinfection and coinfection in the Regina Qu’Appelle Health Region. This information can help health care professionals in Saskatchewan’s urban centres personalize their approach to counselling and treatment to optimize patient outcomes and disease control efforts, including potentially using expedited partner therapy and/or dual therapy where indicated.

Key Words

Gonorrhea sexually transmitted diseases risk factors coinfection chlamydia 

ésumé

Objectifs

Notre but était d’identifier les déterminants démographiques et comportementaux associés au risque d’infection sexuellement transmissible répétée et de coïnfection par la gonorrhée et la chlamydiose dans la région sanitaire de Regina Qu’Appelle (Saskatchewan).

Méthode

Nous avons extrait des dossiers des maladies à déclaration obligatoire de la région sanitaire de Regina Qu’Appelle les données d’un échantillon transversal de cas de gonorrhée confirmés en laboratoire survenus entre 2003 et 2012. Les facteurs de risque d’infection répétée ont été examinés par régression logistique, et les facteurs de coïnfection par la gonorrhée et la chlamydiose, par régression logistique à effets mixtes, afin d’expliquer les diagnostics multiples sur une base individuelle.

Résultats

Les données de 1 143 cas (représentant 1 027 personnes distinctes) et de 1 524 contacts déclarés (représentant 1 383 personnes distinctes) ont été extraites sur la période d’étude de 10 ans. Les facteurs associés aux infections répétées dans la base de données étaient le jeune âge à la première visite (p = 0,01), la coïnfection (p = 0,01) et la participation au commerce du sexe (p < 0,01). Les facteurs associés à la coïnfection lors du diagnostic étaient le jeune âge au diagnostic (p < 0,001) et l’abus d’alcool ou de drogue déclaré (p = 0,04).

Conclusion

Dans cette étude, qui est l’une des premières études épidémiologiques sur la gonorrhée en Saskatchewan, nous avons identifié l’âge, la participation au commerce du sexe et l’abus de drogue et d’alcool comme étant des marqueurs potentiels pour identifier les clients présentant un risque élevé de réinfection et de coïnfection dans la région sanitaire de Regina Qu’Appelle. Cette information peut aider les professionnels de la santé des centres urbains de la Saskatchewan à personnaliser leurs approches de counseling et de traitement pour optimiser leur effet sur les patients et les efforts de lutte contre les maladies, potentiellement en utilisant la thérapie accélérée pour les partenaires et/ou la bithérapie, selon le cas.

Mots Clés

gonorrhée maladies sexuellement transmissibles facteurs de risque coïnfection chlamydia 

References

  1. 1.
    Public Health Agency of Canada. Report on Sexually Transmitted Infections in Canada: 2011. Ottawa, ON: PHAC, 2014.Google Scholar
  2. 2.
    Hook EW, Handsfield, HH. Gonoccocal infections in the adult. In: Holmes KK, Sparling PF, Mardh P, et al. (Eds.), Sexually Transmitted Diseases, 3rd edition. New York, NY: McGraw Hill, 1999;451–66.Google Scholar
  3. 3.
    Wasserheit J. Epidemiological synergy: Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61–77. PMID: 1595015.CrossRefGoogle Scholar
  4. 4.
    Population Health Branch. HIV and AIDS in Saskatchewan, 2010. Regina, SK: Saskatchewan Ministry of Health, 2011.Google Scholar
  5. 5.
    Unemo M, Nicholas, RA. Emergence of multidrug-resistant, extensively drugresistant and untreatable gonorrhea. Future Microbiol 2012;7:1401–22. PMID:23231489._doi: 10.2217/fmb.12.117.CrossRefGoogle Scholar
  6. 6.
    Lemstra M, Neudorf C, Opondo J, deBruin P, Grauer K, Wright J. Epidemiological analysis of Chlamydia trachomatis and Neisseria gonorrhoeae in Saskatoon Health Region. Can J Public Health 2006;98(2): 134–37. PMID: 17441538.Google Scholar
  7. 7.
    Microsoft Corporation. Microsoft Access. Redmond, WA: Microsoft, 2010.Google Scholar
  8. 8.
    Statistics Canada. How postal codes map to geographic areas: Glossary. Ottawa: Statistics Canada, 2007. Available at: https://doi.org/www.statcan.gc.ca/pub/ 92f0138m/2007001/4054931-eng.htm (Accessed July 15, 2014).Google Scholar
  9. 9.
    Microsoft Corporation. Microsoft Excel. Redmond, WA: Microsoft, 2010.Google Scholar
  10. 10.
    StataCorp. Stata Statistical Software: Release 12. College Station, TX: StatCorp, 2011.Google Scholar
  11. 11.
    Thakur SD, Levett PN, Horsman GB, Dillon, JR. Molecular epidemiology of Neisseria gonorrhoeae isolates from Saskatchewan, Canada: Utility of NG-MAST in predicting antimicrobial susceptibility regionally. Sex Transm Infect 2014;90:297–302. PMID: 24503900. doi: 10.1136/sextrans-2013-051229.CrossRefGoogle Scholar
  12. 12.
    Dohoo I, Martin W, Stryhn H. Methods in Epidemiologic Research. Charlottetown, PEI: VER Inc., 2012.Google Scholar
  13. 13.
    Public Health Agency of Canada. Report on Sexually Transmitted Infections in Canada: 2010. Ottawa: PHAC, 2012.Google Scholar
  14. 14.
    Communicable Diseases Australia (CDA). oNational Notifiable Diseases Surveillance System. Available at: https://doi.org/www.www9.health.gov.au/cda/source/ cda-index.cfm (Accessed June 22, 2014).Google Scholar
  15. 15.
    Public Health England. Sexually Transmitted Infections Annual Data. Available at: https://doi.org/www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_ C/1203348026613 (Accessed June 22, 2014).Google Scholar
  16. 16.
    Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: US Dept of Health and Human Services, 2009. Available at: https://doi.org/www.cdc.gov/sTD/stats08/default.htm (Accessed June 22, 2014).Google Scholar
  17. 17.
    De P, Singh AE, Wong T, Kaida A. Predictors of gonorrhea reinfection in a cohort of sexually transmitted disease patients in Alberta, Canada, 1991–2003. Sex Transm Dis 2007;34(1):30–36. doi: 10.1097/01.olq.0000230485. 85132.e9.CrossRefGoogle Scholar
  18. 18.
    Hosenfeld CB, Workowski KA, Berman S, Zaidi A, Dyson J, Mosure D, et al. Repeat infection with chlamydia and gonorrhea among females: A systematic review of the literature. Sex Transm Dis 2009;36(8):478–89. PMID: 19617871. doi: 10.1097/OLQ.0b013e3181a2a933.CrossRefGoogle Scholar
  19. 19.
    Rietmeijer CA, Van Bemmelen R, Judson FN, Douglas, JM. Incidence and repeat infection rates of Chlamydia trachomatis among male and female patients in an STD clinic: Implications for screening and rescreening. Sex Transm Dis 2002;29(2):65–72. PMID: 11818890.CrossRefGoogle Scholar
  20. 20.
    Newman LM, Warner L, Weinstock, HS. Predicting subsequent infection in patients attending sexually transmitted disease clinics. Sex Transm Dis 2006;33(12):737–42. PMID: 16708054.Google Scholar
  21. 21.
    Public Health Agency of Canada. Gonococcal Infections: Revised July 2013 - Section 5 — Management and Treatment of Specific Infections. Ottawa: PHAC, 2013.Google Scholar
  22. 22.
    Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352(7):676–85. PMID: 15716561. doi: 10.1056/NEJMoa041681.CrossRefGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention. Expedited partner therapy. Available at: https://doi.org/www.cdc.gov/std/ept/ (Accessed June 22, 2014).Google Scholar
  24. 24.
    Lyss SB, Kamb ML, Peterman TA, Moran JS, Newman DR, Bolan G, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med 2003;139(3):178–85. PMID: 12899585.CrossRefGoogle Scholar
  25. 25.
    Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov MR, et al. Chlamydia trachomatis and Neisseria gonorrhoeae prevalence and coinfection in adolescents entering selected US juvenile detention centers, 1997–2002. Sex Transm Dis 2005;32(4):255–59. PMID: 15788927.CrossRefGoogle Scholar
  26. 26.
    Dragovic B, Greaves K, Vashisht A, Straughair G, Sabin C, Smith, NA. Chlamydial co-infection among patients with gonorrhoea. Int J STD AIDS 2002;13(4):261–63. PMID: 22877601. doi: 10.1071/SH11146.CrossRefGoogle Scholar
  27. 27.
    Peipert, JF. Genital chlamydial infections. N Engl J Med 2003;349(22):2424–30. PMID: 14681509.CrossRefGoogle Scholar
  28. 28.
    Hijazi L, Thow C, Winter A. Factors affecting co-infection with genital chlamydia and genital gonorrhoea in an urban genitourinary medicine clinic. Sex Transm Infect 2002;78(5):387. doi: 10.1136/sti.78.5.387.CrossRefGoogle Scholar
  29. 29.
    Fenton KA, Johnson AM, McManus S, Erens B. Measuring sexual behaviour: Methodological challenges in survey research. Sex Transm Infect 2001; 77(2):84–92. doi: 10.1136/sti.77.2.84.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2015

Authors and Affiliations

  • Molly A. Trecker
    • 1
    • 2
  • Jo-Anne R. Dillon
    • 1
    • 3
  • Kathy Lloyd
    • 4
  • Maurice Hennink
    • 4
  • Cheryl L. Waldner
    • 2
    • 5
  1. 1.Vaccine and Infectious Disease OrganizationInternational Vaccine CentreSaskatoonCanada
  2. 2.School of Public HealthUniversity of SaskatchewanSaskatoonCanada
  3. 3.Department of Microbiology and Immunology, College of MedicineUniversity of SaskatchewanSaskatoonCanada
  4. 4.Regina Qu’Appelle Health RegionReginaCanada
  5. 5.Western College of Veterinary MedicineUniversity of SaskatchewanSaskatoonCanada

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