# Presentation: 225582

## Repeat Chlamydia trachomatis:                                      Rate and Predictors among Males

- Eileen F. Dunne M.D., M.P.H.
- JB Chapin, C Rietmeijer , CK Kent, J Ellen, C Gaydos,                                        N Willard, L Lloyd, N Birkjukow, S Chung, JA Schillinger, LE Markowitz
- Division of STD Prevention
- Centers for Disease Control and Prevention

## Acknowledgments

- Baltimore:  		Jon Ellen
- 				Charlotte Gaydos
- 				Nancy Willard
- 				Michelle Chung
- Denver: 		Kees Rietmeijer
- 				Laura Lloyd
- San Francisco:  	Charlotte Kent
- 				Nat Birkjukow
- CDC: 			Julie Schillinger
- 				Lauri Markowitz
- 				Maya Sternberg
- 				Johanna Chapin

## Background

*Chlamydia trachomatis* (Ct) infection in females is common and associated with serious sequelae
- PID, ectopic pregnancy and infertility
- Ct infection in males
- Limited resources to screen
- Additional information needed to guide program activities

## Background

- Male Chlamydia Screening Project:
**Demonstration project**:  men ages 15-44 screened for Ct infection
- Baltimore
- Denver
- San Francisco
- Seattle
**Longitudinal Study**:  men with Ct infection recruited for a study of repeat infection
- Baltimore
- Denver
- San Francisco

## Venue Type

**Venue Type**
**	****	****	**** ****	****       **_**Baltimore**_**                 **_**Denver**_             _**San Francisco **_
- 				           (N=10)	            (N=33)                     (N=11)
**Adolescent Primary Care****	****	****X****	****	****X****	****               X**
**Adult Primary Care****	****	****	****	****X****	****	****X**
**Juvenile Detention****	****	****	****	****X****	****	****X**
**Adult Detention****	****	****	****X****	****	****X****	****	****X**
**School Clinics****	****	****	****X****	****	****X****	****	****X**
**School Health Fairs****	****	****	****	****	****	****X**
**College Clinics ****	****	****	****	****	****	****	****X**
**Community Based Organizations****	****	****	****X****	**
**               **
**Drug Treatment****	****	****	****	****	****X****	**
**	****  **
**STD Clinics****	****	****	****	****	****X****	****	****X**
**Street Outreach****	****	****	****	****	****X****	****	****X**

## Objectives

- To evaluate:
- Ct prevalence and predictors of infection
- Cost-effectiveness of screening for Ct infection
- Partner and network characteristics
- Rate and predictors of repeat Ct infection

## Objectives

- Ct prevalence and predictors of infection
- Cost-effectiveness of screening for Ct infection
- Partner and network characteristics
- Rate and predictors of repeat Ct infection

## Longitudinal Study Methods

- Men with Ct infection recruited from various venues in Baltimore, Denver, San Francisco
- Study Design
- Baseline Visit
- Questionnaire
- Partner management
- Follow-up at 1 and 4 months
- Screening for Ct using urine NAATs
- Questionnaire
- Partner management

## Longitudinal Study Methods

- Analysis:
- Men with at least one follow-up visit
- Repeat infection:  defined as Ct infection at the first or second follow-up visit

## Longitudinal Study Methods

- Bivariate
- Characteristics of men at baseline visit
- Characteristics of partners
- Baseline partners
- New partners
- Cox Proportional Hazards Model

## Longitudinal Study Enrollment

- 358 men enrolled

- 272 (76%) study population
-            98 (36%) 1 follow-up visit
-           174 (64%) 2 follow-up visits

## Time in Study

- 					_Median_		_Range_
- Time to
- First Follow-up		33 days		21-215 days
- Time in Study		102 days		21-391 days

## Partner Management

- 272 study population
- 403 partners named
- 74 (18%) partners locatable
- 65 (16%) partners treated

- Locatable

- Treated

##  Study Population

| Characteristic | N    (%) |
| --- | --- |
| Age (yrs)
   15-17 
   18-19
   20-24
   >24 | 
51    (19)
63    (23)
96    (35)
61    (23) |
| Race/Ethnicity
   White
   Hispanic
   Black
   Other | 
(18)
(29)
 (40)
37    (13) |
| City
   Baltimore
   Denver
   San Francisco | 
58    (21)
138  (51)
75    (28) |

## Repeat Infection

- Overall: 31 (11%) men had repeat Ct infection
- 3 men ≥ 1 repeat infection

## Repeat Infection by City

| City | N | Repeat Infection  
n      (%)
 |
| --- | --- | --- |
| Baltimore | 58 |   (12) |
| Denver | 138 | 16    (12) |
| San Francisco | 75 | 8      (11) |

## Repeat Infection by City/Venue

| City/Venue | N | Repeat Infection  
n    (%)
 |
| --- | --- | --- |
| Baltimore/Adolescent Clinics | 18 |         5    (28) |
| Baltimore/School Clinics | 40 |         2     (5) |
| Denver/Adolescent Clinics | 32 |         9    (28) |
| Denver/STD Clinic | 67 |         5     (7) |
| San Francisco/STD Clinic | 57  |         7    (12) |

## Repeat Infection by Age

| Variable | N  | Repeat infection
n    (%) | p value |
| --- | --- | --- | --- |
| Age (yrs)
   15-17 
   18-19
   20-24
   >24
 | 
51
63
96
61 | 
9     (18)
6     (10)
10    (10)
6     (10) | 
.22
 |

## Repeat Infection by Partner

| Partner Characteristic | N  | Repeat infection
n     (%) |
| --- | --- | --- |
| # Partners last 2 months
    0
    1-2 
    ≥3 | 
12
210
45 | 
          0
(13)
(9)
 |
| New Partner during study
    Yes
    No | 
111
161
 | 
16   (14)
(10) |

## Repeat Infection by Partner Type

| Partners during study | N  | Repeat infection
n     (%) |
| --- | --- | --- |
| No partners
Only baseline partners
Baseline and new partners
Only new partners
 | 5 
155
104
8 |           0
15    (10)
16    (15)
          0  |

## Repeat InfectionSignificant findings

| Variable | N  | Repeat infection
n        (%) | p value |
| --- | --- | --- | --- |
| Education level
    <HS
    Some HS
    College
    Graduate school | 
21
136
89
15 | 
        7      (33)
   (7)
  (9)
  2      (13) | 
.003 |
| History of STD
    Yes
    No | 
67
204 | 
13      (19)
18       (9) | 
.01
 |
| Income
    No
    Yes
 | 
97
174
 | 
16       (16)
15        (9) | 
.05 |

## Cox Proportional Hazards Model

| Variable | Hazard Ratio | (95% CI) | p value |
| --- | --- | --- | --- |
| Education level
    <HS
    more than HS | 
5.1
1.0 | 
(2.1, 12.5) | 
<.001
 |
| History of STD
    Yes
    No
 | 
2.4
1.0
 | 
(1.1, 5.4) | 
.03 |
| Income
    No
    Yes
 | 
1.8
1.0 | 
(0.8, 3.9) | 
.14

 |

## Incidence of Repeat Infection

- Cumulative Incidence: 42.3 per 100 person years
- Most infections occurred early

## Cumulative Incidence Curve

## Conclusions

- Repeat Ct infection among men from diverse geographic locations was 11%
- Partner characteristics were not significantly associated with repeat infection
- History of STD, and less than high school education were associated with repeat Ct infection

## Future Directions

- Genotyping
- Evaluating partner characteristics and sexual behaviors during study

## Contact	

- Eileen F. Dunne (_[edunne@cdc.gov](mailto:edunne@cdc.gov)__)_
- 404-639-6184

## Acknowledgments

- Baltimore:  		Jon Ellen
- 				Charlotte Gaydos
- 				Nancy Willard
- 				Michelle Chung
- Denver: 			Kees Rietmeijer
- 				Laura Lloyd
- 				Stewart Thomas
- San Francisco:  		Charlotte Kent
- 				Nat Birkjukow
- Seatle			Jeanne Marrazzo
- CDC: 			Julie Schillinger
- 				Lauri Markowitz
- 				Maya Sternberg
- 				Johanna Chapin
- 				John Papp
- 				Angelica Wendt

## Survival Curve