# Presentation: 676331

## Sexual Risk Behaviors and Sexually Transmitted Infection (STI) Prevalence in an Outpatient Psychiatry Clinic

**LH Bachmann****1,2****, J Feldman****1****, Y Waithaka****1**** **
**and EW Hook III****1**
** **
**1****University of Alabama at Birmingham, Birmingham, AL; **
**2****Birmingham Veterans Administration Medical Center, Birmingham, AL**

## Background

**1 in 5 Americans will have a diagnosable mental disorder during the course of a year**
**5% of adults have serious mental illness**
**Mental illness may result in behaviors that place patients at risk for STI acquisition **
**Few data are available regarding sexual risk behavior and STI prevalence among patients receiving care for chronic mental illness**

## Objectives

**To determine sexual and substance use risk behaviors in patients receiving care at the University of Alabama at Birmingham (UAB) Community Care Psychiatric Outpatient Clinic**** **
**To determine the prevalence of *****C. trachomatis*****, *****N. gonorrhoeae*****, and *****T. vaginalis *****in this population**

## Methods

**Beginning July 2003, male and female patients between 18 and 50 years of age were consecutively approached for study participation**
**Consenting participants underwent an interviewer-administered survey**
**Chart review was performed for DSM-IV diagnoses**

## Methods

**Urine (male) or self-obtained vaginal swabs (female) were obtained for nucleic acid amplification **(GenProbe Aptima Combo 2)** testing for *****C. trachomatis***** and *****N. gonorrhoeae***** **
**Women submitted self-obtained vaginal swabs for *****T. vaginalis***** culture **
**Patients identified with infection were treated according to the 2002 CDC STD Treatment Guidelines**

## Analyses

**Statistical analyses were performed using SAS version 9.  For categorical variables, Mantel-Haentszel chi-squared analysis and Fisher’s Exact tests were used as appropriate.  For continuous variables, *****t***** tests were used to compare means between groups.  *****P*****<0.05 was considered significant**

## Study Population N = 275

|  | Female
N = 126, No (%) | Male
N = 149, No (%) | P value |
| --- | --- | --- | --- |
| Age (Mean) | 39.7 | 37.4 | 0.05 |
| Race |  |  |  |
|       White | 35 (28) | 44 (30) | 0.75 |
|       African- American
      Other | 87 (69)
4 (3) | 98 (66)
7 (4) |  |
| Marital Status |  |  |  |
|       SNM | 51 (40) | 109 (73) |  < .0001 |
|       Married | 12 (10) | 13 (9) |  |
|       Div./Sep. | 53 (42) | 27 (18) |  |
|       Widowed/Other | 10 (8) | 0 (0) |  |
|  |  |  |  |
|  |  |  |  |
|  |  |  |  |
|  |  |  |  |

## Study Population N = 275* (Cont’d)

|  | Female
N = 126, No (%) | Male
N = 149, No (%) | P value |
| --- | --- | --- | --- |
|  |  |  |  |
| Education (Mean Years) | 12.2 | 11.9 | 0.40 |
| Insurance Status |  |  |  |
|       Medicaid | 91 (73) | 98 (67) | 0.37 |
|       None | 30 (24) | 40 (28) |  |
|       Private

Non-psychiatric medical care/12 mo*

History of imprisonment | 4 (3)

83 (66)

46 (37) | 8 (5)

69 (48)

90 (61) | 

0.003

<0.0001 |
| *Denominators include those who answered question |  |  |  |

## DSM-IV Diagnosis by Gender 

| Diagnosis | Female
N = 121, No (%) | Male
N = 138, No (%) | P value |
| --- | --- | --- | --- |
|  |  |  |  |
| Psychotic Disorder | 56 (46) | 110 (80) | <0.0001 |
| Depression | 43 (36) | 20 (14) | <0.0001 |
| Substance Abuse | 15 (12) | 24 (17) | 0.26 |
| Bipolar | 19 (16) | 11 (8) | 0.05 |
| Personality Disorder | 11 (9) | 8 (6) | 0.31 |
| Anxiety Disorder | 9 (7) | 3 (2) | 0.04 |

**DSM-IV Diagnosis by Gender **
**N=259***

## Stability Indicators

**Psychiatric hospitalization since last visit – 18 (7%)**
**Emergency Department since last visit – 34 (13%)**
**Jail since last visit – 7 (3%)**

## Reported Sexual BehaviorsN=259

|  | Female 
N = 121 | Male 
N = 138 | P value |
| --- | --- | --- | --- |
| Type partner |  |  |  |
|       Male | 114 (95) | 3 (2) |  |
|       Female | 3 (2) | 128 (93) |  |
|       Both | 4 (3) | 7 (5) |  |
| History of STD | 68 (56) | 40 (29) | <0.0001 |
| Sex for drugs | 11 (9) | 9 (7) | 0.45 |
| Number partners/6mo / Median (range) | 1 (0-70) | 1 (0-40) |  |
| Sex in last 30 days | 63 (52) | 51 (37) | 0.01 |
| New partner/30d+ | 5 (8) | 15 (29) | 0.04 |
| Condom use |  |  |  |
|       Any | 52 (43) | 78 (57) | 0.03 |
|       100% | 21 (18) | 42 (31) | 0.01 |
| +Denominator includes those reporting sexual activity in last 30 days |  |  |  |

## Substance Use Behavior

|  | Female
N=121
No; (%) | Male
N=138
No;(%) | P value |
| --- | --- | --- | --- |
|  |  |  |  |
| Alcohol Use/30 days |  46 (38)
 | 58 (42) | 0.48 |
| >5 drinks/30d | 11 (9) | 19 (14)
 | 0.24 |
| Use of alcohol or drugs during sex | 10 (8)
 | 30 (22)
 | 0.003 |
| Illicit Drugs/6mo* | 44 (36) | 47 (34) | 0.70 |
| 
*Sedatives, pot, ecstasy, ghb, poppers, speed, hallucinogens, cocaine or IV drugs |  |  |  |

## STI Prevalence

|  | Female
N = 121
No (%) | Male
N = 138 
No (%) |
| --- | --- | --- |
|  |  |  |
| C. Trachomatis | 4 (3.4) | 4 (2.9) |
| N. Gonorrhoeae | 2 (1.7) | 0 |
| T. Vaginalis | 19 (16.2) | N/A |

## Slide 14

|  | Infected | Not Infected | OR (95% CI) |
| --- | --- | --- | --- |
| Race |  |  |  |
|    African-American | 25 | 151 | 6.71(1.49-49.05);P=0.004 |
|    White/Other | 2 | 81 |  |
| Care 12 mo |  |  |  |
|             Yes | 13 | 129 | .70 (.32-1.57); P = 0.39 |
|             No | 14 | 98 |  |
| Genitourinary Symptoms Present |  |  |  |
|    Female |  |  |  |
|             Yes | 10 | 23 | 2.50(.97–6.47); P = 0.05 |
|             No | 13 | 75 |  |
|    Male |  |  |  |
|             Yes | 0 | 6 | P = 0.67 |
|             No | 4 | 128 |  |

## Slide 15

|  | Infected | Not Infected | OR (95% CI) |
| --- | --- | --- | --- |
| Sex in last 6 mo |  |  |  |
|             Yes | 21 | 146 | 2.06 (.80-5.31); P = 0.13 |
|             No | 6 | 86 |  |
| >5 Drinks/30d |  |  |  |
|             Yes | 5 | 25 | 1.88 (0.65-5.41) P=0.23 |
|             No | 22 | 207 |  |
| Illicit Drugs/ 6mo |  |  |  |
|             Yes | 11 | 80 | 1.31 (0.58-2.95) P=0.52 |
|             No | 16 | 152 |  |
| Use During Sex |  |  |  |
|             Yes | 3 | 37 | .65 (0.19-2.28) P=0.50 |
|             No | 24 | 193 |  |

## Conclusions

**Sexual behavior was heterogeneous in this chronically mental ill population**
**1 in 10 patients were infected with an STI, with almost a quarter of cases in patients who denied sexual activity in more than 6 mo**
**Symptoms were not predictive of STI in men **

## Conclusions

**Race was the only significant predictor of infected status**
**Routine STI screening in this setting may reach a group of individuals not captured through other methods**

## Acknowledgements

**Rosalyn Mallory**
**Prashant Tayshetye**
**Coretta Thomas**
**Olivio Clay**
**Sharron Hagy**
**Marga Jones**