# Presentation: 225589

## 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

## 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.

## 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.

## Methods

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

## Inclusion Criteria

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

## Exclusion Criteria

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

## Study Population:Contacts to STD’s

|  | Baltimore
N=1080(%)
 | Birm.
N=822 (%) | Denver
N=3289(%) | Seattle
N=1287(%) | Total
n=6478(%) |
| --- | --- | --- | --- | --- | --- |
| Fem
MSW
MSM
 |    (39)
651   (60)
10       (1) | 362  (44)
459  (56)
1        (0) | 1332 (40)
1757 (53)
200     (6) | 394      (31)
644      (50)
249      (19) |     (39)
3511    (54)
460      (7) |
| White
Hisp
Black | 12       (1)
0
1055   (98) | 72       (9)
10       (1)
725     (88) | 852      (26)
1286    (39)
1044    (32) | 578      (45)
40        (3)
466      (36) | 1514    (23)
1336    (21)
2235    (51) |

## Study Population:Contacts to STD’s

| 

Contact | Baltimore
n=1080(%) | Birmingham
N=822 (%)
 | Denver
N=3289(%) | Seattle
N=1287(%) | Total
N=6478(%) |
| --- | --- | --- | --- | --- | --- |
| CT
GC
CT+GC
NGU
Trich | 248   (23)
240   (22)
12     (1)
148   (14)
430   (40) | 203  (25)
211  (26)
-
108  (13)
296  (36) | 1507 (46)
527   (16)
135     (4)
637   (19)
415   (13) | 614   (48)
294   (23)
52       (4)
171   (13)
128   (10) | 2572 (40)
1272 (20)
199     (3)
1064 (16)
1269 (20) |

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

** **

| 
 | Women
N=2507 (%) | Hetero men
N=3511  (%)
 | MSM
N=460  (%) |
| --- | --- | --- | --- |
| HIV | 0/1404    (0) | 3/1928     (0.3) | 11/204  (5.4) |
| Early syphilis | 1/2507    (0) | 0/3511        (0) | 2/459    (0.4) |
| Late/latent/ or other syphilis | 18/2042 (.9) | 14/2923   (0.5) | 5/351    (1.4) |

## Results: Prevalence of STD Dx’s Concordant with Contact

** **

| 
 | Women
N=2088 
           (%) | Hetero men
N=2860  
              (%) | MSM
N=450  
         (%) |
| --- | --- | --- | --- |
| CT dx in
contact to CT | 242/624
        (38.8) | 769/1602           
           (48.0) | 14/98 
        (14.3) |
| GC dx in
contact to GC | 221/470    
        (47.0) | 78/263
           (29.7) | 101/299
        (33.8) |
| CT dx in
contact to GC | 105/470     
        (22.3) | 42/263
           (16.0) | 26/299
        (8.7) |

## Results: Prevalence of STD Dx’s Discordant with Contact

** **

| 
 | Women
N=2507 
           (%) | Hetero men
N=3511  
              (%) | MSM
N=460  
       (%) |
| --- | --- | --- | --- |
| GC dx in
contact to CT | 29/737
         (3.9) | 56/1801           
              (3.1) | 6/100 
       (6.0) |
| CT or GC dx in
contact to Trich | 29/134    
        (21.6) | 88/819
              (10.7) | - |
| Trich dx in 
contact to
CT, GC, or NGU | 145/2334                              
        (6.2) | - | - |

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

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

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

## 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.

## 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.

## 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.

## Acknowledgements

- _Baltimore, MD_		_Denver, CO_
- R Brotman		L Lloyd
- E Erbelding		K Rietmeijer
- _Birmingham, AL_		_Seattle, WA_
- L Bachmann		A Collier
- S Yu		M Golden
- 			HH Handsfield
- 			K Holmes
- 			F Koch