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NAAT–Identified and Self-Reported Gonorrhea and Chlamydial Infections: Different At-Risk Population Subgroups?

ROGERS, SUSAN M. PhD*; MILLER, HEATHER G. PhD*; MILLER, WILLIAM C. MD, PhD, MPH†; ZENILMAN, JONATHAN M. MD‡; TURNER, CHARLES F. PhD*§

Article

Background: Information on the characteristics and behaviors of persons at high risk for gonorrhea and chlamydial infection has typically been derived from studies of sexually transmitted disease (STD) clinic populations. The Baltimore STD and Behavior Survey (BSBS) used urine-based nucleic acid amplification testing (NAAT) to assess the prevalence and behavioral correlates of gonorrhea and chlamydial infection in a population-based cross-sectional survey of adults in Baltimore, Maryland.

Goal: The goal of this study was to examine the demographic characteristics and behavioral markers of gonorrhea and chlamydial infection as reported by adults with a self-reported history of gonorrhea and chlamydial infection and to compare these to the characteristics and behaviors of individuals with current NAAT-identified gonorrhea and/or chlamydial infection.

Study Design: A probability sample of adults aged 18 to 35 years residing in Baltimore was evaluated with collection of urine specimens and administration of a health and behavior survey. Data and specimens were collected between January 1997 and September 1998.

Results: Respondents with NAAT-detected gonorrhea and/or chlamydial infection (7.9%) did not report a history of high-risk behaviors or more recent occurrences of those behaviors, and the majority were asymptomatic. However, adults in our study who self-reported a history of infection (26.0%) were more likely than those with no history of infection to report multiple partners, paid sex, partners with prior STDs, and STD symptoms—a pattern consistent with findings described in previous clinic-based reports.

Conclusion: The risk profile generated from studies of clinic populations, with a focus on symptomatic disease, may not characterize the broader population with current, untreated, largely asymptomatic infection.

A probability sample of adults in Baltimore, Maryland, with NAAT-detected gonorrhea and chlamydial infections (7.9%) did not report a history of high-risk behaviors, and the majority were asymptomatic. The risk profile generated from evaluations of clinic patients, with a focus on symptomatic disease, may not characterize the broader population with undiagnosed, asymptomatic infection.

From the *Program in Health and Behavior Measurement, Research Triangle Institute, Washington, DC; †School of Medicine and Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina; ‡School of Medicine, Johns Hopkins University, Baltimore, Maryland; and §City University of New York, Queens College and Graduate Center, Flushing, New York

The authors thank Dr. Jonathan Ellen for his review of an earlier version of the manuscript.

Supported by National Institutes of Health (NIH) grants R01-HD31067 and RO1-MH56318 (to Dr. Turner); the Research Triangle Institute; grant RR00046 from the Clinical Associate Physician Program of the General Clinical Research Center, Division of Research Resources, NIH (to Dr. W. Miller); and NIH grants K24AI01633 and UI9AI38533 (to Dr. Zenilman). Abbott Laboratories donated some of the LCR test kits used in this study.

Reprint requests: Susan M. Rogers, PhD, Program in Health and Behavior Measurement, Research Triangle Institute, 1615 M Street NW, Washington, DC 20036. E-mail: smr@rti.org

Received for publication September 21, 2001,

revised December 19, 2001, and accepted December 26, 2001.

© Copyright 2002 American Sexually Transmitted Diseases Association