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Can Social Network Analysis Help Address the High Rates of Bacterial Sexually Transmitted Infections in Saskatchewan?

Trecker, Molly A. PhD*†; Dillon, Jo-Anne R. PhD*‡; Lloyd, Kathy BScN§; Hennink, Maurice MD§; Jolly, Ann PhD¶∥; Waldner, Cheryl PhD†**

Sexually Transmitted Diseases: June 2017 - Volume 44 - Issue 6 - p 338–343
doi: 10.1097/OLQ.0000000000000599
Original Studies

Background: Saskatchewan has one of the highest rates of gonorrhea among the Canadian provinces—more than double the national rate. In light of these high rates, and the growing threat of untreatable infections, improved understanding of gonorrhea transmission dynamics in the province and evaluation of the current system and tools for disease control are important.

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. The database was stratified by calendar year, and social network analysis combined with statistical modeling was used to identify associations between measures of connection within the network and the odds of repeat gonorrhea and risk of coinfection with chlamydia at the time of diagnosis.

Results: Networks were highly fragmented. Younger age and component size were positively associated with being coinfected with chlamydia. Being coinfected, reporting sex trade involvement, and component size were all positively associated with repeat infection.

Conclusions: This is the first study to apply social network analysis to gonorrhea transmission in Saskatchewan and contributes important information about the relationship of network connections to gonorrhea/chlamydia coinfection and repeat gonorrhea. This study also suggests several areas for change of systems-related factors that could greatly increase understanding of social networks and enhance the potential for bacterial sexually transmitted infection control in Saskatchewan.

This study used social network analysis to identify membership in a larger component as an associated risk factor of repeat gonorrhea and coinfection with chlamydia.

From the *Vaccine and Infectious Disease Organization-International Vaccine Centre; †School of Public Health, ‡Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon; §Regina Qu'Appelle Health Region, Regina, Saskatchewan; ¶Centre for Infectious Disease Prevention and Control, Health Canada and Public Health Agency of Canada; ∥Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario; and **Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Source of Funding: The authors gratefully acknowledge the support of the Canadian Institutes of Health Research (CIHR; grants OPC-67017 and MOP77748). Molly Trecker was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship and funding to Jo-Anne Dillon from the University of Saskatchewan.

Conflicts of interest: none declared.

This research was completed in partial fulfillment of requirements toward a PhD thesis for Molly Trecker.

Correspondence: Jo-Anne R Dillon, PhD, Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, c/o VIDO-InterVac, 120 Veterinary Road, Office A218, Saskatoon, Saskatchewan, Canada S7T1C7. E-mail:

Received for publication September 13, 2016, and accepted January 21, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association