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Epidemiologic Risk Factors for Incident Sexually Transmitted Diseases in Young Thai Men

CELENTANO, DAVID D. ScD, MHS*,†; NELSON, KENRAD E. MD; SUPRASERT, SOMBOON RN§; EIUMTRAKUL, SAKOL MD; KUNTOLBUTRA, SURINDA MS; BEYRER, CHRIS MD, MPH; ZENILMAN, JONATHAN MD; WRIGHT, NICHOLAS H. MD, MPH; THEETRANONT, CHOTI MD#

Original Article

Background and Objectives: Prospective studies of incidental sexually transmitted diseases in developing countries rarely have been reported. As the human immunodeficiency virus epidemic widens, knowledge of the epidemiology of sexually transmitted diseases as co-factors for human immunodeficiency virus infection is viewed as vitally important.

Goal: To determine epidemiologic risk factors for incidental sexually transmitted diseases in young men in northern Thailand.

Study Design: A cohort of 2,417 men selected by lottery for military conscription was followed an average of 22 months, with epidemiologic risk factors and sexually transmitted disease histories assessed semiannually. Sexually transmitted diseases were determined by physician or symptom histories obtained by interview.

Results: Sexually transmitted disease incidence was 17.04 per 100 person-years. Gonorrhea and chancroid were commonly reported, whereas incident syphilis was rare. Sexually transmitted disease incidence declined significantly in the 2-year period. Most sexually transmitted diseases were acquired through commercial sex patronage. However, among men who did not report visiting a brothel, there was a significant increase in sexually transmitted diseases among men reporting sex with a girlfriend. Other risk factors included inconsistent condom use, drug use, and low educational level. Frequent alcohol use was associated with incident sexually transmitted diseases in bivariate analysis, but drinking at the time of last brothel visit was not associated with increased sexually transmitted diseases.

Conclusions: Sexually transmitted disease control in Thailand is based on an integrated sexually transmitted disease clinic system. Many commercial sex workers are examined and treated routinely, but too infrequently to reduce sexually transmitted disease transmission between them and their male clients. Condom-use levels in commercial sex settings still may be too low to reduce sexually transmitted disease transmission. More consistent and effective sexually transmitted disease treatment of commercial sex workers and their clients and education of men on the effective and consistent use of condoms is required to reduce the risks of sexually transmitted disease transmission in this population.

* From the Departments of Health Policy and Management and Epidemiology, School of Hygiene and Public Health, and Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland; the § Department of Family Medicine and #Office of the President, Chiang Mai University, Chiang Mai; Kawila Hospital, Royal Thai Army Medical Corps, Chiang Mai, Thailand; and Robert Wood Johnson Medical School, Piscataway, New Jersey

Supported in part by grants from the Rockefeller Foundation, New York, New York; Armed Forces Research Institute for Medical Sciences, Bangkok, Thailand; and Family Health International, Arlington, Virginia, with funds from the United States Agency for International Development, Washington, DC.

Reprint requests: David D. Celentano, ScD, Faculty of Social and Behavioral Sciences, The Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway (Room 700), Baltimore, MD 21205.

Received for publication April 17, 1995; revised September 11, 1995; accepted September 15, 1995.

© Copyright 1996 American Sexually Transmitted Diseases Association