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Sexually Transmitted Disease Clinic Clients at Risk for Subsequent Gonorrhea and Chlamydia Infections: Possible ‘Core’ Transmitters

Gunn, Robert A. MD, MPH*†; Fitzgerald, Star BA; Aral, Sevgi O. PhD*

Sexually Transmitted Diseases: July 2000 - Volume 27 - Issue 6 - p 343–349
Original Articles

Background: From an sexually transmitted disease (STD) intervention perspective, developing a practical way to identify persons in core transmitter groups has been difficult. However, persons who have repeated STD infections may be in such groups.

Goal: To evaluate a self-administered risk assessment approach that would identify STD clinic clients who were at an increased risk of being involved in gonorrhea (GC) or chlamydia (CT) transmission in the subsequent year.

Study Design: Prospective cohort of consecutive STD clinic clients with a 1-year follow-up period.

Results: During a 6-month period in 1995, 2576 STD clinic clients in San Diego completed a risk assessment. Of those clients, 204 (7.9%) had a subsequent STD and 79 (3.1%) had a subsequent GC or CT infection during the 1-year follow-up period. The strongest predictor of a subsequent GC/CT was having a recent history or current clinic visit diagnosis of GC or CT (6.1% subsequent GC/CT rate). The more past episodes of GC or CT, the higher the subsequent GC/CT rate. Unsafe sexual behavior had little effect on further increasing subsequent GC/CT risk.

Conclusion: STD clinic clients with a recent history of GC or CT and a high risk of subsequent GC/CT may be core transmitters who could likely benefit from risk reduction, periodic screening for GC/CT, symptom recognition counseling, and preventive treatment-the essential elements of STD-prevention case management.

*From the Centers for Disease Control and Prevention, Atlanta, Georgia; and the †STD Control Program, Health and Human Services Agency, San Diego, California

The authors thank Michael St. Louis, MD for his review and suggestions, and Jody Thomas for assistance in manuscript preparation.

Reprint requests: Robert A. Gunn, MD, STD Control, P511B, 3851 Rosecrans Street, San Diego, CA 92110. E-mail:

Received for publication August 8, 1999, revised November 4, 1999, and accepted November 10, 1999.

© Copyright 2000 American Sexually Transmitted Diseases Association