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Associations Between Sexually Transmitted Disease Diagnosis and Subsequent Sexual Risk and Sexually Transmitted Disease Incidence Among Adolescents

Crosby, Richard A. PhD*†; DiClemente, Ralph J. PhD*†‡§; Wingood, Gina M. ScD, MPH*†; Salazar, Laura F. PhD*†; Rose, Eve MPH*; Levine, David MD, FAAP; Brown, Larry MD; Lescano, Celia PhD; Pugatch, David MD**; Flanigan, Timothy MD††; Fernandez, Isa PhD‡‡; Schlenger, William PhD§§; Silver, Barabra J. PhD∥∥

Sexually Transmitted Diseases: April 2004 - Volume 31 - Issue 4 - p 205-208
doi: 10.1097/01.OLQ.0000114940.07793.20

Background Empiric evidence is lacking in regard to the subsequent sexually transmitted disease (STD)-associated risk behaviors of adolescents diagnosed and treated for an STD.

Goal The goal of this study was to prospectively identify associations between STD diagnosis and subsequent sexual risk and STD incidence among a sample of U.S. adolescents.

Study Design A cohort of 455 adolescents (age 15–21 years) was followed for 3 months. Adolescents were recruited from primary care clinics and through outreach activities.

Results A total of 10.8% were initially diagnosed with at least one STD. After adjusting for observed covariates, these adolescents (compared with those testing negative) were 2.8 times (P = 0.0001) more likely to be abstinent from sex and 2.2 times more likely to report always using condoms (P = 0.04). However, during the ensuing 3 months, they were approximately 2.4 times more likely to report having sex with multiple partners (P = 0.01), 8.9 times more likely to test positive for trichomonas (P = 0.009), and 3.0 times more likely to test positive for chlamydia (P = 0.04).

Conclusions Compared with those testing negative, adolescents diagnosed with an STD may subsequently adopt safer sex behaviors, including abstinence. However, perhaps in part as a result of having sex with multiple partners, they might fail to practice safer sex behaviors stringently enough to avoid subsequent STD acquisition.

In a prospective study, adolescents diagnosed with an STD subsequently adopted safer sex behaviors, but they were nonetheless significantly more likely to acquire trichomoniasis or chlamydia over a 3-month period.

*Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia; Emory Center for AIDS Research, Atlanta, Georgia; the Departments of Pediatrics and §Medicine, Emory University School of Medicine, Atlanta, Georgia; the Department of Pediatrics, Morehouse School of Medicine, Atlanta, Georgia; the Departments of Psychiatry, **Pediatrics, and ††Medicine, Brown University School of Medicine, Providence, Rhode Island; the ‡‡Department of Epidemiology and Public Health, University of Miami, Miami, Florida; §§Research Triangle Institute, Research Triangle Park, North Carolina; and the ∥∥Center for Mental Health Services, SAMHSA, Rockville, Maryland

This study was supported by a grant from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services.

Correspondence: Richard A. Crosby, PhD, Rollins School of Public Health, 1518 Clifton Road, NE, Room 542, Atlanta, GA 30322. E-mail:

Received for publication September 16, 2003,

revised November 4, 2003, and accepted November 5, 2003.

© Copyright 2004 American Sexually Transmitted Diseases Association