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Bipolar Disorder Is Associated With an Increased Risk of Sexually Transmitted Infections

A Nationwide Population-based Cohort Study

Chen, Shih-Fen, PhD*; Wang, Ling-Yi, PhD; Chiang, Jen-Huai, MS; Shen, Yu-Chih, MD, PhD§

doi: 10.1097/OLQ.0000000000000863
Original Studies

Background Previous studies have suggested that sexually transmitted infections (STI) tend to increase in patients with bipolar disorder during a manic or hypomanic episode. However, in the long-term course of this disease, it is unclear whether patients with bipolar disorder have a higher risk of incident STI.

Methods Using the National Health Insurance Research Database of Taiwan, 3721 patients with bipolar disorder and 14,884 controls without bipolar disorder matched by gender and age were enrolled between 2000 and 2010 and followed up until the end of 2013. Participants who developed any STI (human immunodeficiency virus [HIV], syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis) during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STI between patients with bipolar disorder and comparative controls.

Results Patients with bipolar disorder were prone to develop STI (hazard ratio [HR], 1.67, 95% confidence interval [95% CI], 1.27–2.18) especially for HIV (HR, 3.59; 95% CI, 1.16–11.08) and syphilis (HR, 2.26; 95% CI, 1.06–4.85). In addition, this study found that the incidence of STI was higher among women than men (HR, 1.83; 95% CI, 1.41–2.39).

Conclusions This study shows that bipolar disorder is associated with an increased risk of developing STI, which has direct implications for the development of targeted prevention interventions or regular sexual health screening in mental health clinics to reduce the disproportionate burden of HIV and other STI in patients with bipolar disorder.

A nationwide cohort study conducted in Taiwan showed that patients with bipolar disorder are associated with an increased risk of developing sexually transmitted infections

From the *Center of Medical Genetics, Tzu Chi General Hospital, Hualien, Taiwan;

Epidemiology and Biostatistics Consulting Center, Department of Medical Research and Department of Pharmacy, Tzu Chi General Hospital, Hualien, Taiwan;

Management Office for Health Data, China Medical University Hospital at Taichung, and College of Medicine, China Medical University, Taichung, Taiwan; and

§Department of Psychiatry, Tzu Chi General Hospital at Hualien, and School of Medicine, Tzu Chi University, Hualien, Taiwan

Acknowledgment: This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW107-TDU-B-212-123004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10701010021), NRPB Stroke Clinical Trial Consortium (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Conflict of Interest and Sources of Funding: None declared.

Y.C.S. conceived the study and wrote the article. L.Y.W. provided useful suggestions on design and analysis. J.H.C. performed the entire analysis. S.F.C. managed the literature searches. All authors have approved the final article.

Correspondence: Yu-Chih Shen, MD, PhD, Department of Psychiatry, Tzu-Chi General Hospital, 707, Sec. 3, Chung Yang Rd, Hualien 970, Taiwan. E-mail:

Received for publication March 14, 2018, and accepted April 22, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association