Prevalence and Risk Factors Associated with Chlamydia and Gonorrhea Infection in an Urban Primary Care Clinic

Abstract

PURPOSE: STDs are a major health problem for young adults. While frequently asymptomatic, they can cause serious complications if not detected and treated. To measure the local prevalence of Chlamydia (Ch) and Gonorrhea (GC), and to determine factors predictive of positive Ch and GC tests, we screened patients attending a multi-disciplinary primary care clinic (Pediatrics, Ob/Gyn, General and Specialty Medicine, Podiatry, General Surgery) serving a primarily minority, low-income population in Hartford CT. METHODS: Patients aged 13 to 30 were enrolled from the clinic waiting area. After providing informed consent, they completed a questionnaire (symptoms, risk behaviors, demographics) and provided a urine specimen for Ch and GC Ligase Chain Reaction testing. RESULTS: During 1998 and 1999, 732 patients (64% of eligible patients contacted) were enrolled. 46 failed to provide a urine specimen, leaving a final sample of 550 females (F) and 136 males (M), including 234 adolescents (age 13–19) (184 F, 50 M) and 166 pregnant F. Overall prevalence of Ch or GC was 10.8%, and was similar by gender (F 10.9%, M 10.3%), and age group (adolescent 12.0%, adult 10.2%). 9.6% of pregnant F were infected. Infections were most prevalent among adolescent F (13.0%), and adult M (11.6%). Among patients who reported symptoms (discharge, pain, dysuria, spotting or genital lesions in the past month) prevalence was 20.7% in M, and 12.3% in F. 57.1% of M cases and 56.6% of F cases occurred without reported symptoms. Among adolescents who reported previous sexual intercourse, prevalence was 16% (F 16.9%, M 11.5%). Among adults who reported one or more risky behaviors (new or multiple partners in last 3 months, inconsistent use of barrier contraception) prevalence was 13.7% (F 13.5%; M 15%). Variables associated with positive test results included having a new partner in the last 90 days, and being single. Composite variables combining several risk behaviors also predicted positive results, but these were more sensitive for females. Other individual variables such as inconsistent condom use, number of partners, and previous STD diagnosis were not reliable predictors of positive test results. CONCLUSION: STD prevalence is high in this population. Most individual risk behaviors were not reliable predictors of positive test results. Variables combining several risk factors were better predictors, but still missed many cases. In this high prevalence population, universal screening may be a better strategy than risk stratification.