Abstract
We examined the prevalence trends of non-human immunodeficiency virus (HIV) sexually transmitted infections (STI) and associated patient characteristics in U.S. ambulatory-care settings from 2005–2016. We conducted a retrospective repeated cross-sectional analysis using data from the National Ambulatory Medical Care Survey (NAMCS) for individuals aged 15–64 with a non-HIV STI-related visit. Data were combined into three periods (2005–2008, 2009–2012, and 2013–2016) to obtain reliable estimates. Logistic regression was used for analysis. A total of 19.5 million weighted, non-HIV STI-related ambulatory visits from 2005–2016 were identified. STI-related visits per 100,000 ambulatory care visits increased significantly over the study period: 206 (95% CI = 153–259), 343 (95% CI = 279–407), and 361 (95% CI = 277–446) in 2005–2008, 2009–2012, and 2013–2016, respectively (Ptrend = 0.003). These increases were mainly driven by increases in HPV-related visits (56 to 163 per 100,000 visits) from 2005–2008 to 2009–2012, followed by syphilis- or gonorrhea-related visits (30 to 67 per 100,000 visits) from 2009–2012 to 2013–2016. Higher odds of having STI-related visit were associated with younger age (aged 15–24: aOR = 4.45; 95% CI = 3.19–6.20 and aged 25–44: aOR = 3.59; 95% CI = 2.71–4.77) vs. 45–64-year-olds, Black race (aOR = 2.41; 95% CI = 1.78–3.25) vs. White, and HIV diagnosis (aOR = 10.60; 95% CI = 5.50–20.27) vs. no HIV diagnosis. STI-related office visits increased by over 75% from 2005–2016, and were largely driven by HPV-related STIs and syphilis- or gonorrhea-related STIs.
Highlights
In the United States (U.S.), it is estimated that over 26 million sexually transmitted infections (STI) were acquired in 2018 [1]
Gonorrhea and chlamydia are both causes of pelvic inflammatory disease (PID), which can lead to ectopic pregnancy, tubal infertility, and chronic pelvic pain [3]
We observed significant increasing trends of non-human immunodeficiency virus (HIV) STI-related visits among individuals who were aged 25–44 (36% to 65%), male (25% to 45%), Hispanic (14% to 20%), and residing in the western U.S (20% to 28%) from 2005–2008 to 2013–2016
Summary
In the United States (U.S.), it is estimated that over 26 million sexually transmitted infections (STI) were acquired in 2018 [1]. 66% of STIs are asymptomatic [2] and remain untreated; this increases the risk of acquiring human immunodeficiency virus (HIV), stillbirths, infant death, and infertility [3]. A recent study estimated that STIs account for an annual direct medical cost of USD 16 billion in the U.S [5]. Pharmacological products such as the human papillomavirus (HPV) vaccine (first approved in 2006) and pre-exposure prophylaxis (PrEP) (approved in 2012) have received much attention as the concern that vaccination against HPV and the use of PrEP could promote condomless sex by lowering perceived risks of acquiring an STI (risk compensation) [6,7]
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