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1. Longitudinal association of gonorrhea and bacterial vaginosis with repeat chlamydia diagnoses among U.S. Army women: a retrospective cohort analysis

Author

Christian T. Bautista, Eyako K. Wurapa, Warren B. Sateren, Bruce P. Hollingsworth, and Jose L. Sanchez

Subjects
Gonorrhea, Bacterial vaginosis, Chlamydia, Sexually transmitted infection, Military, Medicine (General), R5-920, Military Science
Abstract

Abstract Background Historically, sexually transmitted infections have affected the health of the U.S. military. To determine whether gonorrhea, bacterial vaginosis, genital herpes, and trichomoniasis are predictors of repeat chlamydia diagnoses among U.S. Army women, medical data reported into the Defense Medical Surveillance System during the 2006–2012 period were analyzed. Methods For all inpatient and outpatient medical records, the first and second International Classification of Diseases, version 9 (ICD-9) diagnostic positions were reviewed for each chlamydia case to determine the occurrence of repeat diagnoses. The Andersen-Gill regression model, an extension of the Cox model for multiple failure-time data, was used to study associations between predictors and repeat chlamydia diagnoses. Results Among 28,201 women with a first chlamydia diagnosis, 5145 (18.2%), 1163 (4.1%), 267 (0.9%), and 88 (0.3%) had one, two, three, and four or more repeat diagnoses, respectively. Overall, the incidence of repeat chlamydia was 8.31 cases per 100 person-years, with a median follow-up time of 3.39 years. Gonorrhea (hazard ratio (HR) = 1.58, 95% CI: 1.44–1.73) and bacterial vaginosis (HR = 1.40, 95% CI: 1.09–1.79) were significant predictors for repeat chlamydia. These estimated hazard ratios were attenuated, but remained significant, after controlling for age, race/ethnicity, marital status, and military rank. No significant association was found for genital herpes (HR = 1.13, 95% CI: 0.55–2.29) and trichomoniasis (HR = 1.43, 95% CI: 0.43–4.68). Conclusions This large cohort study suggests that gonorrhea and bacterial vaginosis were associated with repeat chlamydia diagnoses among U.S. Army women. These findings can be used in formulating new interventions to prevent repeat chlamydia diagnoses.

Published
2018
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2. Repeat infection with Neisseria gonorrhoeae among active duty U.S. Army personnel: a population-based case-series study

Author

Bruce Philip Hollingsworth, Eyako Wurapa, Warren B. Sateren, Jose L. Sanchez, Christian T. Bautista, and Sara Morris

Subjects
Adult, Male, Medical surveillance, medicine.medical_specialty, Active duty, Adolescent, Gonorrhea, repeat, Dermatology, medicine.disease_cause, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Recurrence, Internal medicine, Original Research Articles, Epidemiology, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, sexually transmitted infection, military, Gynecology, 030505 public health, business.industry, Hazard ratio, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Neisseria gonorrhoeae, United States, Military personnel, Infectious Diseases, Military Personnel, Socioeconomic Factors, Population Surveillance, surveillance, epidemiology, Female, 0305 other medical science, business, Case series
Abstract

Little information is known on the rate of repeat gonorrhea infection among U.S. military personnel. We analyzed all gonorrhea cases reported to the Defense Medical Surveillance System during 2006–2012 to determine the rate of repeat infection. During the seven-year study period, 17,602 active duty U.S. Army personnel with a first incident gonorrhea infection were reported. Among the 4987 women with a first gonorrhea infection, 14.4% had at least one repeat infection. Among the 12,615 men with a first gonorrhea infection, 13.7% had at least one repeat infection. Overall, the rate of repeat gonorrhea infection was 44.5 and 48.9 per 1000 person-years for women and men, respectively. Service members aged 17–19 years (hazard ratio [HR] for women = 1.51; HR for men = 1.71), African-American personnel (HR for women = 1.26; HR for men = 2.17), junior enlisted personnel (HR for women = 2.64; HR for men = 1.37), and those with one year or less of service (HR for women = 1.23; HR for men = 1.37) were at higher risk of repeat infection. The findings from this study highlight the need to develop targeted prevention initiatives including education, counseling, and retesting to prevent gonorrhea reinfections among U.S. Army personnel.

Published
2016

3. Association of Bacterial Vaginosis With Chlamydia and Gonorrhea Among Women in the U.S. Army

Author

Christian T. Bautista, Warren B. Sateren, Sara Morris, Bruce Philip Hollingsworth, Jose L. Sanchez, and Eyako Wurapa

Subjects
0301 basic medicine, Adult, medicine.medical_specialty, Epidemiology, 030106 microbiology, Gonorrhea, Sexually Transmitted Diseases, Comorbidity, medicine.disease_cause, Rate ratio, urologic and male genital diseases, Risk Assessment, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Age Distribution, medicine, Confidence Intervals, Prevalence, Humans, 030212 general & internal medicine, Retrospective Studies, Gynecology, Chlamydia, Obstetrics, business.industry, Case-control study, Public Health, Environmental and Occupational Health, Retrospective cohort study, Vaginosis, Bacterial, Chlamydia Infections, medicine.disease, female genital diseases and pregnancy complications, United States, Logistic Models, Military Personnel, Case-Control Studies, Neisseria gonorrhoeae, Female, Bacterial vaginosis, Chlamydia trachomatis, business
Abstract

Introduction Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age, which has been associated with Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers and women attending sexually transmitted infection clinics. Pathogen-specific associations between BV and other sexually transmitted infections among U.S. military women have not been investigated. Methods A population-based, nested case-control study was conducted of all incident chlamydia and gonorrhea cases reported to the Defense Medical Surveillance System during 2006−2012. Using a density sampling approach, for each chlamydia or gonorrhea case, 10 age-matched (±1 year) controls were randomly selected from those women who were never diagnosed with these infections. Incidence rate ratios were estimated using conditional logistic regression. Statistical analysis was carried out in December 2015. Results A total of 37,149 chlamydia cases and 4,987 gonorrhea cases were identified during the study period. Antecedent BV was associated with an increased risk of subsequent chlamydia (adjusted incidence rate ratio=1.51; 95% CI=1.47, 1.55) and gonorrhea (adjusted incidence rate ratio=2.42; 95% CI=2.27, 2.57) infections. For every one additional episode of BV, the risk of acquiring chlamydia and gonorrhea infections increased by 13% and 26%, respectively. A monotonic dose−response relationship was also noted between antecedent BV and subsequent chlamydia and gonorrhea infection. In addition, an effect modification on the additive scale was found between BV and African-American race for gonorrhea, but not for chlamydia. Conclusions Among U.S. Army women, antecedent BV is associated with an increased risk of subsequent chlamydia and gonorrhea infection.

Published
2016

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