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Background: Despite the large body of extant literature on sexually transmitted infections (STIs) in adolescents and young adults (AYAs), more research on social and environmental contextual factors is needed. Also, further examination of STI indicators by gender remains a critical area of research focus., Methods: Anonymous survey data were collected using audio computer-assisted self-interviews in community venues in urban, low-income, STI prevalent, US neighborhoods to reach AYAs, aged 12 to 24 years. Conventional descriptive statistics, bivariate analysis, and multiple logistical regression models were used to assess indicators of a self-reported lifetime prevalence of STIs., Results: Participants (N = 1540) were on average 20.6 years; 57.2% were women, the majority were racial and ethnic minorities (92%), and almost half (49.2%) identified as sexual minorities. Nearly one third (32.%) had 1 or more STIs. As expected, gender differences were identified. For AYA men, being African American/Black, moving residences more than 4 times since kindergarten, and having a history of human immunodeficiency virus testing were each positively associated with STIs. Also, those who strongly disagreed that many young people in their community exchanged sex for money had a significantly lower likelihood of having an STI. For AYA women, exchanging sex for drugs or money, lacking money, which prevented activities, and using marijuana were each associated with STIs., Conclusions: This research extends our understanding of social and environmental contextual influences on AYAs' risk for STIs. It highlights differences in risk exposures that are distinctly different for AYA women and men, suggesting the need for tailored interventions to address their unique economic needs and social challenges.

Background: Young men who have been involved with the criminal justice system are more likely to have concurrent sexual partners, a key driver of sexually transmitted infections. The value men place on having sexual relationships to validate themselves may play an important role in understanding this association., Methods: Data were from a household survey. Young men (N = 132), aged 16 to 24 years, self-reported whether they ever spent time in jail or juvenile detention and if they had sexual partnerships that overlapped in time. A novel scale, "Validation through Sex and Sexual Relationships" (VTSSR) assessed the importance young men place on sex and sexual relationships (α = 0.91). Weighted logistic regression accounted for the sampling design., Results: The mean (SD) VTSSR score was 23.7 (8.8) with no differences by race. Both criminal justice involvement (CJI) (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.12-12.1) and sexual validation (OR, 1.10; 95% CI, 1.04-1.16) were associated with an increased odds of concurrency; however, CJI did not remain associated with concurrency in the fully adjusted model. There was effect modification, CJI was associated with concurrency among those who scored high on sexual validation (OR, 9.18; 95% CI, 1.73-48.6]; however, there was no association among those who scored low on sexual validation. Racial differences were observed between CJI and concurrency, but not between sexual validation and concurrency., Conclusions: Sexual validation may be an important driver of concurrency for men who have been involved with the criminal justice system. Study findings have important implications on how sexual validation may explain racial differences in rates of concurrency.

Background: It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)-related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents' STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship., Methods: A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners., Results: Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time., Conclusions: Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

National survey data designed to delineate clinician perspectives on the indications to hospitalize adolescents for pelvic inflammatory disease indicate that clinicians endorse care consistent with the Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines but that there is less agreement on the social factors that may impair an adolescent's ability to self-care in the outpatient setting.

Sexually transmitted infection (STI) prevalence and risks in a sample of rural Thai adolescents and young adults (14-29 years) were examined. Unprotected sex with a casual partner conferred the greatest risk for prevalent STIs, particularly for younger adolescents, and alcohol use increased the STI risk for women but not for men.

Background: Sex partner concurrency is an important risk factor for sexually transmitted infection transmission. Understanding how adolescents conceptualize the length of their relationships when they break up and get back together is essential to the assessment of concurrency., Methods: A prospective cohort of 392 late adolescents and emerging adults, aged 14 to 19 years at baseline, were recruited from 2 clinics in Baltimore, MD and interviewed semiannually for 3 years. At each interview, participants were asked to report on all of their sexual partners in the previous 6 months, the length of relationship, and whether they thought their partner had other sex partners. For relationships that had broken up and gotten back together, reports of length of the relationship were compared before and after the breakup. Random effects logistic regression was used to examine the association between length of relationship and both breakup and partner concurrency., Results: For relationships that ended and subsequently got back together, participants considered the length of relationship to include the period when they were broken up. Longer relationships were at increased odds of both having broken up and gotten back together (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.02, 1.05) and of partner concurrency (OR = 1.03, 95% CI: 1.02, 1.04). The magnitude of the odds of concurrency was greater for relationships that had broken up and gotten back together (OR = 1.07, 95% CI: 1.02, 1.11)., Conclusions: Findings from this study emphasize the need for an improved understanding of the association between the temporal dynamics of late adolescent and emerging adult romantic relationships and concurrency.

The 2006 Centers for Disease Control and Prevention human immunodeficiency virus testing guidelines, coupled with a quality improvement intervention, can increase the number of human immunodeficiency virus tests performed in sexually active youth aged 12 to 21 years. Such focused interventions may be helpful to promote recommended guidelines and can be an innovative approach to screen adolescents in urban primary care settings.

Background: Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities., Methods: A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users., Results: Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care., Conclusions: More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.

We used 2008-2009 physician and hospital charges to estimate the direct cost of medical care per case of pelvic inflammatory disease. The estimated average total charge per episode was $3,025 (SD: $4155). The estimated average charge for patients treated in ambulatory (outpatient clinic and emergency department) settings was $7440 lower than for those treated on inpatient units.

Background: Secondary transmission remains a significant concern among HIV-infected youth. Little is known, however, about how partner-specific sexual risk behaviors for the secondary transmission of HIV may differ between the 2 largest subgroups of HIV-positive youth, women-who-have-sex-with-men (WSM) and men-who-have-sex-with-men (MSM), METHODS: During 2003-2004, a convenience sample of HIV-infected youth, 13 to 24 years of age, were recruited from 15 Adolescent Medicine Trials Network clinical sites. Approximately 10 to 15 youth were recruited at each site. Participants completed an ACASI survey including questions about sex partners in the past year. Cross-sectional data analyses, including bivariate and multivariable regressions, using generalized estimating equations, were conducted during 2008 to compare recent partner-specific sexual risk behaviors between WSM and MSM., Results: Of 409 participants, 91% (371) were included in this analysis, including 176 WSM and 195 MSM. Ninety-two percent (163 WSM, 177 MSM) provided information on characteristics of their sexual partners. There were significant differences between the 2 groups in recent partner-specific sexual risk behaviors including: lower rates of condom use at last sex among WSM (61% WSM vs. 78% MSM; P = 0.0011); a larger proportion of the sex partners of MSM reported as concurrent (56% MSM vs. 36% WSM; P = 0.0001); and greater use of hard drugs at last sex by MSM and/or their partner (18% MSM vs. 4% WSM; P = 0.0008). When measuring risk as a composite measure of sexual risk behaviors known to be associated with HIV transmission, both groups had high rates of risky behaviors, 74.7% among young MSM compared to 68.1% of WSM., Conclusions: These data suggest that recent partner-specific sexual risk behaviors for HIV transmission are high among young infected MSM and WSM. These findings suggest the need to offer interventions to reduce the secondary transmission of HIV to all HIV-positive youth in care. However, differences in risk behaviors between young MSM and WSM supports population-specific interventions.

Background: Latino youth in the United States are at greater risk for contracting sexually transmitted infections (STIs) in comparison with non-Hispanic white youth., Methods: Sexually active heterosexual Latino youth aged 16 to 22 years (N = 647) were recruited for interviews through a large health maintenance organization or community clinics., Results: Adjusting for gender, age, ethnic heritage, and recruitment method, woman's consistent use of hormonal contraceptives, ambivalence about avoiding pregnancy, longer length of sexual relationship, and greater overall trust in main partner were independently associated with inconsistent condom use and engagement in a greater number of sexual intercourse acts that were unprotected by condom use. Perception that one's main partner had potentially been unfaithful, but not one's own sexual concurrency, was associated with consistent condom use and fewer acts of unprotected sexual intercourse. Sexually concurrent youth who engaged in inconsistent condom use with other partners were more likely to engage in inconsistent condom use and a greater number of unprotected sexual intercourse acts with main partners., Conclusions: Increasing attachment between youth may be a risk factor for the transmission of STIs via normative declines in condom use. Perception that one's partner has potentially been unfaithful may result in greater condom use. However, many Latino adolescents and young adults who engage in sexual concurrency may not take adequate steps to protect their partners from contracting STIs. Some youth may be more focused on the emotional and social repercussions of potentially revealing infidelity by advocating condom use than the physical repercussions of unsafe sex.

Background: Sexual networks play an important role in the transmission of sexually transmitted infections (STIs) and HIV. However, because of the challenges of collecting network data, relatively few empirical reports exist about the structure of sexual networks in general population samples. This study describes the structure of the sexual networks of a household sample of urban black adolescents living in an area with moderate endemic STI rates., Methods: Random digit dialing was used to recruit a household sample of black adolescents from the Bayview-Hunter's Point neighborhood of San Francisco. Participants' recent partners and partners of partners were recruited through snowball sampling. Biologic samples were tested for current infection with gonorrhea or chlamydia. Social network analysis methods were used to describe the characteristics of the resulting sexual networks., Results: One hundred and sixty-six sexually active participants were connected to 388 network members in 159 separate sexual network components. Despite relatively high prevalence of bacterial STIs (13%), components were small (3.5 people on average, and half involved only 2 people), linear and acyclic. Females were less central in their networks than males by local measures but just as central when overall structure was taken into account., Conclusions: Our results confirm, in a new setting, previous observations that sexual network structures necessary for endemic transmission of gonorrhea and chlamydia are sparsely connected.

Background: Urine-based screening for Chlamydia trachomatis using highly sensitive and specific nucleic acid amplification tests offers a unique opportunity to screen men attending school-based health centers., Methods: As part of a large multicenter chlamydia screening project in men, 1434 students were enrolled; 1090 in high schools in Baltimore and 344 middle and high-school students in Denver. Students were screened for chlamydia using urine-based nucleic acid amplification tests at well adolescent visits, acute care visits, or visits for other reasons, such as sports physicals. A self-administered survey to ascertain sexual risk behaviors was used. Data were analyzed separately for Baltimore and Denver, with univariate and multivariate logistic regression analysis., Results: The overall prevalence in asymptomatic adolescent men was 6.8% (7.5% in Baltimore and 4.7% in Denver, P = n.s.). Students in Denver were older, more racially diverse, and more likely to have had intercourse in the previous 2 months than students in Baltimore. Students in Baltimore were more likely than those in Denver to have used a condom at last intercourse with casual and main partners. Among men in Denver but not Baltimore, condom use at last intercourse with both casual (OR 0.15, 95% CI, 0.03, 0.78) and main partners (OR 0.30, 95% CI, 0.10, 0.91) was protective against infection. The only risk factor for CT infection in Baltimore students was age (OR 1.47, 95% CI, 1.23, 1.75). In multivariate analysis that included age (as a continuous variable), race, history of an STI, any sex partner in the last 2 months, >1 sex partner in the past 12 months, a new partner in the last 2 months, and condom use with last main and last casual partner, age (adjusted odds ratio 1.34, 95% CI, 1.11, 1.62) and black race (adjusted odds ratio 2.37, 95% CI, 1.21, 4.63) were the only variables associated with testing chlamydia positive., Conclusions: School-based health centers are important venues in which to perform urine-based screening for chlamydia in sexually active, asymptomatic males, especially in high prevalence communities, and such screening provides the opportunity to identify and treat substantial numbers of chlamydia infections.

Background: Chlamydia trachomatis (Ct) infection, especially repeat infection, is associated with serious sequelae among women, including pelvic inflammatory disease, ectopic pregnancy, and infertility. There are few reports evaluating repeat infection and predictors among men treated for Ct infection., Objective: To measure the predictors and incidence of repeat Ct infection among men., Methods: Men 15 to 35 years of age were screened for Ct infection in different venues in Baltimore, Denver, and San Francisco using urine-based nucleic acid amplification tests. Men with Ct infection were evaluated for repeat Ct infection from February 2001 until September 2003. Enrolled men had a baseline, 1-month, and 4-month follow-up visit and were tested for Ct infection at each visit. Project staff sought to locate and notify all female sex partners of infected men during the study to provide testing and treatment. We evaluated predictors of repeat Ct infection, time to infection, and incidence of infection., Results: Three hundred fifty-nine men were recruited into the study and 272 (76%) had at least 1 follow-up visit with Ct results. Repeat infection occurred in 13% of men with Ct infection; there was no significant difference in repeat infection by site (Denver 13%, Baltimore 13%, San Francisco 12%). Independent predictors of repeat infection were history of an STD and venue. Incidence of repeat infection was 45.4 infections per 100 person years., Conclusion: Repeat Ct infection is common among men and similar in geographically distinct cities. Incidence of repeat Ct infection support routine rescreening of men within the first 3 months after Ct infection.

Background: We examined 2 potentially important factors influencing successful treatment of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) infections identified in an emergency department (ED), health care coverage and reporting the ED as a primary source for health care., Methods: Adult patients aged 18 to 35 years attending an urban ED were screened for Ct and GC. Patients testing positive were contacted by Disease Intervention Specialists and notified of their infection status. Analyses focus on infected patients for whom we have treatment and follow-up information. We used generalized linear models with log link and binomial error distribution to estimate risk ratios (RRs) and 95% confidence intervals (CI)., Results: Of 5537 patients screened in the ED, 348 (6.3%) tested positive for Ct, 143 (2.6%) tested positive for GC, and 43 (0.8%) tested positive for both. Overall, 20% of infected patients did not receive treatment. Among infected patients with no health care coverage 25% (n = 56) were untreated compared with 15% (n = 47) of patients reporting health care coverage (RR: 1.7, 95% CI: 1.2-2.3). Among patients reporting the ED as a primary source for health care 26% (n = 27) were untreated compared with the 18% (n = 77) reporting receiving health care from non-ED sources (RR: 1.4, 95% CI: 1.0-2.1)., Conclusions: EDs often serve as primary care sites for difficult-to-reach populations. We were able to successfully locate and treat the greater part of ED-identified infections. However, one-fifth of infected patients did not receive treatment. ED-based screening programs can benefit from integration with local public health infrastructure to improve notification and treatment services.

Background: Syphilis incidence has been rising in the United States since 2000. Shifts in syphilis epidemic phases may be associated with changes between or within high-risk populations., Objectives/goal: To determine whether shifts in syphilis epidemic phases are associated with changes between or within high-risk populations., Study Design: Using surveillance data collected from Baltimore, MD, 1994-2004, we retrospectively defined epidemic phases and compared epidemiologic profiles of syphilis cases infected during epidemic phase., Results: We defined 3 epidemic phases. The shift between hyperendemic and decline phases was not associated with demographic or behavioral changes among persons with syphilis. Compared to the decline phase, men infected with syphilis during the growth phase were 5 times [odds ratio (OR) 5.32 P <0.001] more likely to report having had sex with men (MSM) or women. Men and women infected during the growth phase were less likely to be >25 years of age (men: OR 0.60, P <0.001; women: OR 0.60, P <0.001), and more likely to be non-African American (men: OR 6.21 P <0.001; women: OR 7.76, P <0.001). Demographic trends persisted when we restricted the analysis to MSM and then restricted to young (age < or =25 years), non-IDU (injecting drug-using) women. Additionally, young, non-IDU women infected in the growth phase were significantly more likely to report > or =5 recent sex partners (OR 4.30, P <0.01) than those in the decline phase., Conclusions: We verified that the shift from a decline to growth phase in Baltimore was mostly because of increases in morbidity among non-African American MSM and young, non-IDU women with > or =5 recent sex workers. Although syphilis control activities have been targeted towards these groups, our analysis underscores the need for real-time investigation of potential tipping points to ensure interventions are properly focused at the beginning of any potential growth phase.

Objective: The objective of this study was to describe acceptability of urine chlamydia testing among asymptomatic men and providers' attitudes toward testing., Study Design: Asymptomatic men (no urethral discharge/dysuria) were offered free testing and characteristics of men who accepted were compared with those who declined. Acceptability logs tallied the proportion who accepted, and a standardized survey was administered to providers at study's end., Results: Median acceptance was 64% (range, 8-100%). Men accepting were younger and more likely to be in adolescent primary care or detention, to report higher numbers of recent partners, no prior sexually transmitted disease, time to last healthcare visit >1 year, and to have received an incentive. Provider-reported barriers to testing included difficulty in conveying importance of testing to asymptomatic men (65%) and time constraints (24%)., Conclusions: Asymptomatic men are likely to accept testing depending on venue and approach. However, barriers exist for men and providers, even when testing is free.

Introduction: Little is known regarding whether partner characteristics explain sex differences in sexually transmitted infection (STI) rates in nonclinic-based, school-aged African American youth., Materials and Methods: A random digit dial household sample of 14- to 19-year-old youth in San Francisco reported the total number, age, race, and perceived history of incarceration, gang membership, and level of sexual activity of their partners. Youth were tested for gonorrhea and chlamydia., Results: Female participants were more likely than male participants to have a partner who was older or had been incarcerated and less likely to have a non-African American partner. Controlling for partner number, female's odds ratio (OR) for having an STI was 1.39 (95% confidence interval [CI] = 0.98-1.98; P = 0.07). Controlling for partner incarceration and number of partners, the borderline sex difference was eliminated (OR = 1.07; 95% CI = 0.70-1.63)., Conclusion: Sex differences in STI rates among African American adolescents may be determined more by the risk of the partner than the risk of the individual.

Background: Sexual partnerships between people at higher and lower risk for sexually transmitted infections (STIs) (i.e., bridging) occur through dissortative mixing and concurrent partnerships, yet the relative effects of these network patterns on population STI spread are poorly understood., Goal: Using a stochastic model, the authors investigated the impact of mixing and concurrency on the spread of a persistent viral STI., Study Design: A total of 1,050 populations were simulated of 1,000 subjects over 400 weeks with varied concurrency levels and mixing patterns. STI prevalence and the average number of secondary transmissions per subject were analyzed with regression., Results: Mixing had a greater impact on prevalence for all groups, whereas concurrency was significant for only the lowest activity group. Mixing patterns moderated the magnitude of concurrency's impact on secondary transmissions., Conclusions: Through connecting subgroups of differential risk, sexual mixing facilitates dissemination of STIs throughout a population. Concurrency expedites transmission by shortening the time between sexual contacts among infected and susceptible persons, particularly during the highly infectious period.

Objectives: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle., Methods: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non-sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests., Results: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P=0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P<0.01)., Conclusions: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups.

Goal: The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore, Maryland, and Denver, Colorado., Study: Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participant's social network was associated with repeat infection., Results: There were 47 participants in Baltimore and 92 in Denver. In both cities, there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participant's social network was protective for repeat STI., Conclusion: These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men.

Objective: The objective of this study was to measure the prevalence of Chlamydia trachomatis (CT) infection among men in clinical and nonclinical settings across the United States., Goal: The goal of this study was to obtain data to inform recommendations regarding male CT screening., Study: The authors conducted a cross-sectional study of CT prevalence among adolescent and adult men in 4 U.S. cities (Baltimore, Denver, San Francisco, and Seattle). CT was detected using urine-based testing, and prevalence was calculated for first testing event., Results: Over 23,000 men were tested for CT over a 3 1/2-year period. The majority (96%) were asymptomatic. Overall, prevalence was 7% and varied significantly between cities (range: Seattle, 1%; Baltimore, 12%), by age (peak prevalence at age 20-24 years, 9%), and between venues where CT testing was offered., Conclusions: At 7%, the prevalence of CT is moderately high among men opportunistically tested in nonclinical and clinical settings.

Background: Geographic areas characterized by a high prevalence of sexually transmitted infections (STIs) are critical to the maintenance and persistence of STIs within populations. Sex partner concurrency has been shown to be associated with increased risk for individual-level STIs., Objectives: The objectives of this study were to determine whether gonorrhea rate per census block group and sex partner concurrency independently and interactively are associated with a current bacterial STI among adolescents., Study: Face-to-face interviews and urine testing for Chlamydia trachomatis and Neisseria gonorrhoeae were conducted among female, sexually active, 14- to 19-year-olds presenting for reproductive clinic care between August 2000 and June 2002., Results: Gonorrhea rate per census block group and sex partner concurrency were not independently but were interactively associated with a current bacterial STI. Among participants with a main sex partner who practiced concurrency, living in high-prevalence geographic areas was significantly associated with a current bacterial STI., Conclusions: The results suggest that geographic context may moderate an adolescent sex partner's behaviors. The research adds to the basic understanding of sexually transmitted disease transmission and acquisition in a high-prevalence inner-city setting.

Objectives: The objective of this study was to determine whether the syphilis epidemic in Baltimore City during the mid-1990s was associated with changes in sexual networks., Methods: Data on index cases of syphilis and their partners were collected from 1996 to 2000 and entered into CDC STD*MIS software. Unique pairs of dyads were used to create networks using SAS Interactive Matrix Language. PAJEK and UCINET were used to analyze the largest component from all years (1996-2000), during the epidemic (1997-1998), and after the epidemic (1999-2000)., Results: Between 1996 and 2000, there were 3343 components containing 18,709 nodes. The 2 largest components were comprised of 1103 nodes and 125 nodes, respectively. From the period during the epidemic to after the epidemic, the average distance among reachable pairs, network centralization, number of n-cliques (n = 2, size = 3), and number of k-plexes (k = 2, n = 3) declined, whereas the block densities increased., Conclusions: Important differences exist between the sexual networks during and after the syphilis epidemic.

Background and Objectives: Adolescent females are frequently treated as a homogenous group but could differ on their sexually transmitted disease (STD) risk because of individual attitudes and exposure through sexual networks., Goal: The goal of this study was to determine if risk perceptions, condom use, and STD prevalence differs within sexual networks., Study Design: Three hundred three adolescent females participating in a longitudinal study of adolescent STD risk perceptions and condom use were categorized as "core," "bridge," and "periphery" in a sexual network according to their and their main sex partner's risk information. Regression analysis determined differences in risk perceptions by network location., Results: We demonstrated an inverse relationship between STD risk perceptions and network location. Adolescents with higher risk perceptions were more likely to use condoms, irrespective of network location., Conclusion: Female adolescents are a heterogeneous group exhibiting different risk perceptions. Different intervention strategies for adolescents at higher risk could be necessary. Interventions designed to raise risk perceptions could be associated with condom use, even for those adolescents at greatest risk.

Background: Traditional syphilis control tools could be limited in high-risk groups in which the disease is concentrated. Novel programmatic methods such as tracking and targeting sex partner meeting venues could be valuable., Goal: The goals of this study were to determine if syphilis cases' sex partner meeting venues are geographically different than their residences and to determine the characteristics of identified meeting places., Results: For cases diagnosed from September 2001 to December 2002 with geocodable data, only 9% of meetings took place in the same census block group as residence, and mean and median distance from residence to meeting place was 1.73 and 1.03 miles. The most common meeting location type overall was a street or corner, but differed by risk behaviors., Conclusion: Baltimore syphilis cases in general met sex partners outside their immediate neighborhoods. Meeting locations could provide new targets for syphilis control interventions.

Background: Although physical attributes have been shown to be associated with sexually transmitted disease (SD) rates, there is little information about the association between social attributes and STD rates., Goal: The objective of this study was to determine the association between gonorrhea prevalence and perceptions of social cohesion in impoverished, urban neighborhoods., Study Design: We conducted a street-based survey of 18- to 24-year-olds residing in selected census block groups in Baltimore City, Maryland. Census block groups eligible for selection were defined as impoverished (greater than 20% in poverty) and unstable (lowest 25th percentile for stability). From the eligible census block groups, 5 from high gonorrhea rate (greater than the 75th percentile) census block groups and 5 from the lower gonorrhea rate (lowest 25th percentile to equal or greater than the 75th percentile) census block groups were randomly selected. Participants within the 10 selected census block groups were recruited using a street-intercept method. Participants were asked about perceived social cohesion and control., Results: Results showed that for young adults 18 to 24 years of age residing in high gonorrhea census block groups, the mean social cohesion index scores were 1.7 points lower than mean social cohesion index scores of the participants residing in the low gonorrhea census block groups (P <0.01)., Conclusion: Future research needs to be conducted to determine the temporal association between gonorrhea prevalence and local social cohesion dynamics.

Background: Latino youth suffer disproportionately from unintended pregnancy and sexually transmitted infections (STIs), but studies of the social context of their sexual behaviors are lacking., Goal: Our qualitative assessment of recruitment venues in a Latino neighborhood had 3 objectives: to identify venues where youth at risk of unintended pregnancy and STIs could be found; to describe different youth "crowds"; and to investigate how and where youth meet their sex partners., Study Design: We conducted ethnographic interviews with 62 youth recruited primarily from street sites. Mapping of venues was conducted with Map-Info., Results: Youth crowds included the Regulars, gang-related crowds, street-economy affiliated crowds, and female crowds. Maps demonstrated the dominance of the venues in the Mission by gang members. Street sites are important venues for meeting sexual partners., Conclusion: The qualitative assessment produced insights and hypotheses that can contribute to the planning of research, outreach, testing, and interventions with Latino youth.

Background: Effective syphilis control and elimination require community effort and innovative case-finding techniques, especially to identify infected persons from core transmission groups., Goal: To summarize the implementation and outcomes of a community-oriented response to a localized outbreak of syphilis directed at sex partner meeting places., Study Design: Syphilis surveillance and rapid response data from a 7-month period were analyzed for risk behaviors, sex partner meeting locations, field investigation outcomes, and social and sexual network connections., Results: Four (6%) of the sixty-nine persons tested were confirmed syphilis reactors, of whom three were new cases. A sexual and needle-sharing network of 15 persons was identified that included two of the new syphilis cases. These two had not been found through standard field investigation., Conclusions: Targeting interventions to sex partner meeting places may effectively complement traditional syphilis control tools and find previously unidentified syphilis cases in high-morbidity areas.

Background: In sexual networks, bridge members engaging in discordant partnering play key roles in maintaining and transmitting sexually transmitted infections (STIs) within a population., Goal: The goal was to characterize adolescents likely to engage in discordant sexual relationships with main and casual sex partners., Study Design: Egocentric data about adolescents and their most recent sex partner(s) collected over 6 months were analyzed with use of logistic regression., Results: History of STI, drug use, and meeting venue were significantly associated with discordant sexual partnering among high-risk adolescents. Participants with histories of high-risk behavior, e.g., hard drug use or STI, were more likely to have had a recent, dissimilar partner than those with lower-risk profiles. Particular meeting venues, such as clubs and street locations, were more likely to be associated with age-discordant, race-discordant, and drug use-discordant partnerships for females., Conclusion: Bridge members of adolescent sexual networks were more likely to have a history of STI, hard drug use, or meeting their sex partner through particular venues.

Background: The authors' previous research has shown that in cross-sectional analysis, partner-specific perceptions of risk for gonorrhea and chlamydial and HIV infection correlated with partner-specific intentions to use condoms., Goal: The goal was to determine whether partner-specific measures of perception of risk for STDs (PRSTD) predict partner-specific condom use 6 months later among high-risk and low-risk youth., Study Design: Youths aged 14 to 19 years were recruited from an STD clinic (n = 236) and an HMO teen clinic (n = 306) and were interviewed at baseline and at 6 months about PRSTD, attitudes about condoms, self-efficacy, normative expectations, and condom use., Results: PRSTD with a main sex partner was an independent predictor of condom use with a main sex partner in the STD clinic cohort (odds ratio = 2.5; 95% CI = 1.1-6.2). There was no association between PRSTD with a casual sex partner and condom use in this cohort or between PRSTD for main or casual sex partners and condom use in the HMO teen clinic cohort., Conclusion: Interventions that target high-risk adolescents should focus on PRSTD with a main sex partner.