Repeat Chlamydia trachomatis: Rate and

Predictors among Males

Eileen F. Dunne M.D., M.P.H.

JB Chapin, C Rietmeijer , CK Kent, J Ellen, C Gaydos, N Willard, L Lloyd, N Birkjukow, S Chung, JA Schillinger, LE

Markowitz

Division of STD PreventionCenters for Disease Control and Prevention

AcknowledgmentsBaltimore: Jon Ellen

Charlotte GaydosNancy WillardMichelle Chung

Denver: Kees RietmeijerLaura Lloyd

San Francisco: Charlotte Kent

Nat Birkjukow

CDC: Julie SchillingerLauri MarkowitzMaya SternbergJohanna Chapin

Background

• Chlamydia trachomatis (Ct) infection in females is common and associated with serious sequelae– PID, ectopic pregnancy and infertility

• Ct infection in males– Limited resources to screen – Additional information needed to guide program

activities

Background• Male Chlamydia Screening Project:

– Demonstration project: men ages 15-44 screened for Ct infection

• Baltimore• Denver• San Francisco• Seattle

– Longitudinal Study: men with Ct infection recruited for a study of repeat infection

• Baltimore• Denver• San Francisco

Venue Type Baltimore Denver San Francisco

(N=10) (N=33) (N=11)

Adolescent Primary Care X X X

Adult Primary Care X X

Juvenile Detention X X

Adult Detention X X X

School Clinics X X X

School Health Fairs X

College Clinics X

Community Based Organizations X Drug Treatment X

STD Clinics X X

Street Outreach X X

Objectives

To evaluate:

• Ct prevalence and predictors of infection• Cost-effectiveness of screening for Ct infection• Partner and network characteristics • Rate and predictors of repeat Ct infection

Objectives

• Ct prevalence and predictors of infection• Cost-effectiveness of screening for Ct infection• Partner and network characteristics • Rate and predictors of repeat Ct infection

Longitudinal Study Methods

• Men with Ct infection recruited from various venues in Baltimore, Denver, San Francisco– Study Design

• Baseline Visit– Questionnaire– Partner management

• Follow-up at 1 and 4 months– Screening for Ct using urine NAATs– Questionnaire– Partner management

Longitudinal Study Methods

• Analysis: – Men with at least one follow-up visit– Repeat infection: defined as Ct infection at the

first or second follow-up visit

Longitudinal Study Methods

• Bivariate • Characteristics of men at baseline visit • Characteristics of partners

– Baseline partners– New partners

• Cox Proportional Hazards Model

Longitudinal Study Enrollment

358 men enrolled

272 (76%) study population

98 (36%) 1 follow-up visit

174 (64%) 2 follow-up visits

Time in Study

Median Range

Time to

First Follow-up 33 days 21-215 days

Time in Study 102 days 21-391 days

Partner Management• 272 study population

– 403 partners named• 74 (18%) partners locatable• 65 (16%) partners treated

LocatableTreated

Study PopulationCharacteristic N (%)Age (yrs) 15-17 18-19 20-24 >24

51 (19)63 (23)96 (35)61 (23)

Race/Ethnicity White Hispanic Black Other

49 (18)77 (29)108 (40)37 (13)

City Baltimore Denver San Francisco

58 (21)138 (51)75 (28)

Repeat Infection

• Overall: 31 (11%) men had repeat Ct infection– 3 men ≥ 1 repeat infection

Repeat Infection by City

City N Repeat Infection n (%)

Baltimore 58 7 (12)Denver 138 16 (12)

San Francisco 75 8 (11)

Repeat Infection by City/Venue

City/Venue N Repeat Infection n (%)

Baltimore/Adolescent Clinics 18 5 (28)

Baltimore/School Clinics 40 2 (5)

Denver/Adolescent Clinics 32 9 (28)

Denver/STD Clinic 67 5 (7)

San Francisco/STD Clinic 57 7 (12)

Repeat Infection by Age

Variable N Repeat infectionn (%)

p value

Age (yrs) 15-17 18-19 20-24 >24

51639661

9 (18)6 (10)10 (10)6 (10)

.22

Repeat Infection by Partner

Partner Characteristic N Repeat infectionn (%)

# Partners last 2 months 0 1-2 ≥3

1221045

027 (13)28 (9)

New Partner during study Yes No

111161

16 (14)16 (10)

Repeat Infection by Partner Type

Partners during study N Repeat infectionn (%)

No partnersOnly baseline partnersBaseline and new partnersOnly new partners

5 1551048

015 (10)16 (15)

0

Repeat InfectionSignificant findings

Variable N Repeat infectionn (%)

p value

Education level <HS Some HS College Graduate school

211368915

7 (33)10 (7)11 (9)

2 (13)

.003

History of STD Yes No

67204

13 (19)18 (9)

.01

Income No Yes

97174

16 (16)15 (9)

.05

Cox Proportional Hazards Model

Variable Hazard Ratio (95% CI) p value

Education level <HS more than HS

5.11.0

(2.1, 12.5) <.001

History of STD Yes No

2.41.0

(1.1, 5.4) .03

Income No Yes

1.81.0

(0.8, 3.9) .14

Incidence of Repeat Infection

• Cumulative Incidence: 42.3 per 100 person years– Most infections occurred early

Cumulative Incidence Curve

0 100 200 300 400

0.0

0.2

0.4

0.6

0.8

1.0

0 100 200 300 400

0.0

0.2

0.4

0.6

0.8

1.0

Time (in Days)

Cum

ula

tive Incid

ence

All MalesRe-infected Males only

Conclusions

• Repeat Ct infection among men from diverse geographic locations was 11%

• Partner characteristics were not significantly associated with repeat infection

• History of STD, and less than high school education were associated with repeat Ct infection

Future Directions

• Genotyping • Evaluating partner characteristics and sexual

behaviors during study

Contact

• Eileen F. Dunne (edunne@cdc.gov)– 404-639-6184

AcknowledgmentsBaltimore: Jon Ellen

Charlotte GaydosNancy WillardMichelle Chung

Denver: Kees RietmeijerLaura Lloyd Stewart Thomas

San Francisco: Charlotte Kent

Nat Birkjukow

Seatle Jeanne Marrazzo

CDC: Julie SchillingerLauri MarkowitzMaya SternbergJohanna ChapinJohn PappAngelica Wendt

Survival Curve

0 100 200 300 400

0.0

0.2

0.4

0.6

0.8

1.0

0 100 200 300 400

0.0

0.2

0.4

0.6

0.8

1.0

Time (in Days)

Pro

bability o

f not bein

g rein

fecte

d b

y t

All MalesRe-infected Males only