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Donald P. Orr, MD; Krystal Johnston, MD; Edward Brizendine, MS; Barry Katz, MD; J. Dennis Fortenberry, MD, MS

Arch Pediatr Adolesc Med. 2001;155:947-953.

Objective  To compare the rates of subsequent infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis in a group of high-risk adolescents and young adults.

Methods  At the time of treatment, 444 unmarried teenagers and young adults aged 13 to 25 years were enrolled from an urban sexually transmitted disease clinic and 3 community-based primary care clinics. Subjects were infected with C trachomatis, N gonorrhoeae, or T vaginalis, were diagnosed as having nongonococcal urethritis (in men), or were uninfected sexual contacts with one of these infections. Subjects returned at 1, 3, 5, and 7 months.

Results  The rate of subsequent infection was substantial. Forty percent of men and 53% of women who were uninfected contacts at enrollment were estimated to be infected within 7 months; 60% of men and 73% of women infected at enrollment were estimated to be reinfected. Among women, subjects who were infected at enrollment had a shorter time to subsequent infection (median, 140 days) compared with uninfected contacts (median, 209 days) (P = .04). Among men, findings were similar, but the difference in median time to subsequent infection was not significant (P = .08). Baseline characteristics that predicted shorter time to reinfection were female sex and infection at enrollment. When sexual behaviors in the 2 months preceding each subsequent data collection visit were included in the model, only being female and reporting at least one new interval sexual partner were significant predictors of subsequent sexually transmitted infections.

Conclusions  These data support recent research that has found high rates of subsequent infection among high-risk adolescents and young adults. Contacts of a sexually transmitted infection appear to be at equally high risk for subsequent infection as those with a personal history of infection. Our data suggest that more frequent than annual screening for N gonorrhoeae, C trachomatis, and T vaginalis would be appropriate in at-risk adolescent and young adult populations, including individuals who are uninfected sexual contacts to a sexually transmitted infection.

From the Section of Adolescent Medicine, Department of Pediatrics (Drs Orr, Johnston, and Fortenberry), and Division of Biostatistics, Department of Medicine (Mr Brizendine and Dr Katz), Indiana University School of Medicine, Indianapolis. Dr Johnston is now affiliated with Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo.

Corresponding author and reprints: Donald P. Orr, MD, Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Outpatient Garage, Room 070, 575 N West Dr, Indianapolis, IN 46202 (e-mail: dporr{at}iupui.edu).

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