Longitudinal association of gonorrhea and bacterial vaginosis with repeat chlamydia diagnoses among U.S. Army women: A retrospective cohort analysis
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摘要
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 the2006–2012 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 was8.31 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.
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 the2006–2012 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 was8.31 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.
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 the2006–2012 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 was8.31 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.
引文
1. CDC.Reported cases of sexually transmitted diseases in the rise,some at ala rming rate.Accessed at http://www.cdc.gov/nchhstp/news room/201 5/std-surveillance-report-press-release.html.
2.AFHSC Sexually transmitted infections,active component,U.S.armed forces,2000-2012.MSMR.2013;20:5-10.
3.Hosenfeld CB,Workowski KA,Berman S,Zaidi A,Dyson J,Mosure D,et al.Repeat infection with chlamydia and gonorrhea among females:a systematic review of the literature.Sex Transm Dis.2009;6:478-89.
4.Orr DP,Johnaton K,Brizendine E,Kartz B,Forterenberry JD.Subsequent sexually transmitted infection in urban adolescents and young adults.Arch Pediatr Adolesc Med.2001;155:947-53.
5.Barnett S,Brundage J.Incidence of recurrent diagnoses of chlamydia trachomatis genital infections among male and female soldiers of the US Army.Sex Transm Infect.2001;77:33-6.
6.Hakre S,Oyler RJ,Ferrell KA,Li F,Michael NL,Scott PT,et al.Chlamydia trachomatis infection rates among a cohort of mobile soldiers stationed at Fort Bragg,North Carolina,2005-2010.BMC Public Health.2014;14:1 81.
7.Owings AJ,Clark LL,Rohrbeck P.Incident and recurrent chlamydia trachomatis and Neisseria gonorrhoeae infections,active component, U.S.armed fo rces,201 0-2014.MSMR.2006;23:20-8.
8.Hillis SD,Nakashima A,Marchbanks PA,Addiss DG,Davis JP. Risk factors for recurrent chlamydia trachomatis infections in women.Am J Obstet Gynecol.1994;170:801-6.
9.Rubertone MV, Brundage JF.The defense medical surveillance system and the department of defense serum repository glimpses of the future of public health surveillance.Am J Public Health.2002;92:1900-4.
10.Lee SE,Nauschuetz W,Jordan N,Lindler L,Steece R,Pfau E,et al.Survey of sexually transmitted disease laboratory methods in US Army laborato ries.Sex Transm Dis.201 0;37:44-8.
11.Learner NK,Jordan NN,Pacha LA,Latif NH,Garges EC,Gaydos JC.Survey of sexually transmitted disease laboratory methods in US army laborato ries,2012.Mil Med. 2017;182:1726-32.
12.Morre SA,Sillekens P,Jacobs MV,van Aarle P,de Blok S,van Gemen B,et al. RNA amplification by nucleic acid sequence-based a mplification with an internal standard enables reliable detection of chlamydia trachomatis in cervical scrapings and urine samples.J Clin Microbiol.1996;34:3108-14.
13.CDC.De-duplication guidance for gonorrhea and chlamydia laboratory reports.Retrieved from https://www.cdc.gov/std/laborato ry/de-duplicationguidance-j u ne201 6.pdf.
14.Andersen PK,Gill RD.Cox's regression model for counting processes:a large sample study.Ann Stat.1982;10:1100-20.
15.Moulton LH,Dibley MJ.Multivariate time-to-event modelsfor studies of recurrent childhood diseases.Int J Epidemiol.1997;26:1334-9.
16.Newman LM,Warner, Weinstock HS.Predicting subsequent infections in patients attending sexually transmitted disease clinics.Sex Transm Dis.2006;33:737-42.
17.Peterman TA,Tian LH,Metcalf CA,Satterwhite CL,Malotte CK,DeAugustine N,et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection:a case for rescreening.Ann Intern Med. 2006;145:564-72.
18.Leppaluoto PA.Autopsy of bacterial vaginosis:a physiological entity rather than a contagious disease.Acta Obstet Gynecol Scand.2008;87:578-9.
19.Vallor AC,Antonio MA,Hawes SE,Hillier SL.Factors associated with acquisition of,or persistent colonization by,vaginal lactobacilli:role of hydrogen peroxide production.J Infect Dis.2001;184:1431-6.
20.Verstraelen H,Verhelst R,Vaneechoutte M,Temmerman M.The epidemiology of bacterial vaginosis in relation to sexual behavior.BMC Infect Dis.2010;10:81.
21.Xu F,Schillinger JA,Markowitz LE,Sternberg MR,Aubin MR,St Louis ME.Repeat chlamydia trachomatis infection in women:analysis through a surveillance case registry in Washington state,1993-1998.Am J Epidemiol.2000;152:1164-70.
22.Twisk JW,Smidt N,de Vente W.Applied analysis of recurrent events:a practical overview.J Epidemiol Community Health.2005;59:706-10.
23.Bautista CT,Wurapa E,Sateren WB,Morris SM,Hollingsworth BP,Sanchez JL.Association of bacterial vaginosis with chlamydia and gonorrhea among women in the U.S.Army.Am J Prev Med.2017;52:632-9.
24.Stahlman S,Javanbakht M,Cochran S,Hamilton AB,Shoptaw S,Gorbach PM.Self-reported sexually transmitted infections and sexual risk behaviors in the U.S.military:how sex influences risk.Sex Transm Dis.2014;41:359-64.
25.Gaydos CA,Howell MR,Quinn TC,McKee KT Jr,Gaydos JC.Sustained high prevalence of chla mydia trachomatis infections in female army recruits.Sex Transm Dis.2003;30:539-44.
26.Mmeje O,Wallet S,Kolenic G,Bell J.Impact of expedited partner therapy(EPT)implementation on chlamydia incidence in the USA.Sex Transm Infect.201 7;pii:sextrans-2016-052887.https://doi.org/10.1 136/s extrans-201 6-052887[Epub ahead of print].
27.Stidham RA,Garges EC,Knapp SA.Expedited partner therapy to combat Neisseria gonorrhoeae and chlamydia trachomatis in military populations:can we apply this best practice?Mil Med.2015;180:876-81.
28.Lau CY,Qureshi AK.Azithromycin versus doxycycline for genital chlamydial infections:a meta-analysis of randomized clinical trial. SepxTran fism Dis.2002;29:497-50.
2.AFHSC Sexually transmitted infections,active component,U.S.armed forces,2000-2012.MSMR.2013;20:5-10.
3.Hosenfeld CB,Workowski KA,Berman S,Zaidi A,Dyson J,Mosure D,et al.Repeat infection with chlamydia and gonorrhea among females:a systematic review of the literature.Sex Transm Dis.2009;6:478-89.
4.Orr DP,Johnaton K,Brizendine E,Kartz B,Forterenberry JD.Subsequent sexually transmitted infection in urban adolescents and young adults.Arch Pediatr Adolesc Med.2001;155:947-53.
5.Barnett S,Brundage J.Incidence of recurrent diagnoses of chlamydia trachomatis genital infections among male and female soldiers of the US Army.Sex Transm Infect.2001;77:33-6.
6.Hakre S,Oyler RJ,Ferrell KA,Li F,Michael NL,Scott PT,et al.Chlamydia trachomatis infection rates among a cohort of mobile soldiers stationed at Fort Bragg,North Carolina,2005-2010.BMC Public Health.2014;14:1 81.
7.Owings AJ,Clark LL,Rohrbeck P.Incident and recurrent chlamydia trachomatis and Neisseria gonorrhoeae infections,active component, U.S.armed fo rces,201 0-2014.MSMR.2006;23:20-8.
8.Hillis SD,Nakashima A,Marchbanks PA,Addiss DG,Davis JP. Risk factors for recurrent chlamydia trachomatis infections in women.Am J Obstet Gynecol.1994;170:801-6.
9.Rubertone MV, Brundage JF.The defense medical surveillance system and the department of defense serum repository glimpses of the future of public health surveillance.Am J Public Health.2002;92:1900-4.
10.Lee SE,Nauschuetz W,Jordan N,Lindler L,Steece R,Pfau E,et al.Survey of sexually transmitted disease laboratory methods in US Army laborato ries.Sex Transm Dis.201 0;37:44-8.
11.Learner NK,Jordan NN,Pacha LA,Latif NH,Garges EC,Gaydos JC.Survey of sexually transmitted disease laboratory methods in US army laborato ries,2012.Mil Med. 2017;182:1726-32.
12.Morre SA,Sillekens P,Jacobs MV,van Aarle P,de Blok S,van Gemen B,et al. RNA amplification by nucleic acid sequence-based a mplification with an internal standard enables reliable detection of chlamydia trachomatis in cervical scrapings and urine samples.J Clin Microbiol.1996;34:3108-14.
13.CDC.De-duplication guidance for gonorrhea and chlamydia laboratory reports.Retrieved from https://www.cdc.gov/std/laborato ry/de-duplicationguidance-j u ne201 6.pdf.
14.Andersen PK,Gill RD.Cox's regression model for counting processes:a large sample study.Ann Stat.1982;10:1100-20.
15.Moulton LH,Dibley MJ.Multivariate time-to-event modelsfor studies of recurrent childhood diseases.Int J Epidemiol.1997;26:1334-9.
16.Newman LM,Warner, Weinstock HS.Predicting subsequent infections in patients attending sexually transmitted disease clinics.Sex Transm Dis.2006;33:737-42.
17.Peterman TA,Tian LH,Metcalf CA,Satterwhite CL,Malotte CK,DeAugustine N,et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection:a case for rescreening.Ann Intern Med. 2006;145:564-72.
18.Leppaluoto PA.Autopsy of bacterial vaginosis:a physiological entity rather than a contagious disease.Acta Obstet Gynecol Scand.2008;87:578-9.
19.Vallor AC,Antonio MA,Hawes SE,Hillier SL.Factors associated with acquisition of,or persistent colonization by,vaginal lactobacilli:role of hydrogen peroxide production.J Infect Dis.2001;184:1431-6.
20.Verstraelen H,Verhelst R,Vaneechoutte M,Temmerman M.The epidemiology of bacterial vaginosis in relation to sexual behavior.BMC Infect Dis.2010;10:81.
21.Xu F,Schillinger JA,Markowitz LE,Sternberg MR,Aubin MR,St Louis ME.Repeat chlamydia trachomatis infection in women:analysis through a surveillance case registry in Washington state,1993-1998.Am J Epidemiol.2000;152:1164-70.
22.Twisk JW,Smidt N,de Vente W.Applied analysis of recurrent events:a practical overview.J Epidemiol Community Health.2005;59:706-10.
23.Bautista CT,Wurapa E,Sateren WB,Morris SM,Hollingsworth BP,Sanchez JL.Association of bacterial vaginosis with chlamydia and gonorrhea among women in the U.S.Army.Am J Prev Med.2017;52:632-9.
24.Stahlman S,Javanbakht M,Cochran S,Hamilton AB,Shoptaw S,Gorbach PM.Self-reported sexually transmitted infections and sexual risk behaviors in the U.S.military:how sex influences risk.Sex Transm Dis.2014;41:359-64.
25.Gaydos CA,Howell MR,Quinn TC,McKee KT Jr,Gaydos JC.Sustained high prevalence of chla mydia trachomatis infections in female army recruits.Sex Transm Dis.2003;30:539-44.
26.Mmeje O,Wallet S,Kolenic G,Bell J.Impact of expedited partner therapy(EPT)implementation on chlamydia incidence in the USA.Sex Transm Infect.201 7;pii:sextrans-2016-052887.https://doi.org/10.1 136/s extrans-201 6-052887[Epub ahead of print].
27.Stidham RA,Garges EC,Knapp SA.Expedited partner therapy to combat Neisseria gonorrhoeae and chlamydia trachomatis in military populations:can we apply this best practice?Mil Med.2015;180:876-81.
28.Lau CY,Qureshi AK.Azithromycin versus doxycycline for genital chlamydial infections:a meta-analysis of randomized clinical trial. SepxTran fism Dis.2002;29:497-50.
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