EPIDEMIOLOGY OF GONOCOCCAL AND CHLAMYDIAL INFECTIONS IN HARROW AND BRENT

Objective: To describe the epidemiology and associated clinical featur es of gonorrhoea and chlamydial infection and to develop a profile of sexually transmitted diseases (STDs) in an outer London health distric t. Design: Hospital-based retrospective study Setting: Genitourinary m edicine clinic, Northwick Park Hospital, Harrow and Brent Health Autho rity Subjects: 70 male and female individuals with gonorrhoea and 129 with chlamydial infection, diagnosed consecutively over 28 months in 1 992-94. Results: More men than women had gonorrhoea (43 versus 27) but more women than men had chlamydial infection (84 versus 45), p < 0.00 1. There was a clear tendency for cases with either infection to locat e along major road and rail transport routes. Foci of gonococcal infec tion were concentrated mainly in the densely populated areas, whereas chlamydial cases were more evenly spread. There was no significant eff ect of gender or type of STD on the odds ratio for residence in Harrow , single marital status or attendance for test of cure. However, the o dds ratios for women having sexual intercourse with a regular partner only or previous STD were 5 (95% CI 2.4 to 10.2), p < 0.001 and 0.3 (9 5% CI 0.18 to 0.69), p = 0.002 times the odds for men, respectively. T he odds ratios for patients with gonococcal infection being employed o r having sex with a regular partner only were 0.5 (95% CI 0.27 to 0.98 ), p = 0.04 and 0.30 (95% CI 0.15 to 0.60), p < 0.001 times the odds f or patients with chlamydial infection, respectively. Of the women with gonorrhoea and previous pregnancy, 68% gave a history of abortion com pared with 44% of those with chlamydial infection (p = 0.03). Conclusi on: The identification of foci of gonococcal and chlamydial infection and apparent location of these infections along the major transport ro utes in our health district require further study. That chlamydial inf ection, unlike gonorrhoea, is evenly distributed irrespective of popul ation concentration and deprivation, suggests urgent need for a compre hensive local effort to control both STDs.