Sexually transmitted disease clinic clients at risk for subsequent gonorrhea and chlamydia infections - Possible 'core' transmitters

Background: From an sexually transmitted disease (STD) intervention perspec tive, developing a practical way to identify persons in core transmitter gr oups has been difficult. However, persons who have repeated STD infections may be in such groups. Goal: To evaluate a self-administered risk assessment approach that would i dentify STD clinic clients who were at an increased risk of being involved in gonorrhea (GC) or chlamydia (CT) transmission in the subsequent year. Study Design: Prospective cohort of consecutive STD clinic clients with a 1 -year follow-up period. Results: During a 6-month period in 1995, 2576 STD clinic clients in San Di ego completed a risk assessment. Of those clients, 204 (7.9%) had a subsequ ent STD and 79 (3.1%) had a subsequent GC or CT infection during the 1-year follow-up period. The strongest predictor of a subsequent GC/CT was having a recent history or current clinic visit diagnosis of GC or CT (6.1% subse quent GC/CT rate). The more past episodes of GC or CT, the higher the subse quent GC/CT rate. Unsafe sexual behavior had little effect on further incre asing subsequent GC/CT risk. Conclusion: STD clinic clients,vith a recent history of GC or CT and a high risk of subsequent GC/CT mag be core transmitters who could likely benefit from risk reduction, periodic screening for GC/CT, symptom recognition cou nseling, and preventive treatment-the essential elements of STD-prevention case management.