Characteristics of those who repeatedly acquire sexually transmitted infections - A retrospective cohort study of attendees at three urban sexually transmitted disease clinics in England

Background: Individuals who repeatedly acquire sexually transmitted infecti ons (STIs) may facilitate the persistence of disease at endemic levels. Ide ntifying those most likely to become reinfected with an STI would help in t he development of targeted interventions. Goal: To investigate the demographic and behavior characteristics of sexual ly transmitted disease (STD) clinic patients most likely to reattend with a n STI, Study Design: The proportion of patients attending three STD clinics in Eng land between 1994 and 1998 who reattended for treatment of acute STI within 1 year was estimated from Kaplan-Meier failure curves. A Cox proportional hazard model was used to investigate the relation between rate of reattenda nce with an acute STI and patient characteristics. Results: Of the 17,466 patients presenting at an STD clinic with an acute S TI, 14% reattended for treatment of an STI within 1 year. Important determi nants of reinfection were age, sexual orientation, and ethnicity: 20% of 12 - to 15-year-old females (adjusted hazard ratio [HR], 1.90; CI, 1.13-3.18, compared with 20- to 24-year-old females), 22% of homosexual ;men (adjusted HR, 1.30; CI, 1.07-1.58, compared with heterosexual men), and 25% of black Caribbean attendees (adjusted HR, 1.87; CI, 1.63-2.13, compared with white s) reattended for treatment of acute STI within 1 year. In addition, 21% of those with a history of STI (adjusted HR, 1.42; CI, 1.28-1.59, compared wi th those with no history of STI) and 17% of individuals reporting three or more partners in the recent past (adjusted HR, 1.53; CI, 1.34-1.73, compare d with those with one partner) reattended for treatment of an acute STI wit hin 1 year. Conclusions: In this STD clinic population, teenage females, homosexual men , black Caribbean attendees, individuals with a history of STI, and those r eporting high rates of sexual partner change repeatedly re-presented with a cute STIs, Directing enhanced STD clinic-based interventions at these group s may be an effective strategy for STI control.