title: Characteristics of those who repeatedly acquire sexually transmitted infections: a retrospective cohort study of attendees at three urban sexually transmitted disease clinics in England.
abstract: BACKGROUND
  Individuals who repeatedly acquire sexually transmitted infections (STIs) may facilitate the persistence of disease at endemic levels. Identifying those most likely to become reinfected with an STI would help in the development of targeted interventions.
  
  
  OBJECTIVE
  To investigate the demographic and behavior characteristics of sexually transmitted disease (STD) clinic patients most likely to reattend with an STI.
  
  
  METHODS
  The proportion of patients attending three STD clinics in England 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 reattendance with an acute STI and patient characteristics.
  
  
  RESULTS
  Of the 17,466 patients presenting at an STD clinic with an acute STI, 14% reattended for treatment of an STI within 1 year. Important determinants 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 whites) 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 with 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, compared with those with one partner) reattended for treatment of an acute STI within 1 year.
  
  
  CONCLUSIONS
  In this STD clinic population, teenage females, homosexual men, black Caribbean attendees, individuals with a history of STI, and those reporting high rates of sexual partner change repeatedly re-presented with acute STIs. Directing enhanced STD clinic-based interventions at these groups may be an effective strategy for STI control.
authors.affiliation: Public Health Laboratory Service, Communicable Disease Surveillance Centre, London; the MRC Clinical Trials Unit, London, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Hughes
authors.forename: A R
authors.initials: AR
authors.lastname: Brady
authors.forename: M A
authors.initials: MA
authors.lastname: Catchpole
authors.forename: K A
authors.initials: KA
authors.lastname: Fenton
authors.forename: P A
authors.initials: PA
authors.lastname: Rogers
authors.forename: G R
authors.initials: GR
authors.lastname: Kinghorn
authors.forename: D E
authors.initials: DE
authors.lastname: Mercey
authors.forename: R N
authors.initials: RN
authors.lastname: Thin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D016016:Proportional Hazards Models; D044469:Racial Groups; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D017678:Sex Distribution; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D016019:Survival Analysis; D014504:Urban Health / Q000706:statistics & numerical data*