title: Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed gonorrhea cases in a local health region from Saskatchewan, Canada.
abstract: OBJECTIVE
  We aimed to identify demographic and behavioural determinants associated with risk of repeat STI infection and coinfection with gonorrhea and chlamydia in the Regina Qu'Appelle Health Region, Saskatchewan.
  
  
  METHODS
  We extracted data from a cross-sectional sample of laboratory confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. Risk factors for repeater status were examined using logistic regression and for coinfection with gonorrhea and chlamydia using mixed-effects logistic regression to account for multiple diagnoses for individual clients.
  
  
  RESULTS
  Data from 1,143 cases (representing 1,027 unique individuals) and 1,524 reported contacts (representing 1,383 unique individuals) were extracted from the 10-year period. Factors associated with repeat infection entries in the database included younger age at first visit (p = 0.01), coinfection (p = 0.01), and sex trade involvement (p &lt; 0.01). Factors associated with coinfection at the time of diagnosis included younger age at diagnosis (p &lt; 0.001) and reported alcohol or drug abuse (p = 0.04).
  
  
  CONCLUSIONS
  In one of the first epidemiologic studies on gonorrhea in Saskatchewan, we have identified age, engagement in the sex trade, and drug and alcohol abuse as potential markers to identify clients with a high risk of reinfection and coinfection in the Regina Qu'Appelle Health Region. This information can help health care professionals in Saskatchewan's urban centres personalize their approach to counselling and treatment to optimize patient outcomes and disease control efforts, including potentially using expedited partner therapy and/or dual therapy where indicated.
authors.affiliation: University of Saskatchewan. molly.trecker@usask.ca.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Trecker
authors.forename: Jo-Anne R
authors.initials: JA
authors.lastname: Dillon
authors.forename: Kathy
authors.initials: K
authors.lastname: Lloyd
authors.forename: Maurice
authors.initials: M
authors.lastname: Hennink
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Waldner
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000437:Alcoholism / Q000453:epidemiology; D002648:Child; D002690:Chlamydia Infections / Q000453:epidemiology*; D060085:Coinfection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012309:Risk-Taking; D012525:Saskatchewan; D011477:Sex Work / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
keywords: Gonorrhea; chlamydia; coinfection; risk factors; sexually transmitted diseases