Background Baltimore City, Maryland, has experienced rates of STDs that are consistently higher than the national average. National surveillance data indicate that in 2000 the rates of gonorrhoea and Chlamydia in Baltimore City were 3.3 and 6.7 times higher than the overall US rate. Among US cities with greater than 200 000 people, Baltimore City ranked among the top four for Chlamydia and gonorrhoea infection rates.
Objective To compare reports of diagnoses of gonorrhoea and Chlamydia among adults residing in Baltimore City to those in other central cities of the US and to assess whether a higher prevalence of sexual and substance use behaviours in Baltimore may account for infection disparity.
Methods We utilised data collected from a cross-sectional probability telephone survey of the USA (N=1,543) and Baltimore City (N=744) adults aged 18–45 years old in 1999–2000. Respondents were asked about a wide range of STI-related risk behaviours and STI history. Bivariate analysis assessed differences in the prevalence of self-reported history of gonorrhoea and chlamydia, substance use, and sexual risk behaviours among residents of Baltimore City and other central cities of the USA Multivariate logistic regression models measured heterogeneity in self-reported history of gonorrhoea and chlamydia by location of residence, substance use and sexual history, adjusting for race and age.
Results Lifetime prevalence of gonorrhoea and chlamydia was 18.2% (95% CI 14.8% to 22.1%) among Baltimore residents and 9.8% (95% CI 7.3% to 13%) among residents of other central cities (p<0.001). In bivariate analysis, Baltimore residents were no more likely to report a history of cocaine or injection drug use than residents of other urban areas (p=0.774). However, Baltimore residents were more likely to report having six or more lifetime sexual partners (49.1% vs 40.7%, Prev. Ratio 1.21 (95% CI 1.2 to 1.24)), multiple partners in the past year (24.3% vs 16.9%, Prev. Ratio 1.4 (95% CI 1.4 to 1.5)), and a history of paid sex (17.8% vs 8.7%, Prev. Ratio 2.0 (95% CI 1.8 to 2.3)).
Conclusion The higher prevalence of sexual risk behaviours among Baltimore adults is likely to accelerate STI transmission and contribute to the higher incidence of STIs in Baltimore.
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