Repeat infection with gonorrhoea in Sheffield, UK: predictable and preventable?
- 1Department of HIV and STIs, Health Protection Agency, London, UK
- 2Department of Statistics, Modelling and Economics, Health Protection Agency, London, UK
- 3Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK
- Correspondence to Dr Gwenda Hughes, Department of HIV and STIs, Health Protection Services Colindale, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK;
Contributors GH conceived the study and wrote the first draft of the manuscript. GK set up the sentinel surveillance scheme and along with GB discussed ideas and contributed to manuscript development. TN, LP and GL undertook all data preparation and statistical analyses and commented on the manuscript.
- Accepted 14 May 2012
- Published Online First 20 June 2012
Background Repeat infection with gonorrhoea may contribute significantly to infection persistence and health service workload. The authors investigated whether repeat infection is associated with particular subgroups who may benefit from tailored interventions.
Methods Data on gonorrhoea diagnoses between 2004 and 2008 were obtained from Sheffield sexually transmitted infection clinic. Kaplan–Meier survival curves were used to estimate the percentage of patients with repeat diagnoses within a year, and a Cox proportional hazard model was used to investigate associated risk factors.
Results Of 1650 patients diagnosed with gonorrhoea, 7.7% (95% CI 6.5% to 9.1%) had a repeat diagnosis within 1 year. Men who have sex with men under 30, teenage heterosexuals, black Caribbeans, people living in deprived areas and those diagnosed in 2004 were most likely to re-present. Of those patients (53%) providing additional behavioural data, repeat diagnosis was more common in those reporting prior history of gonorrhoea, any previous sexually transmitted infection diagnoses, two or more partners in the past 3 months and a high-risk partner in the past year. In an adjusted analysis, repeat diagnosis was independently associated with being a young man who has sex with men, living in a deprived area, a history of gonorrhoea and being diagnosed in 2004 but was most strongly associated with non-completion of behavioural data forms.
Conclusions Groups most at risk of repeat infection with gonorrhoea are highly predictable but are disinclined to provide detailed information on their sexual behaviour. Care pathways including targeted and intensive one-to-one risk reduction counselling, effective partner notification and offers of re-testing could deliver considerable public health benefit.
- sexual behaviour
- epidemiology (general)
- Chlamydia trachomatis
- antimicrobial resistance
- chlamydia infection
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.