Prevalence, incidence, and correlates of chlamydia and gonorrhea among young adult injection drug users

doi:10.1016/S0899-3289(01)00071-2

Journal of Substance Abuse

Volume 13, Issues 1–2, September 2001, Pages 73-88

https://doi.org/10.1016/S0899-3289(01)00071-2 Get rights and content

Abstract

Purpose: To measure prevalence, incidence, and correlates of chlamydia and gonorrhea among injection drug users (IDUs). Methods: Participants (n=2129; 63% male, 52% white, ages 18–30 years) in five US cities were tested for chlamydia and gonorrhea by urine LCR assay and completed a standardized questionnaire about demographics and recent sexual behavior. Logistic regression identified correlates of prevalent infection; incidence rates were calculated from 6-month follow-up data. Results: Chlamydia prevalence was 5.2% and did not differ by gender. Gonorrhea prevalence was 0.2% among men and 2.0% among women, P<.001. Among men, younger age [OR (95% CI): 0.89 (0.83–0.96)], age at sexual debut [0.91 (0.83–0.99)], and African American race [2.92 (1.53–5.59)] were associated with chlamydia. Among women, age at sexual debut [1.16 (1.02–1.31)] and commercial sex [1.96 (1.03–3.74)] were associated with chlamydia, and with gonorrhea [1.27 (1.04–1.56)] and [5.17 (1.66–16.11)], respectively. At 6 months, the cumulative incidence of chlamydia was 1.7% among men and 4.4% among women, P=.03; no men and 1.3% of women tested positive for gonorrhea, P=.01. Implications: Prevalence and correlates of chlamydia and gonorrhea were similar to other samples, suggesting that screening criteria need not be modified for IDU populations. The number of behavioral correlates identified was limited; perhaps unmeasured sexual-network-level factors play a role in determining sexually transmitted disease (STD) prevalence.

Introduction

While sexually transmitted disease (STD) rates in the US have been in serial decline for the past several decades, rates of both chlamydia and gonorrhea have increased in recent years (Centers for Disease Control and Prevention (CDC), 1999). Understanding the epidemiology of these two treatable infections, especially among younger persons where disease burden is high, is important since together they account for over 95% of all STD morbidity in the US (CDC, 1999). Since the beginning of the acquired immune deficiency syndrome (AIDS) epidemic, injection drug users (IDUs) have dramatically reduced their drug-related risk behaviors but continue to practice sexual behaviors that place them at high risk for STD Battjes et al., 1995, Dinwiddie, 1997, Doherty et al., 2000, Donoghoe, 1992, Kim et al., 1993, Semaan et al., 1998. IDUs may be at particularly high risk of STD, but data on the prevalence of STD in this population are sparse. Earlier papers have examined self-reported STD among IDUs but more recently, urine-based tests for STD have become available, and results from such testing are now being reported Hwang et al., 2000, Poulin et al., 1999. Urine testing is more sensitive than self-report. It can also detect asymptomatic infection, and overcome concern for socially desirable responding. In the current study, we report on the prevalence, incidence, and correlates of chlamydia and gonorrhea detected by urine assay in a sample of young, adult IDUs recruited from five cities in the US.

Section snippets

Design

These data derive from the second Collaborative Injection Drug Users Study (CIDUS-II), a CDC-funded prospective study of IDUs in which a common protocol was implemented at six sites in the following five US cities: Baltimore, Chicago, Los Angeles, New Orleans, and New York City. In New York City, separate research teams recruited participants from the two distinct Manhattan neighborhoods of Central/East Harlem and the Lower East Side. The design was a prospective cohort study, with follow-up at

Results

A total of 2198 eligible participants completed the baseline interview. Of these, 2129 (1341 men and 788 women) provided urine samples (97% of those interviewed) and comprise the sample reported on here. Compared to the analyzed sample, the 69 participants without urinalysis were similar with respect to age, race, gender, age at sexual debut, and the proportion engaging in commercial sex. However, they were less likely to have a history of being forced to have sex (P=.04). Baseline

Discussion

The major finding of our study was moderate prevalence of chlamydia and gonorrhea despite high levels of sexual risk behaviors reported by this sample. For example, half of the sample reported more than two opposite-gender sex partners in the six months prior to testing, and less than one fifth reported consistent condom use. Thus, while prevalence rates in this study were similar to rates observed in other samples reporting risky sexual behavior, it is reasonable to have expected even higher

Acknowledgements

The CIDUS-II group is comprised of the following investigators: Baltimore: Crystal Fuller, Steffanie Strathdee, David Vlahov at Johns Hopkins University; Chicago: Susan Bailey, Steve Diaz, Lawrence Ouellet, Lorna Thorpe at the University of Illinois at Chicago; Los Angeles: Peter Kerndt, Javier Lopez-Zatina, David Norton, Terry Woehlre at Los Angeles Department of Health Services; New Orleans: Edward Morse at Tulane University and Patricia Morse at Louisiana State Medical Center; New York

References (33)

A. Andersson-Ellstrom et al.
Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls
Acta Obstetricia et Gynecologica Scandinavica
(1996)
R.J. Battjes et al.
HIV infection and AIDS risk behaviors among injecting drug users entering methadone treatment: an update
Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology
(1995)
S.K. Brodine et al.
Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for chlamydia and gonorrhea screening
Journal of Infectious Diseases
(1998)
R.E. Bunnell et al.
High prevalence and incidence of sexually transmitted disease in urban adolescent females despite moderate risk behaviors
Journal of Infectious Diseases
(1999)
K.C. Carroll et al.
Evaluation of the Abbott LCx ligase chain reaction assay for detection of Chlamydia trachomatis and Neisseria gonorrheoeae in urine and genital swab specimens from a sexually transmitted disease clinic population
Journal of Clinical Microbiology
(1998)
Centers for Disease Control and Prevention (CDC), Division of STD Prevention (1999, September). Sexually transmitted...
M.A. Chernesky et al.
Ability of commercial ligase chain reaction and PCR assays to diagnose Chlamydia trachomatis infections in men by testing first-void urine
Journal of Clinical Microbiology
(1997)
M.A. Chernesky et al.
Diagnosis of Chlamydia trachomatis infections in men and women by testing first-void urine by ligase chain reaction
Journal of Clinical Microbiology
(1994)
J.M. Craig et al.
Semen donors and STD screening
Genitourinary Medicine
(1997)
Diaz, T., Vlahov, D., Edwards, V., Conover, S., & Monterroso, E. (in press). Sex-specific differences in circumstances...

T. Diaz et al.

Sexual orientation and HIV infection prevalence among young Latino injection drug users in Harlem

Journal of Women's Health

(2001)

S.H. Dinwiddie

Characteristics of injection drug users derived from a large family study of alcoholism

Comprehensive Psychiatry

(1997)

M.C. Doherty et al.

Correlates of HIV infection among young adult short-term injection drug users

AIDS

(2000)

M.C. Donoghoe

Sex, HIV and the injecting drug user

British Journal of Addiction

(1992)

M. Durbin et al.

Factors associated with multiple sex partners among junior high school students

Journal of Adolescent Health

(1993)

K.P. Ericksen et al.

Sex, alcohol and sexually transmitted diseases: a national survey

Family Planning Perspectives

(1994)

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¹: For the Collaborative Injection Drug User Study (CIDUS) Group.

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Prevalence, incidence, and correlates of chlamydia and gonorrhea among young adult injection drug users

Abstract

Introduction

Section snippets

Design

Results

Discussion

Acknowledgements

Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls

Acta Obstetricia et Gynecologica Scandinavica

HIV infection and AIDS risk behaviors among injecting drug users entering methadone treatment: an update

Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology

Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for chlamydia and gonorrhea screening

Journal of Infectious Diseases

High prevalence and incidence of sexually transmitted disease in urban adolescent females despite moderate risk behaviors

Journal of Infectious Diseases

Evaluation of the Abbott LCx ligase chain reaction assay for detection of Chlamydia trachomatis and Neisseria gonorrheoeae in urine and genital swab specimens from a sexually transmitted disease clinic population

Journal of Clinical Microbiology

Ability of commercial ligase chain reaction and PCR assays to diagnose Chlamydia trachomatis infections in men by testing first-void urine

Journal of Clinical Microbiology

Diagnosis of Chlamydia trachomatis infections in men and women by testing first-void urine by ligase chain reaction

Journal of Clinical Microbiology

Semen donors and STD screening

Genitourinary Medicine

Sexual orientation and HIV infection prevalence among young Latino injection drug users in Harlem

Journal of Women's Health

Characteristics of injection drug users derived from a large family study of alcoholism

Comprehensive Psychiatry

Correlates of HIV infection among young adult short-term injection drug users

AIDS

Sex, HIV and the injecting drug user

British Journal of Addiction

Factors associated with multiple sex partners among junior high school students

Journal of Adolescent Health

Sex, alcohol and sexually transmitted diseases: a national survey

Family Planning Perspectives