Influence of Study Population on the Identification of Risk Factors for Sexually Transmitted Diseases using a Case-Control Design: The Example of Gonorrhea

Manhart, Lisa E.; Aral, Sevgi O.; Holmes, King K.; Critchlow, Cathy W.; Hughes, James P.; Whittington, William L. H.; Foxman, Betsy
August 2004
American Journal of Epidemiology;Aug2004, Vol. 160 Issue 4, p393
Academic Journal
The population prevalence of many sexually transmitted diseases (STDs) is low. Thus, most epidemiologic studies of STDs are conducted among STD clinic populations to maximize efficiency. However, STD clinic patients have unique sociobehavioral characteristics. To examine the potential effect of study population on identification of risk factors, the authors compared 1) STD clinic patients with a random digit dialing telephone sample, 2) general population cases with random digit dialing controls, and 3) STD clinic cases with STD clinic controls (Seattle, Washington, 1992–1995). Risk factors for gonorrhea identified among STD clinic patients formed a subset of those identified in the general population. In both populations, risk decreased with age (odds ratio for the general population (ORGP) = 0.4, 95% confidence interval (CI): 0.22, 0.59; odds ratio for the clinic population (ORclinic) = 0.5, 95% CI: 0.30, 0.81) and was increased among Blacks (ORGP = 15.5, 95% CI: 4.93, 49.0; ORclinic = 10.5, 95% CI: 4.51, 24.68) and persons whose partner had been jailed (ORGP = 5.4, 95% CI: 2.07, 13.9; ORclinic = 3.1, 95% CI: 1.32, 7.30). Additional factors associated with gonorrhea in the general population included secondary education (OR = 0.3, 95% CI: 0.11, 0.70), anal intercourse (OR = 10.5, 95% CI: 2.01, 54.7, STD history (OR = 5.9, 95% CI: 1.76, 19.5), meeting partners in structured settings (OR = 0.2, 95% CI: 0.09, 0.50), no condom use (OR = 3.2, 95% CI: 1.30, 7.89), and divorce (OR = 3.6, 95% CI: 1.07, 11.9). Risk factors identified in STD clinics will probably be confirmed in a general population sample, despite overcontrolling for shared behaviors; however, factors associated with both disease and STD clinic attendance may be missed.


Related Articles

  • Sexually transmitted infections in adolescents: Maximizing opportunities for optimal care. Allen, Upton D.; MacDonald, Noni E. // Paediatrics & Child Health (1205-7088);Oct2014, Vol. 19 Issue 8, p429 

    Sexually transmitted infections are a growing public health concern in Canada, with rates of Chlamydia trachomatis infection, gonorrhea and syphilis increasing among adolescents and young adults. The present practice point outlines epidemiology, risk factors, laboratory testing and management...

  • Gonorrhoea or chlamydia in a US military HIV-positive cohort. Spaulding, Alicen B.; Lifson, Alan R.; Iverson, Erik R.; Ganesan, Anuradha; Landrum, Michael L.; Weintrob, Amy C.; Agan, Brian K.; Bavaro, Mary F.; O'Connell, Robert J.; Macalino, Grace E. // Sexually Transmitted Infections;Jun2012, Vol. 88 Issue 4, p266 

    Objectives To investigate the epidemiology and risk factors of gonorrhoea (GC) or chlamydia (CT) coinfection in an HIV-positive US military cohort, focusing on the time after participants' knowledge of HIV diagnosis. Methods The authors analysed data from 4461 participants enrolled in the US...

  • Penile implant as a risk factor for sexually acquired gonococcal and chlamydial urethritis in the elderly. Morgan, D. John; Wall, Robert; Richardson, Phillip; Colbeck, Roger; Kapembwa, Moses; Morgan, D J; Wall, R; Richardson, P; Colbeck, R; Kapembwa, M // International Journal of STD & AIDS;Jul1996, Vol. 7 Issue 4, p292 

    The article discusses the case of an older man with sexually acquired gonococcal and chlamydial urethritis. This case shows a penile implant as a risk factor for sexually acquired gonococcal and chlamydial urethritis in the elderly. The gonorrhea responded promptly to treatment with oral...

  • Prevalence of and Risk Factors for Self-reported Sexually Transmitted Infections in Slovenia in 2000. Grgič-Vitek, Marta; Švab, Igor; Klavs, Irena // Croatian Medical Journal;2006, Vol. 47 Issue 5, p722 

    Aim To estimate the prevalence of self-reported sexually transmitted infections (STIs) and examine the associations between self-reported STIs and sociodemographic and behavioral factors among sexually active Slovenians aged 18-49 years. Methods Data were collected during 1999-2001 from a...

  • Incident sexually transmitted infections and their risk factors in an Aboriginal community in Australia: a population based cohort study. Miller, P. J.; Law, M.; Torzillo, P. J.; Kaldor, J. // Sexually Transmitted Infections;Feb2001, Vol. 77 Issue 1, p21 

    Objective: To identify risk factors for incident sexually transmitted infections (STI) in a remote Aboriginal community in Australia. Design: A population based cohort study. Setting: An Aboriginal community in central Australia. Participants: 1034 Aboriginal people aged 12-40 years, resident in...

  • Rural Gonorrhea in the Southeastern United States: A Neglected Epidemic? Thomas, James C.; Schoenbach, Victor J.; Weiner, Debra H.; Parker, Edith A.; Earp, Jo Anne // American Journal of Epidemiology;1996, Vol. 143 Issue 3, p269 

    Some rural counties in the southeastern United States are experiencing high rates of gonorrhea; however, existing knowledge of epidemiologic patterns of gonorrhea within communities is from urban areas. This paper describes the epidemiology of gonorrhea within a rural country of North Carolina...

  • Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India. Nayyar, Charu; Chander, Ram; Gupta, Poonam; Sherwal, B. L. // Indian Journal of Sexually Transmitted Diseases;Jul-Dec2014, Vol. 35 Issue 2, p114 

    Background: Acquired Immunodeficiency Syndrome (AIDS), is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS....

  • HIV and sexually transmitted infections at the borderlands: situational analysis of sexual health in the Brazilian Amazon. Benzaken, Adele; Sabidó, Meritxell; Galban, Enrique; Dutra, Daniel Lúcio Rodrigues; Leturiondo, André Luiz; Mayaud, Philippe // Sexually Transmitted Infections;Jun2012, Vol. 88 Issue 4, p294 

    Objectives The borderlands are considered areas of increased vulnerability to HIV and sexually transmitted infections (STI). The study aimed to determine the STI/HIV prevalence and risk factors in the triple-border area of the Brazilian Amazon. Methods A situational analysis of sexual health was...

  • Increased sexually transmitted infection incidence in a low risk population: Identifying the risk factors. Shiely, Frances; Horgan, Mary; Hayes, Kevin // European Journal of Public Health;Apr2010, Vol. 20 Issue 2, p207 

    Background: Between 1994 and 2006, the incidence of sexually transmitted infections (STIs) in Ireland has increased by over 300%. Recent literature would suggest that this figure is an underestimation of the true scale of infection. Our objective was to determine the risk factors associated with...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics