Comprehensive assessment of sociodemographic and behavioral risk factors for Mycoplasma genitalium infection in women.

BACKGROUND: Neisseria gonorrhoeae and Chlamydia trachomatis are characterized by different risk factors, thus control strategies for each also differ. In contrast, risk factors for Mycoplasma genitalium have not been well characterized. METHODS: Between 2000 and 2006, 1090 women ages 14 to 45 attending the Public Health-Seattle & King County Sexually Transmitted Diseases Clinic in Seattle, WA, underwent clinical examination and computer-assisted survey interview. M. genitalium was detected by transcription mediated amplification from self-obtained vaginal swab specimens. C. trachomatis and N. gonorrhoeae were detected by culture from cervical swab specimens. RESULTS: Prevalent M. genitalium infection was detected in 84 women (7.7%), C. trachomatis in 63 (5.8%), and N. gonorrhoeae in 26 (2.4%). Age <20 and nonwhite race were associated with increased risk for all 3 organisms. In addition, risk for M. genitalium was higher for women with a black partner (adjusted odds ratio [AOR]: 3.4; 95% confidence interval = 1.83-6.29), those never married (AOR: 2.6; 1.08-6.25), using Depo-Provera (AOR: 2.3; 1.19-4.46), and smoking (AOR: 1.7; 1.03-2.83). Drug use, history of STI in the past year, ≤high school education, meeting and having intercourse the same day, anal sex, douching, and hormonal contraception were associated with N. gonorrhoeae or C. trachomatis, but not with M. genitalium. Number of partners was not associated with any of the 3 organisms. CONCLUSIONS: The limited number of risk factors for prevalent infection common to all 3 pathogens suggests that M. genitalium may circulate in different sexual networks than N. gonorrhoeae or C. trachomatis. The predominance of sociodemographic risk factors for M. genitalium, rather than high-risk sexual behaviors, suggests broad-based testing may be the most effective control strategy.

Age- and gender-specific estimates of partnership formation and dissolution rates in the Seattle sex survey.

PURPOSE: Partnership formation and dissolution rates are primary determinants of sexually transmitted infection (STI) transmission dynamics. METHODS: The authors used data on persons' lifetime sexual experiences from a 2003-2004 random digit dialing survey of Seattle residents aged 18-39 years (N=1,194) to estimate age- and gender-specific partnership formation and dissolution rates. Partnership start and end dates were used to estimate participants' ages at the start of each partnership and partnership durations, and partnerships not enumerated in the survey were imputed. RESULTS: Partnership formation peaked at age 19 at 0.9 (95% confidence interval [CI]: 0.76-1.04) partnerships per year and decreased to 0.1 to 0.2 after age 30 for women and peaked at age 20 at 1.4 (95% CI: 1.08-1.64) and declined to 0.5 after age 30 for men. Nearly one fourth (23.7%) of partnerships ended within 1 week and more than one half (51.2%) ended within 12 weeks. Most (63.5%) individuals 30 to 39 years of age had not formed a new sexual partnership in the past 3 years. CONCLUSION: A large proportion of the heterosexual population is no longer at substantial STI risk by their early 30s, but similar analyses among high-risk populations may give insight into reasons for the profound disparities in STI rates across populations.

Measuring sex partner concurrency: it's what's missing that counts.

BACKGROUND: Sex partner concurrency is an important determinant of STI transmission dynamics, yet its measurement is not standardized. GOAL: : We assessed the agreement, compared correlates, and investigated data quality and completeness between 2 common concurrency measures. STUDY DESIGN: Young adults (ages 18-26) attending public STD clinics between 2001 and 2004 in Seattle, St. Louis, and New Orleans, provided data on 2 or more sex partners in a computer-administered survey interview (N = 680). Concurrency with last partner was measured in 2 ways: (a) a direct question about other sexual contacts during the most recent sexual relationship and (b) overlapping start and end dates of the 2 most recent relationships. RESULTS: Although 56% reported concurrency by direct questioning and 54% by overlapping dates, the kappa statistic for agreement between measures was only fair (0.395). Indeed, 29% of those reporting concurrent partners by the direct question did not do so by overlapping dates and 26% of participants concurrent by overlapping dates were not concurrent by the direct question. Each of the measures had dissimilar correlates, and concurrency data were missing or uninterpretable more often for the overlapping dates measure (21.3%) than the direct question (1.8%). CONCLUSIONS: Concurrency was common by both measures but the measures were not interchangeable. Although the overlapping dates measure provided information about partnership duration, it is subject to missing or uninterpretable data. The direct question substantially minimized the amount of missing data and may be more appropriate for use with computer-administered survey interview.