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Background: In 2006, Tennessee ranked eighth nationally for rates of syphilis infections, ninth for chlamydia, and tenth for gonorrhea. Serious sequelae are associated with repeat infection with these sexually transmitted diseases (STDs).
Objectives: To describe the epidemiology of repeat STD infection in Tennessee.
Methods: Individuals diagnosed in Tennessee with a chlamydia or gonorrhea infection during August 2005 – September 2008 were included in this study. The proportion of individuals with at least one repeat infection (defined as a chlamydia, gonorrhea or syphilis infection at least 90 days after diagnosis of the initial infection with chlamydia or gonorrhea) was determined and Cox proportional regression models were used to analyze predictors of repeat infections.
Results: Of 79,206 STD cases, 8.2% of the population had at least one repeat infection with chlamydia, gonorrhea, or syphilis within one year. Among those < 25 years old 9.8% had a repeat infection within one year. Blacks had the greatest rate of repeat infection (11%) compared to other racial/ethnic groups. Young age at initial infection and black race were predominant factors in predicting repeat infections (hazard ratio = 3.3 and 2.1, respectively). Multivariate analyses confirmed age < 25 years (HR=2.4, 95% CI 1.2-4.6) and black race (HR=1.8, 95% CI 1.2-3.1) as significant risk factors for repeat infection.
Conclusions: Targeted screening, testing, treatment and counseling of patients who are young and/or of black race could help reduce STD morbidity in Tennessee.
Implications for Programs, Policy, and/or Research: In efforts to reduce the high incidence of Chlamydia infection and subsequent repeat infections, Tennessee health services providers were authorized to supply Expedited Partner Therapy (EPT). Hopefully, with increasing acceptance of EPT, chlamydia and gonorrhea morbidity will be reduced in Tennessee.