Prevalence of Concurrent Sexual Partnerships and Their Associations with GC/CT Infection Among African American Patients Attending An Urban STD Clinic in Mississippi

Background: Models suggest that a high proportion of concurrent partnerships in a population can significantly increase the rate of spread of STIs. The debate continues about how best to measure concurrency and its relationship to STIs.

Objectives: To determine which of two concurrency definitions better predict CT/GC infection among STD clinic patients.

Methods: We surveyed 1,182 patients in Jackson, Mississippi. We examined associations between STDs and concurrency. We compared outcomes using the UN’s definition (D1) which collects dates for first and last intercourse with each partner and asks whether the person intends to have sex with X again with a simpler definition (D2): “at the time you were having sex with X, were you having sex with someone else?”    

Results: Patients were mostly African-American (96%), young (mean age=25) and female (62%). Approximately 5% (N=56) self-identified as gay/lesbian and 5% (N=64) as bisexual. Nearly 22% (N=273) tested positive for either GC/CT; 18% (N=217) tested positive for CT;6% (N=66) tested positive for GC. Twenty-five individuals were co-infected. Concurrency prevalence varied by definition: Using D1, 24% (N=356) were concurrent and 44% (N=611) were concurrent using D2. STD outcomes were not significantly associated with either concurrency definition. Among the two infections,  GC was more strongly associated with definition D1. Of those concurrent according to D1,  30% (N=19) tested positive for GC (OR=1.29, 95% CI=.74, 2.25). Of those concurrent according to D2, 48% (N=30) tested positive for GC (OR=1.15, 95% CI=.69, 1.92).

Conclusions: Concurrency is highly prevalent in this population, although prevalence varied according to definition used. There was a moderate effect size for D1 concurrency for GC suggesting concurrency may facilitate transmission. Concurrency definitions that solicit specific dates of intercourse may better predict  gonorrhea than simpler definitions.   Implications for Programs, Policy, and Research:  Better measures of concurrency are needed to best assess the impact of concurrency on STD outcomes.