Background: Invasive Meningococcal Disease (IMD) is acquired through respiratory droplets. From 2012-2013, an IMD outbreak occurred in men-who-have-sex-with-men (MSM) in NYC. We measured the association between diagnosis of sexually transmitted diseases (STDs), a marker for risky sexual behavior, and IMD.
Methods: IMD cases ages 15 to 64 reported during 2000-2012 were matched to the STD registry. The relative risk (RR) of IMD for persons with an STD was defined as the ratio of: the number of persons with both IMD and STD divided by total persons in the STD registry, to the number of persons with IMD but without STD divided by the city population without STD. Relative risks were examined by age group, sex, type of STD, and year. RRs were calculated for two non-sexually transmitted diseases, Haemophilus influenzae (Hi)and Rocky Mountain Spotted Fever (RMSF).
Results: Among 285 IMD cases, 26 (9%) were in the STD registry. The RR of having IMD given an STD was 13.3 (95% confidence interval [CI] 8.9-20.0). RRs were highest for persons ages 45-64 (52.8 [95% CI 21.3-130.0]), men (22.4 [95% CI 13.3-37.6]), and men with syphilis (79.5 [95% CI 40.5-156.2]). The RR before the outbreak (2000-2011) was 7.6 (95% CI 4.6-12.4); during the peak outbreak year (2012), it was 67.9 (95% CI 28.1-163.8). RRs for Hiand RMSF were 7.9 (95% CI 5.4-11.7) and 5.0 (95% CI 2.4-10.6), respectively. The RR of IMD for persons in the STD registry was 2.7 times the RR for persons with RMSF (RR Ratio: 2.7, 95% CI 1.13-6.3).
Conclusions: Presence in the STD registry was positively associated with IMD. The association was especially strong for men and during the outbreak year, suggesting the relationship between STD and IMD may be driven by MSM. Further research is needed to understand the interaction of STDs, HIV, and social network with the risk of IMD.