Once Is Not Enough: Re-screening Sexually Transmitted Disease (STD) Clinic Patients in Six Months to Detect New STDs

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Once Is Not Enough Re-screening Sexually
Transmitted Disease (STD) Clinic Patients in Six
Months to Detect New STDs 

• Bolu, Omotayo1 Lindsey, C1 Peterman, T1 Kamb,
  M1 Bolan, G2 Zenilman, J3 Douglas, J4 Malotte
  K5 Rogers J6, for the Project RESPECT study
  group
• 1Division HIV/AIDS Prevention, CDC, Atlanta,
  Georgia
• 2San Francisco Health Department
• 3Baltimore City Health Department Johns Hopkins
  University
• 4Denver Public Health , Colorado Department of
  Health and Environ.
• 5 Long Beach Health Department and California
  State University
• 6 New Jersey Health Department (Trenton) Newark
  STD Clinic
•  

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BackgroundandObjectives
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• STD clinic patients
• - Are at risk for new STDs
• - Do not always return to the clinic when they
  
• have a new infection since many STDs
  are
• - asymptomatic
• - unrecognized
• Question
• Should STD clinic patients return in 6 months for
  re-screening because they may have a new STD ?

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Objectives

• Determine
• 1. What percentage of STDs would be missed if
  STD clinic patients are not scheduled for
  follow-up visit
• 2. Which STD clinic patients should be scheduled
  for
• follow-up visit

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Methods
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Project RESPECT
Cities Baltimore, Denver, Newark,
Long Beach, San Francisco Participants
Heterosexual STD clinic patients gt 14 years HIV
-
5758 participants
Arm 3 1443
Arm 1 1438
Arm 2 1447
Arm 4 1430
4328 had 6-month scheduled
appointment (Days 161-219 after baseline)
No scheduled visit
All participants Return anytime for STD
exam New STDs Gonorrhea, Chlamydia,
Syphilis, HIV
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• Participants divided into two groups
• - Scheduled follow-up Arms 1, 2,
  3 (N4328)
• - No scheduled follow-up Arm 4
  (N1430)
• - Arm 4 (N1430) x 3.0265 (N4328)
• (to adjust for group size)
• The number of new STDs diagnosed in both groups
  over the entire 6-month study period were counted

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• To estimate STDs that would have been missed if
  clients were not scheduled for 6-month (days
  161-219 after baseline) follow-up visit
• - New STDs in __ New
  STDs in
• Scheduled group unscheduled group
• Subgroup analysis identified predictors for STDs
  that would have been missed if no scheduled
  follow-up visit

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Results
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6 month period
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• During the 6 month scheduled period (Days
  161-219)
• 238 new STDs 56 chlamydia (CT) 31 gonorrhea
  
• (GC) 8 CT GC 4 syphilis 0.5 GC,CT
  syphilis
• 0.5 HIV
• Scheduled follow-up 2709 (63) returned
• 202 new STDs
• No scheduled follow-up 36 new STDs
• 166 new
  STDs would have
• been missed if no scheduled visit.
• 6 (166/2709) of those returning had new STDs

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Predictors for Missed STDs
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Percentages of new STDs at 6 months among
persons with baseline STD by site
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Summary of Results

• Of those returning in the scheduled group, 6 had
  a new STD that would have been missed if there
  was no scheduled visit
• The main predictor is having a baseline STD 12
  had a new STD

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Limitation

• Diagnostic test for chlamydia in the unscheduled
  group was less sensitive and may have
  underestimated the number of new STDs in this
  group

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Conclusions

• 6 of STD clinic patients had a new STD, which
  would have been missed if they were not scheduled
  for a visit.
• The main predictor Baseline STD (12)
• Recommendation
• Persons with baseline STD should be asked to
• return for re-screening at six months because
• many would have a new STD

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Tests performed
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Calculating Predictors