Characteristics of Cases with Repeated Sexually Transmitted Infections, Massachusetts, 2014-2016

Abstract

Background

Persons with prior sexually transmitted infections (STIs) are at high risk for re-infection. No recent studies have examined the frequency with which persons within a geographic area are diagnosed and reported with multiple bacterial STIs over time.

Methods

We conducted a retrospective, population-based study of confirmed syphilis, gonorrhea, and chlamydial infections reported to the Massachusetts state surveillance system within a two-year period, July 28, 2014 - July 27, 2016.

Results

Among the Massachusetts population 13-65 years old (4,847,510), 49,142 (1.0%) were reported with ≥1 STI; 6,999 (14.2% of those with one STI) had ≥2 STIs, accounting for 27.7% of STIs. Of cases with ≥5 STIs (high-volume repeaters), 118 (74%) were men and 42 (26%) women. Men spanned the age spectrum, were predominantly white, non-Hispanic, and 87% reported same-sex contacts. Women were younger, predominantly non-white, without known same-sex contacts. Women were re-infected with gonorrhea and chlamydia, or chlamydia alone; none had syphilis or HIV infection. All men with syphilis also had gonorrhea and/or chlamydia; 35% were diagnosed with HIV, before, during the study period, or within 10 months after. The majority (56%) of high-volume repeaters were seen at more than one care site/system.

Conclusions

In Massachusetts, a large proportion of bacterial STIs are reported from a small sub-population, many of whom have been repeatedly infected and are likely to have a higher impact on STI/HIV rates. Public health can play a crucial role in reaching high-volume repeaters, whose STI history may be hidden from clinicians due to fragmented care.