Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates...
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![Page 1: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/1.jpg)
Geographic Bridges for Importation of STD in
the Seattle Metropolitan Area:Barbarians at the Gates
Roxanne P. Kerani, Matthew R. Golden, William L.H. Whittington,
Hunter H. Handsfield, King K. Holmes
![Page 2: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/2.jpg)
Background
• Bridges serve as links for subpopulations with differing prevalances of STD
• Geographic bridges may import STD from high to low prevalence regions
• Few studies have examined travel and STDs other than HIV
![Page 3: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/3.jpg)
Objectives
• To describe geographic bridges residing
in the Seattle Metropolitan Area (SMA)
• To compare attributes of partnerships
involving partners residing in and
outside of the SMA
![Page 4: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/4.jpg)
Methods• Data collected as part of a study of
expedited partner treatment
• Study period: Oct, 1998 – Jan, 2002
• Population: Residents of King Co., WA– Heterosexual– 14+ years– Diagnosed & reported with gonorrhea or
chlamydia– Contacted within 14 days of treatment
![Page 5: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/5.jpg)
Methods• Exclusions:
– Current incarceration– No provider consent for contact– No sex partners (SP) in previous 60 days– Persons with unknown residence
• N = 3,123
• Interviews included questions regarding up to nine SPs in previous 60 days
![Page 6: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/6.jpg)
Bridgers
King
Pierce
Snohomish
Participants with partners residing both in (local) and outside (distant) the SMA
![Page 7: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/7.jpg)
Methods
• Analyses of individuals:
– Bivariate: T-tests and chi-squares
– Multivariate: Logistic regression
• Analyses of partnerships
– Bivariate: GEE models
![Page 8: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/8.jpg)
Study Population
![Page 9: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/9.jpg)
Bridgers
• 310 (9.5%) of participants reported at least
one distant partner
• 140 (4.9%) of participants reported both
local and distant partners (bridgers)
![Page 10: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/10.jpg)
Percent BridgersDemographics & STD Dx
4.3%
6.3%
3.3%3.5%
5.4%
2.8%
4.2%5.3%
5.5%
3.7%
0%
2%
4%
6%
8%
10%
W 20+ Wh Oth CT Both
p=0.18p=0.06 p<0.01 p=0.02
M <20 GAA
![Page 11: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/11.jpg)
Education, Employment, and Residence
5.7%6.2%
3.8%5.0%
3.5%4.3%
3.4%
0%
2%
4%
6%
8%
10%
HS <HS Full Part Un NE Oth
p<0.01p<0.01p=0.06
![Page 12: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/12.jpg)
Number of Sex Partners
3.8
7.6
1.4
2.5
0
2
4
6
8
10
60 Days12Months
Non-Bridgers
Bridgers
*p<0.01
*
*
1.4
2.53.8
7.6
0
2
4
6
8
10
60 Days 12Months
Non-Bridgers
Bridgers
*p<0.01
*
*
![Page 13: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/13.jpg)
Concurrency and Reason for Visit
8.3%
3.7%
6.1%
3.9%
0%
2%
4%
6%
8%
10%
Yes No Symptoms Other
<
p<0.01 p=0.01
Concurrency
![Page 14: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/14.jpg)
Multivariate Results
1.79
1.031.61
2.21
1.53
1.80
1.40
1.0 1.5 2.0 2.5 3.0 3.5
Full time
Part time
North & East Side
Concurrency
White
Number SP
Gonorrhea
Odds Ratio
![Page 15: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/15.jpg)
Results - Partnerships
• Partnerships among bridgers: N=329
• Residence of partners:
– 53% SMA
– 14% Elsewhere in WA
– 33% Within the US, outside WA
![Page 16: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/16.jpg)
Partner Type and Ability to Contact
1.00
0.712.29
1.13
1.00
2.90
0.0 0.1 1.0 10.0
One time
Casual
Regular
Main
Can't Contact
Can Contact
Odds Ratio
![Page 17: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/17.jpg)
Partner Knowledge of Infectionand Perceived Future Sex with SP
1.00
1.91
1.78
1.00
1.0 1.5 2.0 2.5 3.0 3.5
No
Yes
No
Yes
Partner Knows
Future Sex
Odds Ratio
![Page 18: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/18.jpg)
Partnerships: Perceived Transmission Direction
1.00
1.53
0.63
1.00
0.0 0.1 1.0 10.0
Yes
No
Yes
No
Infectee
Transmitter
Odds Ratio
![Page 19: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/19.jpg)
Summary
• 5% of patients were geographic bridges
• Bridgers were more likely to be white, older, employed, and of higher SES, and to report more partners and concurrency
• Distant partnerships were more likely to represent casual relationships with little potential for future contact
![Page 20: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/20.jpg)
Limitations
• Study sample not representative of all
gonorrhea and chlamydia cases in King Co.
• Direction of transmission is unknown
• We don’t know where sex took place
• Anonymous partners may be underrepresented
![Page 21: Geographic Bridges for Importation of STD in the Seattle Metropolitan Area: Barbarians at the Gates Roxanne P. Kerani, Matthew R. Golden, William L.H.](https://reader036.fdocuments.net/reader036/viewer/2022081516/56649da15503460f94a8cd23/html5/thumbnails/21.jpg)
Conclusions• Factors associated with bridging are
generally those associated with low rates of STD
• Bridges may be important in maintaining GC/CT endemicity in low prevalence populations
• Is business travel related to risky sex?
• Control of disease in some populations may require enhanced collaboration between distant public health agencies