Original Article

Sexually Transmitted Infection Risk among Women Is Not Fully Explained by Partner Numbers

Authors: Christina A. Muzny, MD, Hanne S. Harbison, MHS, MSN, Erika L. Austin, PhD, MPH, Jane R. Schwebke, MD, Barbara Van Der Pol, PhD, MPH, Edward W. Hook, MD

Abstract

Objectives: Increased sexual partner numbers may contribute to sexually transmitted infection (STI) risk for some but not all women. This study compared women reporting having four or more partners during the preceding year (multiple partnership group) with those reporting having one partner (single partnership group) with regard to sexually risky behaviors and other modifiable predictors of STI risk. We also compared the prevalence of bacterial vaginosis, trichomoniasis, chlamydia, gonorrhea, syphilis, herpes simplex virus type 2, and human immunodeficiency virus among groups.

Methods: Eligible female patients 16 years and older presenting to an urban STI clinic completed a questionnaire followed by a pelvic examination with testing for bacterial vaginosis, trichomoniasis, chlamydia, and gonorrhea. Serum was collected for human immunodeficiency virus, syphilis, and herpes simplex virus type 2 serological testing.

Results: Between May 2011 and October 2013, 213 participants were enrolled in the study: 107 in the multiple partnership group and 106 in the single partnership group. Women with multiple partners were more likely to be younger, prefer to have sex with men and women, report drug use, engage in sex for money/drugs, have sex with homosexual/bisexual men, have sex with a partner who has been incarcerated, have sex while drinking alcohol, and have a new partner as the most recent partner. Women in the single partnership group were more likely to report a regular partner and no condom use at their last sexual encounter. STI prevalence rates were high in both groups and not significantly different except for Chlamydia trachomatis, which was more common in women with multiple sex partners (18% vs 6%, P = 0.01). In logistic regression analysis adjusted for age, education, partner number group, and condom use at last sexual encounter, only age 25 years and younger was associated with chlamydia (odds ratio 7.82, confidence interval 2.23–27.46).

Conclusions: The lack of condom use with regular sex partners in the single partnership group may have mitigated the risks associated with participation in sexually risky behaviors among the multiple partnership group, resulting in high STI rates among both groups. Women should be counseled regarding the risk of STI transmission from their regular partner or partners in addition to a casual partner or partners.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Laumann EO, Gagnon JH, Michael RT, et al. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago:University of Chicago Press;1994.
 
2. Aral SO, Holmes KK. The epidemiology of STIs and their social and behavioral determinants: industrialized and developing countries. In: Holmes KK, Sparling PF, Stamm EW, eds. Sexually Transmitted Diseases. 4th ed. New York: McGraw-Hill; 2008: 53-92.
 
3. Upchurch DM, Brady WE, Reichart CA, et al. Behavioral contributions to acquisition of gonorrhea in patients attending an inner city sexually transmitted disease clinic. J Infect Dis 1990;161:938-941.
 
4. Seidman SN, Mosher WD, Aral SO. Women with multiple sexual partners: United States, 1988. Am J Public Health 1992;82:1388-1394.
 
5. Orr DP, Fortenberry JD, Blythe MJ. Validity of self-reported sexual behaviors in adolescent women using biomarker outcomes. Sex Transm Dis 1997;24:261-266.
 
6. Van Wagoner NJ, Harbison HS, Drewry J, et al. Characteristics of women reporting multiple recent sex partners presenting to a sexually transmitted disease clinic for care. Sex Transm Dis 2011;38:210-215.
 
7. Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc 2010;102:614-620.
 
8. Feldhaus KM, Koziol-McLain J, Amsbury HL, et al. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA 1997;277:1357-1361.
 
9. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Measurement 1977;1:385-401.
 
10. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705-714.
 
11. Upchurch DM, Weisman CS, Shepherd M, et al. Interpartner reliability of reporting of recent sexual behaviors. Am J Epidemiol 1991;134:1159-1166.
 
12. Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983;74:14-22.
 
13. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010;59(RR-12):1-110.
 
14. Datta SD, Sternberg M, Johnson RE, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med 2007;147:89-96.
 
15. Ginocchio CC, Chapin K, Smith JS, et al. Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol 2012;50:2601-2608.
 
16. Bunnell RE, Dahlberg L, Rolfs R, et al. High prevalence and incidence of sexually transmitted diseases in urban adolescent females despite moderate risk behaviors. J Infect Dis 1999;180:1624-1631.
 
17. Lichtenstein B, Desmond RA, Schwebke JR. Partnership concurrency status and condom use among women diagnosed with Trichomonas vaginalis. Womens Health Issues 2008;18:369-374.
 
18. Lichtenstein B. Domestic violence, sexual ownership, and HIV risk in women in the American deep south. Soc Sci Med 2005;60:701-714.
 
19. Friedman SR, Flom PL, Kottiri BJ, et al. Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use “ drugs.” AIDS Care 2001;13:285-296.
 
20. Riehman KS, Wechsberg WM, Francis SA, et al. Discordance in monogamy beliefs, sexual concurrency, and condom use among young adult substance-involved couples: implications for risk of sexually transmitted infections. Sex Transm Dis 2006;33:677-682.
 
21. Worth D. Sexual decision-making and AIDS: why condom promotion among vulnerable women is likely to fail. Stud Fam Plann 1989;20(6 Pt 1):297-307.
 
22. DiClemente RJ, Davis TL, Swartzendruber A, et al. Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial. Women Health 2014;54:726-749.
 
23. DiClemente RJ, Wingood GM, Sales JM, et al. Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents: a randomized clinical trial. JAMA Pediatr 2014;168:938-946.
 
24. Geronimus AT, Bound J, Waidmann TA, et al. Excess mortality among blacks and whites in the United States. N Engl J Med 1996;335:1552-1558.
 
25. Green TC, Pouget ER, Harrington M, et al. Limiting options: sex ratios, incarceration rates, and sexual risk behavior among people on probation and parole. Sex Transm Dis 2012;39:424-430.
 
26. Dauria EF, Elifson K, Arriola KJ, et al. Male incarceration rates and rates of sexually transmitted infections: results from a longitudinal analysis in a southeastern US city. Sex Transm Dis 2015;42:324-328.
 
27. Warren JT, Harvey SM, Washburn IJ, et al. Concurrent sexual partnerships among young heterosexual adults at increased HIV risk: types and characteristics. Sex Transm Dis 2015;42:180-184.
 
28. Aral SO, Holmes KK, Padian NS, et al. Overview: individual and population approaches to the epidemiology and prevention of sexually transmitted diseases and human immunodeficiency virus infection. J Infect Dis 1996;174(Suppl 2):S127-S133.
 
29. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet 2008;372:337-340.
 
30. Adimora AA, Schoenbach VJ, Martinson FE, et al. Social context of sexual relationships among rural African Americans. Sex Transm Dis 2001;28:69-76.
 
31. Schwebke JR, Hobbs MM, Taylor SN, et al. Molecular testing for Trichomonas vaginalis in women: results from a prospective U.S. clinical trial. J Clin Microbiol 2011;49:4106-4111.
 
32. Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol 2014;52:885-889.
 
33. Muzny CA, Blackburn RJ, Sinsky RJ, et al. Added benefit of nucleic acid amplification testing for the diagnosis of Trichomonas vaginalis among men and women attending a sexually transmitted diseases clinic. Clin Infect Dis 2014;59:834-841.
 
34. LeFevre ML. U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014;161:902-910.