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  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. Whittington, Hunter H. Handsfield, King K. Holmes

  2. 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

  3. 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

  4. 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

  5. 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

  6. Bridgers Participants with partners residing both in (local) and outside (distant) the SMA

  7. Methods • Analyses of individuals: • Bivariate: T-tests and chi-squares • Multivariate: Logistic regression • Analyses of partnerships • Bivariate: GEE models

  8. Study Population

  9. Bridgers • 310 (9.5%) of participants reported at least one distant partner • 140 (4.9%) of participants reported both local and distant partners (bridgers)

  10. Percent BridgersDemographics & STD Dx

  11. Education, Employment, and Residence

  12. Number of Sex Partners

  13. Concurrency and Reason for Visit

  14. Multivariate Results

  15. Results - Partnerships • Partnerships among bridgers: N=329 • Residence of partners: • 53% SMA • 14% Elsewhere in WA • 33% Within the US, outside WA

  16. Partner Type and Ability to Contact

  17. Partner Knowledge of Infectionand Perceived Future Sex with SP

  18. Partnerships: Perceived Transmission Direction

  19. 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

  20. 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

  21. 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

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