Correlates of sexually transmitted infection histories in a cohort of American male health professionals
Several epidemiologic studies have investigated sexually transmitted infections (STIs) and later risk of genitourinary conditions with suggestive positive results. While these results may reflect causal associations, other possible explanations include confounding by factors possibly related to both STI acquisition and genitourinary condition risk such as recognized STI-risk factors/correlates, and other factors not typically considered in relation to STIs (e.g., general health-related behaviors or markers of such behaviors). Very few of these factors have been investigated in older populations in which STIs and genitourinary conditions are typically studied. Therefore, we investigated STI history correlates in one such population, the Health Professionals Follow-up Study.
We ascertained histories of potential correlates, gonorrhea, syphilis by questionnaire (n = 36,032), and performed serologic testing for Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus, and human herpesvirus type 8 infection in a subset (n = 651).
Positive correlations were observed for African–American race, foreign birth, southern residence, smoking, alcohol consumption, ejaculation frequency, vasectomy, and high cholesterol. Inverse correlations were observed for social integration and routine health-related examinations.
These findings provide useful information on potential confounders for epidemiologic investigations of STIs and chronic diseases, and interesting new hypotheses for STI prevention (e.g., STI counseling before vasectomy).
KeywordsSexually transmitted diseases Epidemiology Confounding factor (epidemiology)
We are grateful to Jill Arnold, Elizabeth Frost-Hawes, Mira Kaufman, Laura Sampson, Alvin Wing, and Mildred Wolff for their continued help in conducting the Health Professionals Follow-up Study. We thank Billie J. Wood, Te-Hung Chang, Barbara Silver, and Stefanie Morosky for performing C. trachomatis, T. vaginalis, HPV, and HHV-8 antibody testing, respectively. We also thank Ligia A. Pinto, and Dr. Allan Hildesheim for generous provision of HPV-16 antibody positive control serum and Dr. Patti E. Gravitt for advice regarding HPV antibody testing. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Siobhan Sutcliffe was supported by a Doctoral Research Award from the Canadian Prostate Cancer Research Initiative/Canadian Institutes of Health Research, and the Fund for Research and Progress in Urology, John Hopkins Medical Institutions. This work was supported by research grants CA55075, HL35464 (Harvard), and P50CA58236 (Hopkins) from the National Institutes of Health, and the Summer Epidemiology Program Fund, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
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