Cancer Causes & Control

, 20:1623 | Cite as

Correlates of sexually transmitted infection histories in a cohort of American male health professionals

  • Siobhan Sutcliffe
  • Ichiro Kawachi
  • John F. Alderete
  • Charlotte A. Gaydos
  • Lisa P. Jacobson
  • Frank J. Jenkins
  • Raphael P. Viscidi
  • Jonathan M. Zenilman
  • Elizabeth A. Platz
Original paper



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).


Sexually 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.


  1. 1.
    Dennis LK, Dawson DV (2002) Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology 13(1):72–79CrossRefPubMedGoogle Scholar
  2. 2.
    Taylor ML, Mainous AGIII, Wells BJ (2005) Prostate cancer and sexually transmitted diseases: a meta-analysis. Fam Med 37(7):506–512PubMedGoogle Scholar
  3. 3.
    Fernandez L, Galan Y, Jimenez R, Gutierrez A, Guerra M, Pereda C et al (2005) Sexual behaviour, history of sexually transmitted diseases, and the risk of prostate cancer: a case–control study in Cuba. Int J Epidemiol 34(1):193–197CrossRefPubMedGoogle Scholar
  4. 4.
    Huang WY, Hayes R, Pfeiffer R, Viscidi RP, Lee FK, Wang YF et al (2008) Sexually transmissible infections and prostate cancer risk. Cancer Epidemiol Biomarkers Prev 17(9):2374–2381CrossRefPubMedGoogle Scholar
  5. 5.
    Sarma AV, McLaughlin JC, Wallner LP, Dunn RL, Cooney KA, Schottenfeld D et al (2006) Sexual behavior, sexually transmitted diseases and prostatitis: the risk of prostate cancer in black men. J Urol 176(3):1108–1113CrossRefPubMedGoogle Scholar
  6. 6.
    Lightfoot N, Conlon M, Kreiger N, Sass-Kortsak A, Purdham J, Darlington G (2004) Medical history, sexual, and maturational factors and prostate cancer risk. Ann Epidemiol 14(9):655–662CrossRefPubMedGoogle Scholar
  7. 7.
    Hoffman LJ, Bunker CH, Pellett PE, Trump DL, Patrick AL, Dollard SC et al (2004) Elevated seroprevalence of human herpesvirus 8 among men with prostate cancer. J Infect Dis 189(1):15–20CrossRefPubMedGoogle Scholar
  8. 8.
    Sutcliffe S, Giovannucci E, Alderete JF, Chang TH, Gaydos CA, Zenilman JM et al (2006) Plasma antibodies against Trichomonas vaginalis and subsequent risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 15(5):939–945CrossRefPubMedGoogle Scholar
  9. 9.
    Adami HO, Kuper H, Andersson SO, Bergstrom R, Dillner J (2003) Prostate cancer risk and serologic evidence of human papilloma virus infection: a population-based case–control study. Cancer Epidemiol Biomarkers Prev 12(9):872–875PubMedGoogle Scholar
  10. 10.
    Oishi K, Okada K, Yoshida O, Yamabe H, Ohno Y, Hayes RB et al (1990) A case–control study of prostatic cancer in Kyoto, Japan: sexual risk factors. Prostate 17(4):269–279CrossRefPubMedGoogle Scholar
  11. 11.
    Signorello LB, Tzonou A, Lagiou P, Samoli E, Zavitsanos X, Trichopoulos D (1999) The epidemiology of benign prostatic hyperplasia: a study in Greece. BJU Int. 84(3):286–291CrossRefPubMedGoogle Scholar
  12. 12.
    Joseph MA, Harlow SD, Wei JT, Sarma AV, Dunn RL, Taylor JM et al (2003) Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol 157(10):906–914CrossRefPubMedGoogle Scholar
  13. 13.
    Araki H, Watanabe H, Mishina T, Nakao M (1983) High-risk group for benign prostatic hypertrophy. Prostate 4(3):253–264CrossRefPubMedGoogle Scholar
  14. 14.
    Sutcliffe S, Giovannucci E, De Marzo AM, Willett WC, Platz EA (2005) Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms. Am J Epidemiol 162(9):898–906CrossRefPubMedGoogle Scholar
  15. 15.
    Michaud DS, Platz EA, Giovannucci E (2007) Gonorrhoea and male bladder cancer in a prospective study. Br J Cancer 96(1):169–171CrossRefPubMedGoogle Scholar
  16. 16.
    La Vecchia C, Negri E, D’Avanzo B, Savoldelli R, Franceschi S (1991) Genital and urinary tract diseases and bladder cancer. Cancer Res 51(2):629–631PubMedGoogle Scholar
  17. 17.
    Mazzaferro KE, Murray PJ, Ness RB, Bass DC, Tyus N, Cook RL (2006) Depression, stress, and social support as predictors of high-risk sexual behaviors and STIs in young women. J Adolesc Health 39(4):601–603CrossRefPubMedGoogle Scholar
  18. 18.
    Ekstrand ML, Coates TJ (1990) Maintenance of safer sexual behaviors and predictors of risky sex: the San Francisco men’s health study. Am J Public Health 80(8):973–977CrossRefPubMedGoogle Scholar
  19. 19.
    St. Lawrence JS, Brasfield TL, Jefferson KW, Allyene E, Shirley A (1994) Social support as a factor in African-American adolescents’ sexual risk behavior. J Adolesc Res 9(3):292–310CrossRefGoogle Scholar
  20. 20.
    Smith CA (1997) Factors associated with early sexual activity among urban adolescents. Soc Work 42(4):334–346PubMedGoogle Scholar
  21. 21.
    Sabo DF, Miller KE, Farrell MP, Melnick MJ, Barnes GM (1999) High school athletic participation, sexual behavior and adolescent pregnancy: a regional study. J Adolesc Health 25(3):207–216CrossRefPubMedGoogle Scholar
  22. 22.
    Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J et al (1997) Protecting adolescents from harm. Findings from the national longitudinal study on adolescent health. JAMA 278(10):823–832CrossRefPubMedGoogle Scholar
  23. 23.
    Henrich CC, Brookmeyer KA, Shrier LA, Shahar G (2006) Supportive relationships and sexual risk behavior in adolescence: an ecological-transactional approach. J Pediatr Psychol 31(3):286–297CrossRefPubMedGoogle Scholar
  24. 24.
    Crosby RA, DiClemente RJ, Wingood GM, Cobb BK, Harrington K, Davies SL et al (2001) HIV/STD-protective benefits of living with mothers in perceived supportive families: a study of high-risk African American female teens. Prev Med 33(3):175–178CrossRefPubMedGoogle Scholar
  25. 25.
    Boyer CB, Tschann JM, Shafer MA (1999) Predictors of risk for sexually transmitted diseases in ninth grade urban high school students. J Adolesc Res 14(4):448–465CrossRefPubMedGoogle Scholar
  26. 26.
    Aral SO, Holmes KK (1999) Social and behavioral determinants of the epidemiology of STDs: industrialized and developing countries. In: Holmes K, Sparling P, Mardh P, Lemon S, Stamm W, Piot P et al (eds) Sexually transmitted diseases, 3rd edn. The McGraw-Hill Companies, New York, pp 39–76Google Scholar
  27. 27.
    Cook RL, Clark DB (2005) Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis 32(3):156–164CrossRefPubMedGoogle Scholar
  28. 28.
    Wolf R, Freedman D (2000) Cigarette smoking, sexually transmitted diseases, and HIV/AIDS. Int J Dermatol 39(1):1–9CrossRefPubMedGoogle Scholar
  29. 29.
    Sutcliffe S, Giovannucci E, De Marzo AM, Leitzmann MF, Willett WC, Platz EA (2006) Gonorrhea, syphilis, clinical prostatitis, and the risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 15(11):2160–2166CrossRefPubMedGoogle Scholar
  30. 30.
    Sutcliffe S, Giovannucci E, Gaydos CA, Viscidi RP, Jenkins FJ, Zenilman JM et al (2007) Plasma antibodies against Chlamydia trachomatis, human papillomavirus, and human herpesvirus type 8 in relation to prostate cancer: a prospective study. Cancer Epidemiol Biomarkers Prev 16(8):1573–1580CrossRefPubMedGoogle Scholar
  31. 31.
    Berkman L (1977) Social networks, host resistance, and mortality: a follow-up study of Alameda County residents. Doctoral dissertation, University of California at Berkeley, BerkeleyGoogle Scholar
  32. 32.
    Viscidi RP, Ahdieh-Grant L, Clayman B, Fox K, Massad LS, Cu-Uvin S et al (2003) Serum immunoglobulin G response to Human Papillomavirus type 16 virus-like particles in Human Immunodeficiency Virus (HIV)-positive and risk-matched HIV-negative women. JID 187:194–205CrossRefPubMedGoogle Scholar
  33. 33.
    Jenkins FJ, Hoffman LJ, Liegey-Dougall A (2002) Reactivation of and primary infection with human herpesvirus 8 among solid-organ transplant recipients. J Infect Dis 185(9):1238–1243CrossRefPubMedGoogle Scholar
  34. 34.
    Franceschi S, Geddes M (1995) Epidemiology of classic Kaposi’s sarcoma, with special reference to mediterranean population. Tumori 81(5):308–314PubMedGoogle Scholar
  35. 35.
    Blackbourn DJ, Ambroziak J, Lennette E, Adams M, Ramachandran B, Levy JA (1997) Infectious human herpesvirus 8 in a healthy North American blood donor. Lancet 349(9052):609–611CrossRefPubMedGoogle Scholar
  36. 36.
    Centers for Disease Control and Prevention (2005) Sexually transmitted disease surveillance. US Department of Health and Human Services, Atlanta November 2006Google Scholar
  37. 37.
    Barone MA, Johnson CH, Luick MA, Teutonico DL, Magnani RJ (2004) Characteristics of men receiving vasectomies in the United States, 1998–1999. Perspect Sex Reprod Health. 36(1):27–33CrossRefPubMedGoogle Scholar
  38. 38.
    Engels EA, Atkinson JO, Graubard BI, McQuillan GM, Gamache C, Mbisa G et al (2007) Risk factors for human herpesvirus 8 infection among adults in the United States and evidence for sexual transmission. J Infect Dis 196(2):199–207CrossRefPubMedGoogle Scholar
  39. 39.
    Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA (2000) Sexual orientation and health: comparisons in the women’s health initiative sample. Arch Fam Med 9(9):843–853CrossRefPubMedGoogle Scholar
  40. 40.
    Dukers NH, Rezza G (2003) Human herpesvirus 8 epidemiology: what we do and do not know. AIDS 17(12):1717–1730CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Siobhan Sutcliffe
    • 1
  • Ichiro Kawachi
    • 2
  • John F. Alderete
    • 3
  • Charlotte A. Gaydos
    • 4
  • Lisa P. Jacobson
    • 5
  • Frank J. Jenkins
    • 6
    • 9
  • Raphael P. Viscidi
    • 7
  • Jonathan M. Zenilman
    • 4
  • Elizabeth A. Platz
    • 5
    • 8
  1. 1.Alvin J. Siteman Cancer Center and the Department of SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Society, Human Development and HealthHarvard School of Public HealthBostonUSA
  3. 3.School of Molecular Biosciences, Fulmer HallWashington State UniversityPullmanUSA
  4. 4.Division of Infectious Diseases, Department of MedicineJohns Hopkins Medical InstitutionsBaltimoreUSA
  5. 5.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Department of Pathology, School of MedicineUniversity of PittsburghPittsburghUSA
  7. 7.Stanley Division of Developmental Neurovirology, Department of PediatricsJohns Hopkins Medical InstitutionsBaltimoreUSA
  8. 8.James Buchanan Brady Urological Institute, Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins Medical InstitutionsBaltimoreUSA
  9. 9.Departments of Infectious Diseases and Microbiology, School of Public HealthUniversity of PittsburghPittsburghUSA

Personalised recommendations