Longitudinal Associations Among Relationship Factors, Partner Change, and Sexually Transmitted Infection Acquisition in Adolescent Women

Background: The Centers for Disease Control and Prevention (CDC) recommends clinical and serologic re-evaluation at 6 and 12 months after diagnosis with early syphilis, to determine treatment efficacy. Methods: This was a retrospective cohort study of men who have sex with men enrolled in primary care at a lesbian, gay, bisexual, and transgender health center. We used multivariable Poisson regression to examine associations between patient characteristics and timely follow-up (return clinic visit within 6 months of initial diagnosis) and among patients with timely follow-up, factors associated with rescreening at the follow-up visit. Results: January 2002 through December 2008, 5788 tests for syphilis were performed; 256 (4.4%) cases of early syphilis were detected among 225 men. Of 225 134 (59.6%) had timely follow-up. After implementation of electronic medical records and enhanced DIS follow-up, timely follow-up increased from 53% to 76% and rescreening increased from 64% to 81%. HIV-positive men were more likely to have timely follow-up (adjusted relative risk [aRR] = 1.93; 95% CI: 1.31-2.85), as were patients diagnosed 2007-2008 (aRR = 1.28; 95% CI: 1.04-1.57). Among patients with timely follow-up, 94 (70%) were rescreened for syphilis. Diagnosis in 2007-2008 was associated with a greater likelihood that the patient was rescreened at the follow-up visit (aRR = 1.24; 95% CI: 1.00-1.53). Conclusions: Timely follow-up and rescreening improved during the study period, subsequent to implementation of electronic medical records and enhanced DIS follow-up. Even in this later period, the combination of lack of timely follow-up and rescreening resulted in 39% of patients without CDC recommended follow-up. Further efforts are needed to improve timely follow-up by patients and rescreening by clinicians.