OBJECTIVES. The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. METHODS. Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. RESULTS. For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. CONCLUSIONS. HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics.

During the second half of the 1980s, Miami had a syphilis epidemic while gonorrhea rates decreased. To determine whether the direction of these trends truly differed within all population subgroups or whether they resulted from aggregating groups within which trends were similar, records from four sexually transmitted disease clinics from 1986 to 1990 and census data from 1990 were used to compare race-, sex-, age-, and zip code-specific groups. Syphilis and gonorrhea clustering was similar; 50% of cases occurred in the same zip codes, representing 10% of the population. In all groups, gonorrhea decreased (aggregate 48%) while syphilis first increased (aggregate 47%) and then decreased. Determining reasons for these different trends may facilitate controlling these diseases.

OBJECTIVES. The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS. Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS. Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS. We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.

Partner notification identified many infected and potentially infected people. The cost and effectiveness of the three types of provider notification were similar. Alternative approaches are needed to reach infected partners who could not be notified.

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