SAN ANTONIO — What makes researchers study the male partners of adolescent and adult women infected with a sexually transmitted infection? When their female patients get treated and return reinfected, it makes them think there must be a way to improve and deliver age- and partner-appropriate prevention messages.

“Once you diagnose an STI in an adolescent girl, you know there is at least one more person who has an STI,” Dr. Andrea Thurman said. “I was treating girls who I knew were taking their medication but kept coming back.

“They were getting reinfected by their partners. I don't think these male partners were getting treated,” she said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Dr. Thurman and her colleagues proposed that prevention messages targeted to male sexual partners based on the age of the woman might be more effective. So they looked for demographic and behavioral differences between partners of teenagers and partners of adult women. They compared the male partners of 152 adolescent girls (14- to 19-years-old, mean age 18 years) with the partners of 362 adult women (20 years and older, mean age 24 years).

All women in the study had a lab-verified, nonviral sexually transmitted infection (STI) diagnosis. “STIs are common in teens, and we cannot screen them enough,” Dr. Thurman said. Prevalence might be as high as 25%, based on a study by Forhan et al. presented at the 2008 National STD Prevention Conference in Chicago.

As part of study participation, each woman was required to invite a male sexual partner from the previous 2 months to participate. Approximately half the men tested positive for an STI at intake. However, partners of teenage women were significantly more likely to have such an infection (57% vs. 47%), especially chlamydia (51% vs. 39%). The gonorrhea coinfection rates were not significantly different (13% vs. 11%), and syphilis affected 1% of male partners in both groups.

“It is unclear why these men partnered with teenagers were more infected,” Dr. Thurman said. It was not exposure, she added. “We thought that teens were having more sex, but the mean number of sexual acts in past 3 months was not significantly different between partners of teens, 68, and partners of adults, 62.”

The mean age of partners of teenage women was 21 years versus 26 years for the partners of adults. Partners of teenage women were more likely to have less money and a higher number of partners; they were more likely to report current drug use and fewer had a high school education. In addition, partners of teens were more likely to be unmarried and not live with the index woman.

“These are things that we all assume, but it was interesting to look at [more than] 500 couples and see what is going on in their relationships, and what they are thinking,” Dr. Thurman said.

Mean length of monogamy was 10 months for partners of teenagers versus almost 20 months for partners of adult women. “The guys dating the teenagers are like the girls—they are sampling around,” said Dr. Thurman of the University of Texas Health Sciences Center, San Antonio.

“Men partnered with teens were significantly more likely to report using any drug, including marijuana, within 1 month,” Dr. Thurman said. A total of 95 (63%) partners of teenagers reported recent drug use versus 158 (44%) men dating adult women.

The researchers found a significant difference in reported condom use: A total of 41 (47%) of 88 partners of teenagers said they did not use condoms, compared with 69 (32%) of 215 partners of adult women specifically because “they like the sensation of 'skin on skin,'” Dr. Thurman said. “Keep this in mind when counseling teenage women—they may have different issues than adult women.”

In some cases, when a woman tests positive for an STI, she agrees to notify her partner. Another approach is provider referral. “Someone from the ob.gyn. [office] calls and says an anonymous woman tested positive for chlamydia, and they offer to call in a prescription for him. The more I do this, the more men appreciate this,” she said.

A meeting attendee asked how often Dr. Thurman encounters an infected woman who does not know the partner's last name or address. “Not so much in this study,” she replied. “This was a self-selected group of women who already tested positive for an STI.”

Dr. Thurman had no conflicts of interest.

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'I was treating girls who I knew were taking their medication but kept coming back.'

Source DR. THURMAN

Treat Male Partners of Teens Who Have an STI