Skip to main content
NCBI home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Oct;80(5):379–385. doi: 10.1136/sti.2003.007575

Investigating ethnic inequalities in the incidence of sexually transmitted infections: mathematical modelling study

K Turner 1, G Garnett 1, A Ghani 1, J Sterne 1, N Low 1
PMCID: PMC1744908  PMID: 15459406

Abstract

Objectives: To investigate ethnic differences in rates of gonorrhoea using empirical sexual behaviour data in a simple mathematical model. To explore the impact of different intervention strategies in this simulated population.

Methods: The findings from cross sectional studies of gonorrhoea rates and sexual behaviour in three ethnic groups in south east London were used to determine the parameters for a deterministic, mathematical model of gonorrhoea transmission dynamics, in a population stratified by sex, sexual activity (rate of partner change), and ethnic group (white, black African, and black Caribbean). We compared predicted and observed rates of infection and simulated the effects of targeted and population-wide intervention strategies.

Results: In model simulations the reported sexual behaviours and mixing patterns generated major differences in the rates of gonorrhoea experienced by each subpopulation. The fit of the model to observed data was sensitive to assumptions about the degree of mixing by level of sexual activity, the numbers of sexual partnerships reported by men and women, and the degree to which observed data underestimate female infection rates. Interventions to reduce duration of infection were most effective when targeted at black Caribbeans.

Conclusions: Average measures of sexual behaviour in large populations are inadequate descriptors for the epidemiology of gonorrhoea. The consistency between the model results and empirical data shows that profound differences in gonorrhoea rates between ethnic groups can be explained by modest differences in a limited number of sexual behaviours and mixing patterns. Targeting effective services to particular ethnic groups can have a disproportionate influence on disease reduction in the whole community.

Full Text

The Full Text of this article is available as a PDF (224.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aral S. O., Hughes J. P., Stoner B., Whittington W., Handsfield H. H., Anderson R. M., Holmes K. K. Sexual mixing patterns in the spread of gonococcal and chlamydial infections. Am J Public Health. 1999 Jun;89(6):825–833. doi: 10.2105/ajph.89.6.825. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Becker K. M., Glass G. E., Brathwaite W., Zenilman J. M. Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system. Am J Epidemiol. 1998 Apr 1;147(7):709–716. doi: 10.1093/oxfordjournals.aje.a009513. [DOI] [PubMed] [Google Scholar]
  3. De Cock K. M., Low N. HIV and AIDS, other sexually transmitted diseases, and tuberculosis in ethnic minorities in United Kingdom: is surveillance serving its purpose? BMJ. 1997 Jun 14;314(7096):1747–1751. doi: 10.1136/bmj.314.7096.1747. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ellen J. M., Aral S. O., Madger L. S. Do differences in sexual behaviors account for the racial/ethnic differences in adolescents' self-reported history of a sexually transmitted disease? Sex Transm Dis. 1998 Mar;25(3):125–129. doi: 10.1097/00007435-199803000-00002. [DOI] [PubMed] [Google Scholar]
  5. Ellen J. M., Kohn R. P., Bolan G. A., Shiboski S., Krieger N. Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992. Am J Public Health. 1995 Nov;85(11):1546–1548. doi: 10.2105/ajph.85.11.1546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fenton K. A. Strategies for improving sexual health in ethnic minorities. Curr Opin Infect Dis. 2001 Feb;14(1):63–69. doi: 10.1097/00001432-200102000-00011. [DOI] [PubMed] [Google Scholar]
  7. Garnett G. P. An introduction to mathematical models in sexually transmitted disease epidemiology. Sex Transm Infect. 2002 Feb;78(1):7–12. doi: 10.1136/sti.78.1.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Garnett G. P., Anderson R. M. Balancing sexual partnerships in an age and activity stratified model of HIV transmission in heterosexual populations. IMA J Math Appl Med Biol. 1994;11(3):161–192. doi: 10.1093/imammb/11.3.161. [DOI] [PubMed] [Google Scholar]
  9. Garnett G. P., Hughes J. P., Anderson R. M., Stoner B. P., Aral S. O., Whittington W. L., Handsfield H. H., Holmes K. K. Sexual mixing patterns of patients attending sexually transmitted diseases clinics. Sex Transm Dis. 1996 May-Jun;23(3):248–257. doi: 10.1097/00007435-199605000-00015. [DOI] [PubMed] [Google Scholar]
  10. Garnett G. P., Mertz K. J., Finelli L., Levine W. C., St Louis M. E. The transmission dynamics of gonorrhoea: modelling the reported behaviour of infected patients from Newark, New Jersey. Philos Trans R Soc Lond B Biol Sci. 1999 Apr 29;354(1384):787–797. doi: 10.1098/rstb.1999.0431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ghani A. C., Garnett G. P. Risks of acquiring and transmitting sexually transmitted diseases in sexual partner networks. Sex Transm Dis. 2000 Nov;27(10):579–587. doi: 10.1097/00007435-200011000-00006. [DOI] [PubMed] [Google Scholar]
  12. Harrison W. O., Hooper R. R., Wiesner P. J., Campbell A. F., Karney W. W., Reynolds G. H., Jones O. G., Holmes K. K. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med. 1979 May 10;300(19):1074–1078. doi: 10.1056/NEJM197905103001903. [DOI] [PubMed] [Google Scholar]
  13. Johnson A. M., Mercer C. H., Erens B., Copas A. J., McManus S., Wellings K., Fenton K. A., Korovessis C., Macdowall W., Nanchahal K. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet. 2001 Dec 1;358(9296):1835–1842. doi: 10.1016/S0140-6736(01)06883-0. [DOI] [PubMed] [Google Scholar]
  14. Kretzschmar M., van Duynhoven Y. T., Severijnen A. J. Modeling prevention strategies for gonorrhea and Chlamydia using stochastic network simulations. Am J Epidemiol. 1996 Aug 1;144(3):306–317. doi: 10.1093/oxfordjournals.aje.a008926. [DOI] [PubMed] [Google Scholar]
  15. Laumann E. O., Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999 May;26(5):250–261. doi: 10.1097/00007435-199905000-00003. [DOI] [PubMed] [Google Scholar]
  16. Low N., Connell P., McKevitt C., Baggili Tamara, Tenant-Flowers Melinda, More Christine, Zuckerman Mark, Hamilton Michael, Jones Jef, Blake Mark. 'You can't tell by looking': pilot study of a community-based intervention to detect asymptomatic sexually transmitted infections. Int J STD AIDS. 2003 Dec;14(12):830–834. doi: 10.1258/095646203322556174. [DOI] [PubMed] [Google Scholar]
  17. Low N., Daker-White G., Barlow D., Pozniak A. L. Gonorrhoea in inner London: results of a cross sectional study. BMJ. 1997 Jun 14;314(7096):1719–1723. doi: 10.1136/bmj.314.7096.1719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Low N., Sterne J. A., Barlow D. Inequalities in rates of gonorrhoea and chlamydia between black ethnic groups in south east London: cross sectional study. Sex Transm Infect. 2001 Feb;77(1):15–20. doi: 10.1136/sti.77.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Morris M., Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997 Apr;11(5):641–648. doi: 10.1097/00002030-199705000-00012. [DOI] [PubMed] [Google Scholar]
  20. Morris M. Telling tails explain the discrepancy in sexual partner reports. Nature. 1993 Sep 30;365(6445):437–440. doi: 10.1038/365437a0. [DOI] [PubMed] [Google Scholar]
  21. Platt R., Rice P. A., McCormack W. M. Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea. JAMA. 1983 Dec 16;250(23):3205–3209. [PubMed] [Google Scholar]
  22. Potterat J. J., Rothenberg R. B. Sexual network data help assess putative STD reporting bias. Sex Transm Dis. 1997 Oct;24(9):552–553. doi: 10.1097/00007435-199710000-00012. [DOI] [PubMed] [Google Scholar]
  23. Rietmeijer C. A., Yamaguchi K. J., Ortiz C. G., Montstream S. A., LeRoux T., Ehret J. M., Judson F. N., Douglas J. M. Feasibility and yield of screening urine for Chlamydia trachomatis by polymerase chain reaction among high-risk male youth in field-based and other nonclinic settings. A new strategy for sexually transmitted disease control. Sex Transm Dis. 1997 Aug;24(7):429–435. doi: 10.1097/00007435-199708000-00008. [DOI] [PubMed] [Google Scholar]
  24. Smucker D. R., Thomas J. C. Evidence of thorough reporting of sexually transmitted diseases in a southern rural county. Sex Transm Dis. 1995 May-Jun;22(3):149–154. doi: 10.1097/00007435-199505000-00003. [DOI] [PubMed] [Google Scholar]
  25. Turner Charles F., Rogers Susan M., Miller Heather G., Miller William C., Gribble James N., Chromy James R., Leone Peter A., Cooley Phillip C., Quinn Thomas C., Zenilman Jonathan M. Untreated gonococcal and chlamydial infection in a probability sample of adults. JAMA. 2002 Feb 13;287(6):726–733. doi: 10.1001/jama.287.6.726. [DOI] [PubMed] [Google Scholar]
  26. Uche CO, Anderson RM. Mixing matrices: Necessary constraints in populations of finite size. IMA J Math Appl Med Biol. 1996 Mar;13(1):23–33. [PubMed] [Google Scholar]
  27. Wadsworth J., Wellings K., Johnson A. M., Field J. Sexual behaviour. BMJ. 1993 Feb 27;306(6877):582–583. doi: 10.1136/bmj.306.6877.582-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wasserheit J. N. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis. 1992 Mar-Apr;19(2):61–77. [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES