Study Reveals Higher Prevalence of STIs Among Adolescents, Young Adults with Sickle Cell Disease

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More than one sixth of adolescents and young adults (AYAs) with sickle cell disease (SCD) were diagnosed with sexually transmitted infections (STIs), according to a recent study presented at the 2023 American Society of Hematology (ASH) Annual Meeting and Exposition, held in San Diego, California.1 Even when controlling for age and sex, results revealed this patient population is diagnosed with STIs more frequently when compared with their Black and non-Black peers.

“Preventing STIs is a key aspect of healthcare for AYAs,” wrote lead investigator Joseph Walden, BS, associated with Nationwide Children's Hospital Research Institute’s Creary Lab, founded by Susan Creary, MD, MSc, and colleagues. “Those with SCD may be at particularly high risk given health disparities, knowledge gaps, negative reproductive health outcomes, and barriers to comprehensive sexual and reproductive healthcare for this underserved minority population. While studies show that risky sexual behavior is prevalent in AYAs with SCD (AYAs-SCD), it remains unclear how the prevalence of STIs in AYAs-SCD compares to STI prevalence seen in Black AYAs and AYAs in general.”

To better understand this issue, investigators analyzed the prevalence of STIs among AYAs with SCD who visited the emergency department or were admitted for any reason and compared those results to Black and non-Black AYAs in the same setting. The Pediatric Health Information System (PHIS) database, which includes clinical data from >50 children’s hospitals in the United States, to pull information on hospital discharges and emergency departments involving patients aged 13 – 25 years between January 2022 through May 2023.

Patients with SCD were identified using diagnosis codes. STIs, including gonorrhea, trichomonas vaginalis, syphilis, chlamydia trachomatis, human immunodeficiency virus, and herpes simplex virus, were also identified using diagnosis codes. The prevalence of STI was described as the percentage of encounters with an STI diagnosis during the study. STI prevalence in AYAs-SCD was compared with both Black AYAs and non-Black AYAs without SCD, while controlling for sex and age using logistic regression models.

A total of 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs were included in the analysis. Patients with AYAs-SCD were generally older (16.8 years) than Black AYAs (16.0 years; P <.0001) and non-Black AYAs (16.0 years; P <.0001).

There was a higher prevalence of STI diagnosis in the SCD cohort (17.1%) compared with the control groups (Black: 10.7%; P <.0001, non-Black: 11.8%; P <.0001), even when investigators controlled for age and sex.

The results showed despite a possible delay in physical sexual maturation in AYAs-SCD, patients aged 13 – 15 years made up a significant proportion of STI diagnoses in the SCD cohort. Coupled with a higher prevalence of STIs in the 13 – 18 years age group, findings underscore the need to increase testing for STI in younger patients with SCD.

Additionally, females accounted for most STI diagnoses across cohorts, which may be partially due to the increased STI testing frequency in female patients.

Investigators noted the study was limited by its retrospective design, its focus on hospital-based visits, being unable to account for hospital-specific STI testing methods, and heavily relying on the accuracy of coding. Therefore, they encourage future research to explore the rates of STI testing in this patient population, the prevalence of STIs in ambulatory settings, the association between contraception and STI diagnosis in these patients, and ways to address STIs in young patients with SCD.

“While understanding testing practices is necessary to determine the true prevalence of STIs in AYAs with SCD, these findings indicate a potential disparity in STI risk for AYAs-SCD that is not accounted for by race,” investigators concluded.

References

1. ^{Walden J, Stanek JR, Nahata L, Creary SE. It’s Time to Act: Contextualizing the Prevalence of Sexually Transmitted Infections in Adolescents and Young Adults with Sickle Cell Disease. Presented at: ASH Annual Meeting and Exposition. San Diego, CA. December 9-12, 2023.}