Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway

Katarina Skjælaaen; Helle Nesvold; Mette Brekke; Miriam Sare; Elisabeth Toverud Landaas; Ibrahimu Mdala; Anne Olaug Olsen; Odd Martin Vallersnes

doi:10.1136/bmjopen-2022-064934

Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway

BMJ Open. 2022 Dec 1;12(12):e064934. doi: 10.1136/bmjopen-2022-064934.

Authors

Katarina Skjælaaen^{1

2}, Helle Nesvold², Mette Brekke¹, Miriam Sare³, Elisabeth Toverud Landaas^{3

4}, Ibrahimu Mdala¹, Anne Olaug Olsen^{5

6}, Odd Martin Vallersnes^{7

8}

Affiliations

¹ Department of General Practice, University of Oslo, Oslo, Norway.
² Oslo Sexual Assault Centre, City of Oslo Health Agency, Oslo, Norway.
³ Department of Microbiology, Oslo University Hospital, Oslo, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.
⁶ Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway.
⁷ Department of General Practice, University of Oslo, Oslo, Norway o.m.vallersnes@medisin.uio.no.
⁸ Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.

Abstract

Objectives: We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up.

Design: Prospective observational cohort study.

Setting: Sexual assault centre in Oslo, Norway.

Participants: 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019.

Outcome measures: Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up.

Results: At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)).

Conclusions: Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up.

Trial registration number: ClinicalTrials.gov Registry (NCT03132389).

Keywords: epidemiology; forensic medicine; genitourinary medicine; microbiology; sexual medicine.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Azithromycin / therapeutic use
Child
Cohort Studies
Female
Gonorrhea*
Humans
Male
Norway / epidemiology
Prospective Studies
Sex Offenses*
Sexually Transmitted Diseases* / epidemiology

Substances

Azithromycin

Associated data

ClinicalTrials.gov/NCT03132389