(P367) Recurrent Chlamydia and Gonorrhea Infections in US Army Soldiers: 2015-2019

Background: Recurrent Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are
common and contribute to a growing disease burden while increasing the likelihood of developing
sequelae such as pelvic inflammatory disease and infertility. Military members are classified as a high-
risk, high-impact population for whom STI prevention and surveillance should be prioritized, yet little
information is available regarding reinfection in this population, particularly among Army members who
bare a disproportionate share of the burden. Therefore, we assessed recurrent infections and correlates
of risk among US Army soldiers.

Methods: Army active component soldiers during calendar years 2015-2019 were studied using Defense
Manpower Data Center personnel records and case data from (1) disease reporting system records
submitted by Military Health System (MHS) providers, (2) MHS laboratory records, and (3) MHS
outpatient records. DoD surveillance case definitions were implemented to include case report
confirmatory criteria, validated algorithms for identifying laboratory positive tests, recognized diagnostic
codes, and a 30-day “gap-in-care” rule to identify incident cases. Multinomial logistic regression was
used to characterize risk.

Results: In total, 840,138 soldiers were studied who contributed 2.8 + 1.7 person-years of observation
on average; 6% had at least one CT infection (n=45,895) and 1% had at least one NG infection (n=8,923).
Among soldiers with CT, 21% had one or more repeat infections (9,803/45,895); 14% of soldiers with NG
had one or more repeat infections (1,216/8,923). For those with documented infections, CT recurrence
was higher in women (27% versus 19%), whereas NG recurrence was higher in men (14% versus 12%).
Soldiers who were <25 years, female, Non-Hispanic Black, enlisted, not married, less educated, or
assigned to Southern US regions or to overseas regions in the Pacific had increased odds of infection
(single or recurrent). The strength of association was heightened with repeat infection (e.g., for soldiers
<25 relative to soldiers 35+: OR [single CT infection] =7.1 [95%CI: 6.6-7.6]; OR [repeat CT infection] =
13.3 [95% CI: 11.1-15.9]).

Conclusion: This study provided data on the contributions of recurrent infections to the burden of CT
and NG infections in the Army. It identified target populations, both male and female, for interventions.