Risk of sexual transmitted infection following bipolar disorder: a nationwide population-based cohort study

// Shyh-Chyang Lee 2, 3, * , Chang-Kuo Hu 4, * , Jeng-Hsiu Hung 5, 6 , Albert C. Yang 7, 8, 9 , Shih-Jen Tsai 7, 9 , Min-Wei Huang 10 , Li-Yu Hu 1, 9 and Cheng-Che Shen 9, 10 1 Department of Psychiatry & Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2 Department of Orthopedics, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan 3 Department of Information Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan 4 Division of Neurosurgery, Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan 5 Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan 6 School of Medicine, Tzu Chi University, Hualien, Taiwan 7 Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan 8 Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan 9 School of Medicine, National Yang-Ming University, Taipei, Taiwan 10 Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan * These authors contributed equally to this work Correspondence to: Li-Yu Hu, email: lyhu@vghks.gov.tw Cheng-Che Shen, email: pures1000@yahoo.com.tw Keywords: bipolar disorder; sexually transmitted infection; epidemiology; public health; nationwide study Received: December 04, 2017      Accepted: February 25, 2018      Published: April 03, 2018 ABSTRACT Background: Bipolar disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous studies have investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial. Objective: We explored the association between bipolar disorder and the subsequent development of STIs, including human immunodeficiency virus infection; primary, secondary, and latent syphilis; genital warts; gonorrhea; chlamydial infection; and trichomoniasis. Results: The bipolar cohort consisted of 1293 patients, and the comparison cohort consisted of 5172 matched control subjects without bipolar disorder. The incidence of subsequent STIs (hazard ratio (HR) = 2.23, 95% confidence interval (CI) 1.68–2.96) was higher among the patients with bipolar disorder than in the comparison cohort. Furthermore, female gender is a risk factor for acquisition of STIs (HR = 2.36, 95% CI 1.73–4.89) among patients with bipolar disorder. For individual STIs, the results indicated that the patients with bipolar disorder exhibited a markedly higher risk for subsequently contracting syphilis, genital warts, and trichomoniasis. Conclusions: Bipolar disorder might increase the risk of subsequent newly diagnosed STIs, including syphilis, genital warts, and trichomoniasis. Clinicians should pay particular attention to STIs in patients with bipolar disorder. Patients with bipolar disorder, especially those with a history of high-risk sexual behaviors, should be routinely screened for STIs. Methods: We identified patients who were diagnosed with bipolar disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without bipolar disorder who were matched with the bipolar cohort according to age and gender. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.