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Young people with bipolar disorder more likely to contract STIs

In Taiwan, adolescents and young adults with bipolar disorder were more likely to contract subsequent STIs than those without bipolar disorder, according to longitudinal study findings reported in Journal of Clinical Psychiatry.

However, the researchers found that prompt and regular treatment for bipolar disorder may decrease the risk for STIs among this population.

Prior study has indicated a link between bipolar disorders and risky sexual behaviors, as well as between bipolar disorder and risk for STIs, according to Mu-Hong Chen, MD, from the department of psychiatry, Taipei Veterans General Hospital, Taiwan, and colleagues.

“These studies were limited by their small sample sizes and lack of investigation of the effects of bipolar disorder medications on STI risk,” they wrote. “Additionally, these studies employed cross-sectional rather than longitudinal study designs; therefore, they could not clarify the temporal association between bipolar disorder and STIs.”

Chen and colleagues evaluated the link between bipolar disorder and risk for STIs as well as the effects of bipolar disorder medications on STI risk using 2001 to 2009 data from more than 26,000 adolescents and young adults with bipolar disorder and more than 100,000 age- and sex-matched controls in the Taiwan National Health Insurance Research Database. Researchers identified all patients who contracted any type of STI (ie, HIV, syphilis, genital warts, gonorrhea, chlamydial infection and trichomoniasis) during follow-up from enrollment to the end of 2011.

Overall, teenagers and young adults with bipolar disorder contracted STIs at an earlier age and at a higher incidence than controls during the follow-up period.

After adjusting for demographic data, psychiatric comorbidities and bipolar disorder medications, analysis revealed that bipolar disorder was an independent risk factor for subsequent STI among:

• adolescents (HR = 6.12; 95% CI, 4.23-8.88);
• young adults (HR = 3.91; 95% CI, 3.42-4.47);
• males (HR = 5.7; 95% CI, 4.52-7.2); and
• females (HR = 3.59; 95% CI, 3.09-4.18).

Although bipolar disorder was associated with increased risk for each STI, the highest risk was observed for HIV (HR = 11.43; 95% CI, 7.24-18.04) and the lowest risk was for chlamydia (HR = 2.02; 95% CI, 1.42-2.88). In addition, adolescents and young adults with both bipolar disorder and substance use disorders were at highest risk for subsequent STI (HR = 1.94; 95% CI, 1.71-2.2).

Chen and colleagues also found that long-term use of mood stabilizers (HR = 0.54; 95% CI, 0.34-0.86) and atypical antipsychotics (HR = 0.82; 95% CI, 0.71-0.95) was linked to a lower likelihood for contracting STIs.

“Given the increased risk for STIs, it appears that this should be a topic of frequent discussion in treatment with adolescents and young adults with bipolar disorder, and risky sexual behaviors should be regularly assessed and addressed as a focus of treatment with this population, especially when the patient is also abusing alcohol or other substances,” they wrote. “We recommend that clinical psychiatrists focus on helping patients with bipolar disorder reduce their frequency of risky sexual behaviors and related risk for STIs.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.