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Roxanne P. Kerani, PhD, MPH, Mark S. Handcock, PhD, H. Hunter Handsfield, MD and King K. Holmes, MD, PhD

At the time of the study, H. Hunter Handsfield, King K. Holmes, and Roxanne P. Kerani were with the Center for AIDS and STD at the University of Washington School of Medicine, Seattle. H. Hunter Handsfield also is affiliated with Public Health–Seattle and King County, Seattle, Wash. Mark S. Handcock is with the Department of Statistics at the University of Washington.

Correspondence: Requests for reprints should be sent to Roxanne Kerani, MPH, PhD, Public Health–Seattle and King County, Harborview Medical Center, #359777, 325 9th Ave, Seattle, WA 98104 (e-mail: rkerani{at}u.washington.edu).

Objectives. We measured and compared the concentration of primary and secondary syphilis, gonorrhea, chlamydial infection, and genital herpes in a large county with urban, suburban, and rural settings.

Methods. We geocoded sexually transmitted infections reported to King County, Washington health department in 2000–2001 to census tract of residence. We used a model-based approach to measure concentration with Lorenz curves and Gini coefficients.

Results. Syphilis exhibited the highest level of concentration (estimated Gini coefficient = 0.68, 95% confidence interval [CI] = 0.64, 0.78), followed by gonorrhea (estimated Gini coefficient=0.57; 95% CI=0.54, 0.60), chlamydial infection (estimated Gini coefficient = 0.45; 95% CI = 0.40, 0.43), and herpes (estimated Gini coefficient=0.26; 95% CI=0.22, 0.29).

Conclusions. Geographically targeted interventions may be most appropriate for syphilis and gonorrhea. For less-concentrated infections, control strategies must reach a wider portion of the population.

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