Public Health Impact

Multiple studies and surveillance projects have demonstrated a high prevalence of STDs in persons entering jails and juvenile corrections facilities.^1-4 The prevalence rates for chlamydia and gonorrhea in these settings are consistently among the highest observed in any venue. Screening for chlamydia, gonorrhea, and syphilis at intake offers an opportunity to identify infections, prevent complications, and reduce transmission in the general community. For example, data from one study in a locale with high syphilis incidence suggested that screening and treatment of women inmates for syphilis may result in reduction of syphilis in the general community.⁵ In some locations, a substantial proportion of all early syphilis cases are reported from corrections facilities.⁴ Collecting positivity data and analyzing trends in STD prevalence in the inmate population can provide a tool for monitoring trends in STD prevalence in the general community.^3-4

Description of Population

In 2006, STD screening data from corrections facilities were reported from 34 states for chlamydia, 30 states for gonorrhea, and 16 states for syphilis. These data were reported in response to CDC's request for data, as part of the Corrections STD Prevalence Monitoring Project and/or the Infertility Prevention Project (IPP). IPP provided CDC with line-listed data for chlamydia and gonorrhea.

The figures and tables shown in this section represent 48,445 chlamydia tests in women and 124,201 in men; 39,688 gonorrhea tests in women and 106,088 in men; and 36,445 syphilis serologic tests in women and 155,054 in men entering corrections facilities during 2006.

Chlamydia

Overall, positivity was higher in women than in men for almost all age groups.

Adolescent Men - In adolescent men entering 83 juvenile corrections facilities, median chlamydia positivity by facility was 5.3% (range: 0.5% to 46.7%) (Table AA). In men 12 to 18 years of age entering these juvenile corrections facilities, the overall chlamydia positivity was 6.4% (Figure BB). Chlamydia positivity increased from 0.4% for adolescent men aged 12 years to 9.5% for those aged 18 years.

Adolescent Women - In adolescent women entering 57 juvenile corrections facilities, median chlamydia positivity by facility was 14.2% (range: 2.8% to 29.4%); positivity was greater than 10% in almost all facilities reporting data (Table AA). In women 12 to 18 years of age entering these juvenile corrections facilities, the overall chlamydia positivity was 14.3% (Figure BB). Positivity in women increased from 6.6% for those aged 12 years to 15.6% for those aged 16 years and, then, declined to 11.8% for those aged 18 years.

Men - In men entering 59 adult corrections facilities, the median chlamydia positivity by facility was 8.8% (range 0.9% to 26.7%) (Table BB). Positivity in young adult men (< 25 years) in these facilities was higher than that observed in adolescent men attending juvenile facilities (Figure CC). Chlamydia positivity decreased with age from 10.3% for those younger than 20 years of age to 2.5% for those older than 34 years.

Women - In women entering 39 adult corrections facilities, median positivity for chlamydia by facility was 8.3% (range: 1.3% to 22.3%) (Table BB). Overall, in women entering these adult corrections facilities, the chlamydia positivity was 9.3% (Figure CC). Chlamydia positivity decreased with age from 19.1% for those younger than 20 years to 3.8% for those older than 34 years. Chlamydia positivity in women entering adult correction facilities was significantly lower than that in women entering juvenile corrections facilities. However, chlamydia positivity in women younger than 20 years of age attending adult corrections facilities was higher than that in women attending juvenile corrections facilities.

Gonorrhea

Overall, positivity in women was uniformly higher than in men for all age groups.

Adolescent Men - The median positivity for gonorrhea by facility in men entering 62 juvenile corrections facilities was 0.9% (range: 0.0% to 4.5%) (Table CC). The overall positivity was 1.3% in men 12 to 18 years of age attending these facilities. (Figure DD). Gonorrhea positivity increased with age from 0.5% for those aged 12 years to 2.0% for those aged 18.

Adolescent Women - The median positivity for gonorrhea by facility in women entering 37 juvenile corrections facilities was 3.8% (range: 0.0% to 12.2%) (Table CC). In women 12 to 18 years of age entering these juvenile corrections facilities, the overall gonorrhea positivity was 5.2% (Figure DD). Gonorrhea positivity did not vary by age.

Men - In men entering 52 adult corrections facilities, the median gonorrhea positivity was 2.3% (range: 0.0% to 18.3%) (Table DD). Overall gonorrhea positivity for men attending these facilities was 2.1%. Gonorrhea positivity was highest in men aged 20 to 24 years at 2.7%, declining with age to 1.4% in men older than 34 years. Men aged younger than 20 years attending adult facilities had higher gonorrhea positivity than men attending juvenile detention facilities.

Women - In women entering 35 reporting adult facilities, the median positivity by facility was 4.2% (range: 0.0% to 10.9%) (Table DD). Overall, in women entering adult corrections facilities, the gonorrhea positivity was 4.5% (Figure EE).

Gonorrhea positivity decreased with age from 8.4% for those younger than 20 years to 2.4% for those older than 34 years. Women younger than 20 years attending adult facilities had higher gonorrhea positivity than women attending juvenile detention facilities.

Syphilis

Adolescent Men - The median syphilis serologic positivity by facility was 0.0% (range: 0.0% to 3.5%) in adolescent men entering 15 juvenile corrections facilities (Table EE).

Adolescent Women - The median syphilis serologic positivity by facility was 1.4% (range: 0.4% to 1.8%) in adolescent women entering five juvenile corrections facilities (Table EE).

Men - In men entering 58 adult corrections facilities, the median syphilis serologic positivity by facility was 1.4% (range: 0.0% to 7.8%) (Table FF).

Women - In women entering 32 adult corrections facilities, the median serologic positivity by facility was 3.9% (range: 0.0% to 21.7%) (Table FF).

¹ Heimberger TS. Chang HG. Birkhead GS. DiFerdinando GD. Greenberg AJ. Gunn R. Morse DL. High prevalence of syphilis detected through a jail screening program. A potential public health measure to address the syphilis epidemic. Arch Intern Med 1993;153:1799-1804.

² Centers for Disease Control and Prevention. Syphilis screening among women arrestees at the Cook County Jail – Chicago, 1996. MMWR 1998;47:432-3.

³ Mertz KJ, Schwebke JR, Gaydos CA, Beideinger HA, Tulloch SD, Levine WC. Screening women in jails for chlamydial and gonococcal infection using urine tests: Feasibility, acceptability, prevalence and treatment rates. Sexually Transmitted Diseases 2002;29:271-276.

⁴ Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the United States identified in corrections facilities, 1999–2002. Sexually Transmitted Diseases 2004;31:360-364.

⁵ Blank S, McDonnell DD, Rubin SR et al. New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women’s correctional setting. Sexually Transmitted Diseases 1997; 24:218-26.

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Page last modified: November 13, 2007
Page last reviewed: November 13, 2007
Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention