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 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 Reduction of chlamydia and gonorrhea in the community may also result from chlamydia and gonorrhea screening and treatment in jails.⁶ 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 2005, STD screening data from corrections facilities were reported from 32 states for chlamydia, 29 states for gonorrhea, and 13 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 Regional Infertility Prevention Project (IPP). IPP provided CDC with line-listed data for chlamydia, gonorrhea, and syphilis (syphilis line-listed data only from San Francisco and Los Angeles).

The tables and figures shown in this section represent 58,977 chlamydia tests in women and 141,132 in men; 49,675 gonorrhea tests in women and 120,676 in men; and 69,661 syphilis serologic tests in women and in 226,619 men entering corrections facilities during 2005.

Chlamydia

In adolescent women entering 57 juvenile corrections facilities, the median chlamydia positivity by facility was 14.2% (range 3.7% to 33.7%); positivity was uniformly high (greater than 10%) in all facilities reporting data (Table AA). Positivity in women was also uniformly higher than in men. In adolescent men entering 87 juvenile corrections facilities, the median chlamydia positivity was 6.0% (range 0.0% to 44.8%).

In women 12 to 19 years of age entering juvenile corrections facilities, the overall chlamydia positivity was 16.3% (Figure CC). Positivity was high (greater than 10%) for all ages and uniformly higher in women than in men. Positivity in women increased from 12.8% for those aged 12 years to 17.2% for those aged 16 years and, then, declined to 16.1% for those aged 19 years. In men 12 to 19 years of age entering juvenile corrections facilities, the overall chlamydia positivity was 6.6%. Chlamydia positivity increased from 1.7% for those aged 12 years to 11.5% for those aged 19 years.

In women entering 38 adult corrections facilities, the median positivity for chlamydia by facility was 7.4% (range 1.7% to 21.4%) (Table BB). In men entering 41 adult corrections facilities, the median chlamydia positivity was 8.1% (range 2.3% to 20.8%).

In women entering adult corrections facilities, the overall chlamydia positivity was 8.9% (Figure DD). Chlamydia positivity decreased with age from 19.1% for those aged < 20 years to 3.9% for those aged > 34 years. Similar trends were also observed in adult men. Positivity was higher in women than in men for all age groups. Positivity in young adult women (< 25 years) was similar to positivity in adolescent women, but positivity in young adult men (< 25 years) was higher than in adolescent men. Although overall chlamydia positivity in women entering adult correction facilities was significantly lower than in women entering juvenile corrections facilities, chlamydia positivity in women aged < 20 years attending adult corrections facilities was higher than in women attending juvenile corrections facilities.

Gonorrhea

The median positivity by facility for gonorrhea in women entering 38 juvenile corrections facilities was 4.7% (range 0.9% to 14.2%). Positivity in women was uniformly higher than in men. The median positivity for gonorrhea in men entering 65 juvenile corrections facilities was 1.0% (range 0.0% to 19.0%) (Table CC).

In women 12 to 19 years of age entering juvenile corrections facilities, the overall gonorrhea positivity was 5.9% (Figure EE). Gonorrhea positivity increased with age from 2.2% for those aged 12 years to 6.5% for those aged 16 years, and then, declined to 4.8% for those aged 19 years. Positivity in women was higher than in men for all ages.

In women entering 33 adult facilities, the median positivity by facility was 2.8% (range 0.0% to 13.8%) (Table DD). In men entering 35 adult corrections facilities, the median gonorrhea positivity was 2.3% (range 0.0% to 11.8%).

In women entering adult corrections facilities, the overall gonorrhea positivity was 3.9%. Gonorrhea positivity decreased with age from 7.3% for those aged < 20 years to 2.2% for those aged > 34 years (Figure FF). A similar trend was also observed in adult men. Positivity in women was higher than in men for all age groups. Women aged < 20 years attending adult facilities had higher gonorrhea positivity than women attending juvenile detention facilities. This was also true for men.

Syphilis

The median syphilis serologic positivity (RPR quantitative test) by facility was 1.3% (range 0.0% to 14.6%) in adolescent women entering nine juvenile corrections facilities and 0.6% (range 0.0% to 6.9%) in adolescent men entering 8 juvenile corrections facilities (Table EE).

In women entering 23 adult corrections facilities the median serologic positivity was 5.2% (range 1.2% to 12.6%) (Table FF).

In men at 32 adult corrections facilities, the median syphilis serologic positivity was 3.7% (range 0.4% to 9.5%)

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.

⁶ Barry P, Kent CK, Scott KC, Goldenson J, Klausner JD. Sexually transmitted infection screening in county jails is associated with a decrease in community prevalence of gonorrhea and chlamydia – San Francisco, 1997–2004 [Abstract no. D1f]. In: Program and abstracts of the 2006 National STD Prevention Conference, Jacksonville, Florida, May 8-11, 2006.