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 community.
A substantial proportion of all early syphilis cases are reported
from corrections facilities.4Collecting positivity
data and analyzing trends in STD prevalence in this population
can provide one method for monitoring trends in STD prevalence
in the community.4
Observations
In 2003, STD screening data from corrections facilities
were reported from 34, 23, and 10 states on chlamydia, gonorrhea,
and syphilis, respectively. These data were reported as
part of the Jail STD Prevalence Monitoring Project, the
Adolescent Women Reproductive Health Monitoring Project,
the Syphilis Elimination Initiative, the Regional Infertility
Prevention Program, or in response to CDC's request
for data.
The maps shown in this section represent approximately
114,000 chlamydia tests in men and 53,000 in women; 82,000
gonorrhea tests in men and 39,000 in women; and 186,000
syphilis tests in men and 38,000 in women entering corrections
facilities during 2003.
Chlamydia positivity was higher in women screened in juvenile
corrections facilities than in adult corrections facilities.
In adolescent women entering 48 juvenile corrections facilities,
the median facility positivity for chlamydia was 15.9% (range
2.7% to 33.5%); positivity was greater than 10% in 37 of
48 facilities reporting data (Figure
JJ). In adult women
entering 36 corrections facilities, the median positivity
for chlamydia was 6.3% (range 1.3% to 19.2%).
The median chlamydia positivity in adolescent men entering
64 juvenile corrections facilities was 5.4% (range 1.3%
to 12.9%) (Figure KK). In adult men entering 37 corrections
facilities, the median positivity was 6.4% (range 1.0% to
27.1%).
The median positivity for gonorrhea in women entering
28 juvenile corrections facilities was 5.7% (range 0.5%
to 15.9%); positivity was greater than 4% in 17 of juvenile
corrections facilities (Figure
LL). In adult women entering
22 corrections facilities, the median positivity for gonorrhea
was 1.8% (range 0.4% to 10.1%).
The median positivity for gonorrhea in adolescent men
entering 35 juvenile corrections facilities was 1.3% (range
0.3% to 4.5%) (Figure MM). In adult men entering 20 facilities,
the median positivity was 1.8% (range 0.3% to 10.2%).
The median percentage of reactive syphilis tests by facility
was 7.5% (range 2.4% to 10.7%) for women entering 11 adult
corrections facilities and 0.5% (range 0.1% to 1.0%) for
adolescent women entering 4 juvenile corrections facilities
(Figure NN); the median percentage was 2.3% (range 0.2%
to 8.3%) in men at 13 adult corrections facilities and 0.3%
in men at 6 juvenile facilities (Figure
OO). The percentage
of reactive syphilis tests representing cases of syphilis
varied from facility to facility.
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. Sex Transm Dis 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. Sex Transm Diseases 2004;31:360-364.