STDs in Persons Entering Corrections Facilities

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 Prevalence rates for chlamydia and gonorrhea in these settings are consistently among the highest observed in any venue.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. ⁶

Description of Population

In 2007, STD screening data from corrections facilities were reported from 37 states and Puerto Rico for chlamydia, 33 states and Puerto Rico for gonorrhea, and 19 states for syphilis. The Infertility Prevention Project (IPP) provided CDC with line-listed data for chlamydia and gonorrhea. Aggregate syphilis data were reported to CDC by local and state STD prevention programs.

The figures and tables shown in this section represent 47,042 chlamydia tests in women and 115,014 in men; 37,243 gonorrhea tests in women and 97,666 in men; and 50,666 syphilis serologic tests in women and 200,064 in men entering corrections facilities during 2007.

Chlamydia

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

Adolescent Men – In adolescent men entering 109 juvenile corrections facilities in 2007, the median chlamydia positivity by facility was 5.7% (range: 0.0% to 14.2%) (Table A). In men 12 to 18 years of age entering these facilities, the overall chlamydia positivity was 6.4% (Figure DD). Chlamydia positivity increased from 1.4% for adolescent men aged 12 years to 9.1% for those aged 18 years.

Adolescent Women – In adolescent women entering 73 juvenile corrections facilities in 2007, median chlamydia positivity by facility was 14.3% (range: 2.5% to 32.1%); positivity was greater than 10% in almost all facilities reporting data (Table A). In women 12 to18 years of age entering these facilities, the overall chlamydia positivity was 14.8% (Figure DD). Positivity in women increased from 6.8% for those aged 12 years to 15.7% for those aged 14 years and, then remained high for women aged 15 to 18 years.

Men – In men entering 51 adult corrections facilities in 2007, the median chlamydia positivity by facility was 7.7% (range: 0.5% to 25.3%) (Table D). Positivity in young adult men aged less than 25 years in these facilities (8.7%) was higher than the overall prevalence observed in adolescent men entering juvenile facilities (6.4%) (Figure EE). Chlamydia positivity decreased with age from 8.7% for those younger than 25 years of age to 1.8% for those older than 34 years. Overall positivity among adult men entering corrections facilities in 2007 was 6.2%

Women - In women entering 37 adult corrections facilities in 2007, median positivity for chlamydia by facility was 6.4% (range: 0.0% to 21.0%) (Table B). Overall, in women entering these facilities, the chlamydia positivity was 9.7% (Figure EE). Chlamydia positivity decreased with age from 18.6% for those younger than 20 years to 3.5% for those older than 34 years. Overall chlamydia positivity in women entering adult corrections facilities (9.7%) was significantly lower than that in adolescent women entering juvenile corrections facilities (14.8%). 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, gonorrhea positivity in women was uniformly higher than in men for all age groups.

Adolescent Men – The median positivity for gonorrhea by facility in adolescent men entering 90 juvenile corrections facilities in 2007 was 1.0% (range: 0.0% to 4.5%) (Table C). The overall positivity was 1.2% in men 12 to 18 years of age attending these facilities. (Figure FF). Gonorrhea positivity increased with age from 0.1% for those aged 12 years to 2.1% for those aged 18 years.

Adolescent Women – The median positivity for gonorrhea by facility in women entering 52 juvenile corrections facilities in 2007 was 5.3% (range: 0.0% to 13.9%) (Table C). In women 12 to 18 years of age entering these, the overall gonorrhea positivity was 5.6% (Figure FF). In 2007, gonorrhea positivity increased with age from 1.8% among 12-year-olds to 7.1% among young women aged 18 years of age.

Men – In men entering 42 adult corrections facilities in 2007, the median gonorrhea positivity was 1.7% (range: 0.0% to 10.7%) (Table D). Overall gonorrhea positivity for men attending these facilities was 1.6% (Figure GG). Gonorrhea positivity was highest in men aged 20 to 24 years at 2.2%, declining with age to 0.9% 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 31 adult corrections facilities in 2007, the median gonorrhea positivity by facility was 2.9% (range: 0.0% to 7.3%) (Table D). Overall, in women entering these facilities, the gonorrhea positivity was 3.7% (Figure GG). Gonorrhea positivity decreased with age from 6.5% for those younger than 20 years to 1.5% for those older than 34 years. Women younger than 20 years attending adult facilities had higher gonorrhea positivity than young women attending juvenile detention facilities.

Syphilis

Adolescent Men – In 2007, the median syphilis serologic positivity by facility was 0.1% (range: 0.0% to 0.9%) in adolescent men entering eight juvenile corrections facilities (Table E).

Adolescent Women – In 2007, the median syphilis serologic positivity by facility was 0.2% (range: 0.0% to 2.1%) in adolescent women entering five juvenile corrections facilities (Table E).

Men – In men entering 60 adult corrections facilities in 2007, the median syphilis serologic positivity by facility was 1.0% (range: 0.0% to 47.0%) (Table F).

Women – In women entering 36 adult corrections facilities in 2007, the median serologic positivity by facility was 2.1% (range: 0.0% to 28.0%) (Table F).

 

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 Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov MR, Brock J, Tulloch S, and the Jail Prevalence Monitoring Project. Chlamydia trachomatis and Neisseria gonorrhoeae prevalence and coinfection in adolescents entering selected US juvenile detention centers, 1997–2002. Sex Transm Dis 2005;29:255–259.

³ Joesoef MR, Weinstock HS, Kent CK, Chow JM, Boudov MR, Parvez FM, Cox T, Lincoln T, Miller JL, Sternberg MS and the Corrections STD Prevalence Monitoring Group. Sex and age correlates of chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: Implications for screening policy. Sex Transm Dis (in press)

⁴ Satterwhite CL, Joesoef MR, Datta SD,  Weinstock H. Estimates of Chlamydia trachomatis Infections among men: United States. Sex Trans Dis (in press)

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 Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the United States identified in corrections facilities, 1999–2002. Sex Trans Dis 2004; 29:271–276.