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 Screening for chlamydia, gonorrhea, and syphilis at intake offers an opportunity to identify infections, prevent complications, and reduce transmission in the community. In cities where routine syphilis screening in jails occurs, a substantial percentage of all reported cases is identified in jails.⁴ Collecting 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 2002, seven states reported syphilis screening data from corrections facilities to CDC. Twenty-eight states reported chlamydia screening data and nineteen states reported gonorrhea screening data from corrections facilities. These data were reported as part of either 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 170,000 syphilis tests in men and 31,000 in women; 150,000 chlamydia tests in men and 44,000 in women; and 123,000 gonorrhea tests in men and 37,000 in women.
  
• The median percentage of reactive syphilis tests by facility was 7.1% (range 0.6% to 19.0%) for women entering 10 adult corrections facilities and 1.0% for adolescent women entering 1 juvenile corrections facility (Figure GG); it was 3.4% (range 0.9% to 5.2%) among men at 10 adult corrections facilities and 0.1% in men at 1 juvenile facility (Figure HH). The percentage of reactive syphilis tests representing cases of syphilis varied from facility to facility.
  
• Chlamydia positivity was higher in women screened in juvenile corrections facilities than in adult corrections facilities. In adolescent women entering juvenile corrections facilities, the median facility positivity for chlamydia was 16.7% (range 6.3% to 28.3%); positivity was greater than 10% in 31 of 32 facilities reporting data (Figure II). In adult women entering 17 corrections facilities, the median positivity for chlamydia was 3.2% (range 0.8% to 14.5%).
  
• The median chlamydia positivity in adolescent men entering 42 juvenile corrections facilities was 6.0% (range 0.6% to 15.7%) (Figure JJ). In adult men entering 6 corrections facilities, the median positivity was 5.3% (range 3.5% to 8.0%).
  
• The median positivity for gonorrhea in women entering 22 juvenile corrections facilities was 5.6% (range 0.6% to 12.4%); positivity was greater than 4% in 16 of 22 juvenile corrections facilities (Figure KK). In adult women entering 14 corrections facilities, the median positivity for gonorrhea was 2.3% (range 0.2% to 6.2%).
  
• The median positivity for gonorrhea in adolescent men entering 25 juvenile corrections facilities was 1.7% (range 0.3% to 4.5%) (Figure LL). In adult men entering six facilities, the median positivity was also 1.7% (range 0.7% to 3.0%).
  

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 RH, Scholl DT, Shane SM, Lemoine AL, Farley TA. Screening for syphilis in arrestees: Usefulness for community-wide syphilis surveillance and control. Sex Transm Dis 2002;29:150-156.