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 location with high syphilis incidence suggested that screening and treatment of female inmates for syphilis may reduce 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 2010, STD screening data from corrections facilities were reported in 36 states and Puerto Rico for chlamydia and gonorrhea. Line-listed (i.e., case-specific) data for chlamydia and gonorrhea are provided to CDC through the Infertility Prevention Project (IPP). The figures and tables presented in this section represent 47,489 chlamydia tests of women (25,089 from juvenile corrections facilities and 22,400 from adult facilities), 112,133 chlamydia tests of men (77,027 from juvenile facilities and 35,106 from adult facilities), 43,319 gonorrhea tests of women (21,401 from juvenile facilities and 21,918 from adult facilities), and 106,371 gonorrhea tests of men (72,446 from juvenile facilities and 33,925 from adult facilities). Syphilis data from notifiable disease surveillance are reported to CDC by local and state STD prevention programs.

Chlamydia

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

Males in Juvenile Corrections Facilities—Among males aged 12–18 years entering 128 juvenile corrections facilities, the overall chlamydia positivity was 6.9% (Figure BB). Chlamydia positivity ranged from 1.5% for adolescent males aged 12 years to 10.0% for those aged 18 years.

Females in Juvenile Corrections Facilities—Among females aged 12–18 years entering 73 juvenile corrections facilities, the overall chlamydia positivity was 15.3% (Figure BB). Positivity ranged from 7.2% for females aged 12 years to 17.0% for those aged 16 years.

Men in Adult Corrections Facilities—Among men entering 55 adult corrections facilities in 2010, positivity in men aged younger than 20 years (11.7%) was higher than the overall prevalence observed in adolescent males entering juvenile facilities (6.9%) (Figure CC). Chlamydia positivity decreased with age, from 11.7% for those aged younger than 20 years to 1.9% for those aged older than 34 years. Overall chlamydia positivity among adult men entering corrections facilities in 2010 was 6.7%.

Women in Adult Corrections Facilities—Among women entering 32 adult corrections facilities in 2010, positivity was 6.9% (Figure CC). Chlamydia positivity decreased with age, from 15.3% for those aged younger than 20 years to 2.4% for those aged older than 34 years. Overall chlamydia positivity in women entering adult corrections facilities (6.9%) was substantially lower than that in adolescent females entering juvenile corrections facilities (15.3%). However, chlamydia positivity among women aged younger than 20 years entering adult corrections facilities was similar to that among women entering juvenile corrections facilities.

Gonorrhea

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

Males in Juvenile Corrections Facilities—The overall gonorrhea positivity for adolescent males entering 123 juvenile corrections facilities in 2010 was 1.1% (Figure DD). Positivity increased with age, from 0.1% for those aged 12 years to 2.1% for those aged 18 years.

Females in Juvenile Corrections Facilities—The overall gonorrhea positivity for adolescent females entering 60 juvenile corrections facilities in 2010 was 4.2% (Figure DD). Positivity generally increased with increasing age, from 2.8% for those aged 12 years to 5.1% of those aged 18 years.

Men in Adult Corrections Facilities—The overall gonorrhea positivity for men entering 55 adult corrections facilities in 2010 was 1.0% (Figure EE). Positivity was highest in men aged younger than 20 years (1.6%) and declined with age to 0.4% in men aged older than 34 years. Men aged younger than 20 years entering adult facilities (1.6%) had higher gonorrhea positivity than males entering juvenile corrections facilities (1.1%).

Women in Adult Corrections Facilities—Among women entering 32 adult corrections facilities in 2010, overall gonorrhea positivity was 1.9% (Figure EE). Positivity decreased with age, from 3.7% among those aged younger than 20 years to 0.9% among those aged older than 34 years. Women aged younger than 20 years entering adult facilities (3.7%) had lower gonorrhea positivity than females entering juvenile corrections facilities (4.2%).

Syphilis

In 2010, reports of P&S syphilis cases from correctional facilities accounted for 5% of P&S syphilis among MSW, 3% among women, and 1% among MSM (Figure 46).

1 Heimberger TS, Chang HG, Birkhead GS, DiFerdinando GD, Greenberg AJ, Gunn R, et al. High prevalence of syphilis detected through a jail screening program. A potential public health measure to address the syphilis epidemic. Arch Intern Med. 1993;153:1799-804.

2 Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov MR, et al. Chlamydia trachomatis and Neisseria gonorrhoeae prevalence and coinfection in adolescents entering selected US juvenile detention centers, 1997–2002. Sex Transm Dis. 2005;29:255-59.

3 Joesoef MR, Weinstock HS, Kent CK, Chow JM, Boudov MR, Parvez FM, et al. Sex and age correlates of chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: implications for screening policy. Sex Transm Dis. 2009;36(Suppl 2):S67-71.

4 Satterwhite CL, Joesoef MR, Datta SD, Weinstock H. Estimates of Chlamydia trachomatis infections among men: United States. Sex Transm Dis. 2008;35(Suppl 11):S3-7.

5 Blank S, McDonnell DD, Rubin SR, Neal JJ, Brome MW, Masterson MB, et al. New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women’s correctional setting. Sex Transm Dis. 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 Transm Dis. 2004;29:271-76.