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 2008, STD screening data from corrections facilities were reported from 38 states and Puerto Rico for chlamydia, 36 states and Puerto Rico for gonorrhea. IPP provided CDC with line-listed data for chlamydia and gonorrhea. Syphilis data were reported to CDC by local and state STD prevention programs.

The figures and tables shown in this section represent 50,968 chlamydia tests in women and 129,548 in men and 42,124 gonorrhea tests in women and 114,984 in men.

Chlamydia

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

Males in Juvenile Corrections—In men 12 to 18 years of age entering 128 juvenile corrections facilities, the overall chlamydia positivity was 6.4% (Figure CC). Chlamydia positivity increased from 1.0% for adolescent men aged 12 years of age to 8.7% for those 18 years of age.

Females in Juvenile Corrections—In women 12 to 18 years of age entering 82 juvenile corrections facilities, the overall chlamydia positivity was 14.5% (Figure CC). Positivity in women increased from 4.6% for those 12 years of age to 16.4% for those 16 years of age and remained high for women 17 to 18 years of age.

Men in Jails—In men entering 62 adult corrections facilities in 2008, positivity in men less than 20 years of age (10.6%) was higher than the overall prevalence observed in adolescent men entering juvenile facilities (6.4%) (Figure DD). Chlamydia positivity decreased with age from 10.6% for those younger than 20 years of age to 2.2% for those older than 34 years. Overall positivity among adult men entering corrections facilities in 2008 was 7.0%.

Women in Jails—In women entering 41 adult corrections facilities in 2008, the chlamydia positivity was 8.5% (Figure DD). Chlamydia positivity decreased with age from 16.5% for those younger than 20 years of age to 3.4% for those older than 34 years of age. Overall chlamydia positivity in women entering adult corrections facilities (8.5%) was substantially lower than that in adolescent women entering juvenile corrections facilities (14.5%). 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.

Males in Juvenile Corrections—The overall positivity for adolescent men entering 110 juvenile corrections facilities in 2008 was 1.1% (Figure EE). Gonorrhea positivity increased with age from 0.2% for those 12 years of age to 1.7% for those 18 years of age.

Females in Juvenile Corrections—The overall gonorrhea positivity was 4.6% in women entering 63 juvenile corrections facilities in 2008 (Figure EE). In 2008, gonorrhea positivity increased with age from 1.2% among 12-year-olds to 5.2% among young women 15 years of age and remained high for women 16 to 18 years of age.

Men in Jails—Overall gonorrhea positivity for men attending 58 adult corrections facilities in 2008 was 1.4% (Figure FF). Gonorrhea positivity was highest in men younger than 20 years of age at 2.0%, declining with age to 0.7% in men older than 34 years of age. Men younger than 20 years of age attending adult facilities had higher gonorrhea positivity than men attending juvenile corrections facilities.

Women in Jails—Overall, in women entering 37 adult corrections facilities in 2008, the gonorrhea positivity was 2.6% (Figure FF). Gonorrhea positivity decreased with age from 4.0% among those younger than 20 years of age to 1.4% among those older than 34 years of age. Women younger than 20 years of age attending adult facilities had similar gonorrhea positivity as young women attending juvenile corrections facilities.

Syphilis

In 2007, reports of P&S syphilis from correctional facilities accounted for 7% of P&S syphilis among heterosexual men, 6% among women, and 1% among MSM. In 2008, reports of P&S syphilis from correctional facilities accounted for 7% of P&S syphilis among heterosexual men, 5% among women, and 1% among MSM (Figure 42).

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 2009;36: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:S3-S7.

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. 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;29:271–276.