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 2009, STD screening data from corrections facilities were reported in 37 states and Puerto Rico for chlamydia, 36 states and Puerto Rico for gonorrhea, and 19 states for syphilis. Line-listed (i.e., case-specific) data for chlamydia and gonorrhea are provided to CDC through the Infertility Prevention Project (IPP). Aggregate syphilis data are reported to CDC by local and state STD prevention programs.The figures and tables presented in this section represent 50,968 chlamydia tests of women, 129,548 chlamydia tests of men, 42,124 gonorrhea tests of women, and 114,984 gonorrhea tests of men.

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 123 juvenile corrections facilities, the overall chlamydia positivity was 6.6% (Figure AA). Chlamydia positivity increased from 1.2% for adolescent males aged 12 years to 10.1% for those aged 18 years.

Females in Juvenile Corrections Facilities—Among females aged 12–18 years entering 83 juvenile corrections facilities, the overall chlamydia positivity was 14.8% (Figure AA). Positivity increased from 4.7% for females aged 12 years to 16.2% for those aged 16 years and remained high for women aged 17–18 years.

Men in Adult Corrections Facilities—Among men entering 59 adult corrections facilities in 2009, positivity in men younger than aged 20 years (10.8%) was higher than the overall prevalence observed in adolescent males entering juvenile facilities (6.6%) (Figure BB). Chlamydia positivity decreased with age, from 10.8% for those younger than aged 20 years to 1.8% for those older than 34 years. Overall positivity among adult men entering corrections facilities in 2009 was 6.6%.

Women in Adult Corrections Facilities—Among women entering 31 adult corrections facilities in 2009, positivity was 7.2% (Figure BB). Chlamydia positivity decreased with age, from 16.6% for those younger than aged 20 years to 2.3% for those older than aged 34 years. Overall chlamydia positivity in women entering adult corrections facilities (7.2%) was substantially lower than that in adolescent females entering juvenile corrections facilities (14.8%). However, chlamydia positivity among women younger than aged 20 years entering adult corrections facilities was higher than 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 118 juvenile corrections facilities in 2009 was 1.0% (Figure CC). Positivity increased with age, from 0.1% for those aged 12 years to 1.4% for those aged 18 years.

Females in Juvenile Corrections Facilities—The overall gonorrhea positivity for adolescent females entering 71 juvenile corrections facilities in 2009 was 3.9% (Figure CC). Positivity increased with age, from 1.8% for those aged 12 years to 4.4% for those aged 16 years and remained high for women aged 17–18 years.

Men in Adult Corrections Facilities—The overall gonorrhea positivity for men entering 57 adult corrections facilities in 2009 was 1.2% (Figure DD). Positivity was highest in men younger than aged 20 years (2.2%) and declined with age to 0.4% in men older than aged 34 years. Men younger than aged 20 years entering adult facilities had higher gonorrhea positivity than males entering juvenile corrections facilities.

Women in Adult Corrections Facilities—Among women entering 29 adult corrections facilities in 2009, overall gonorrhea positivity was 1.6% (Figure DD). Positivity decreased with age, from 3.1% among those younger than aged 20 years to 0.7% among those older than aged 34 years. Women younger than aged 20 years entering adult facilities had lower gonorrhea positivity than females entering juvenile corrections facilities.

Syphilis

In 2008, reports of P&S syphilis from correctional facilities accounted for 7% of P&S syphilis among men who have sex with women only (MSW), 5% among women, and 1% among men who have sex with men (MSM). In 2009, reports of P&S syphilis from correctional facilities accounted for 5% of P&S syphilis among MSW, 4% among women, and 1% among MSM (Figure 45).

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.