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 2011, STD screening data from corrections facilities were reported in 33 states and Puerto Rico for chlamydia and in 32 states and Puerto Rico for gonorrhea. Line-listed (i.e., case-specific) data for chlamydia and gonorrhea are provided to CDC through the regional infertility prevention infrastructure. The figures and tables presented in this section represent 40,211 chlamydia tests of women (19,081 from juvenile corrections facilities and 21,130 from adult facilities), 96,917 chlamydia tests of men (64,350 from juvenile facilities and 32,567 from adult facilities), 37,754 gonorrhea tests of women (16,991 from juvenile facilities and 20,763 from adult facilities), and 93,193 gonorrhea tests of men (61,080 from juvenile facilities and 32,113 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 118 juvenile corrections facilities, the overall chlamydia positivity was 7.4% (Figure BB). Chlamydia positivity ranged from 1.0% for adolescent males aged 12 years to 10.2% for those aged 18 years.

Females in Juvenile Corrections Facilities—Among females aged 12–18 years entering 63 juvenile corrections facilities, the overall chlamydia positivity was 15.7% (Figure BB). Positivity ranged from 5.4% for females aged 12 years to 17.3% for those aged 17 years.

Men in Adult Corrections Facilities—Among men entering 49 adult corrections facilities in 2011, positivity in men aged younger than 20 years (12.6%) was higher than the overall prevalence observed in adolescent males entering juvenile facilities (7.4%) (Figure CC). Chlamydia positivity decreased with age, from 12.6% for those aged younger than 20 years to 1.6% for those aged older than 34 years. Overall chlamydia positivity among adult men entering corrections facilities in 2011 was 7.1%.

Women in Adult Corrections Facilities—Among women entering 34 adult corrections facilities in 2011, positivity was 7.4% (Figure CC). Chlamydia positivity decreased with age, from 16.8% for those aged younger than 20 years to 2.5% for those aged older than 34 years. Overall chlamydia positivity in women entering adult corrections facilities (7.4%) was substantially lower than that in adolescent females entering juvenile corrections facilities (15.7%). However, chlamydia positivity among women aged younger than 20 years entering adult corrections facilities was similar to that among females 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 115 juvenile corrections facilities in 2011 was 1.2% (Figure DD). Positivity increased with age, from 0.1% for those aged 12 years to 2.3% for those aged 18 years.

Females in Juvenile Corrections Facilities—The overall gonorrhea positivity for adolescent females entering 57 juvenile corrections facilities in 2011 was 4.4% (Figure DD). Positivity ranged from 2.5% for those aged 13 years to 4.9% for those aged 16 years.

Men in Adult Corrections Facilities—The overall gonorrhea positivity for men entering 49 adult corrections facilities in 2011 was 1.0% (Figure EE). Positivity was highest in men aged younger than 20 years (1.7%) and declined with age to 0.4% in men aged older than 34 years. Men aged younger than 20 years entering adult facilities (1.7%) had a similar gonorrhea positivity compared with males entering juvenile corrections facilities (1.2%).

Women in Adult Corrections Facilities—Among women entering 32 adult corrections facilities in 2011, overall gonorrhea positivity was 1.8% (Figure EE). Positivity decreased with age, from 4.3% among those aged younger than 20 years to 0.8% among those aged older than 34 years. Women aged younger than 20 years entering adult facilities (4.3%) had a similar gonorrhea positivity compared with females entering juvenile corrections facilities (4.4%).

Syphilis

In 2011, reports of P&S syphilis cases from corrections facilities accounted for 6% of P&S syphilis among MSW, 3% among women, and 1% among MSM (Figure 49).

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.