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STD Screening and Treatment During Jail Intake: The National Syphilis Elimination Perspective

Beltrami, John F. MD, MPH&TM; Williams, Samantha PhD; Valentine, Jo MSW

doi: 10.1097/01.olq.0000256435.68989.7a
Letter to the Editor

Division of STD Prevention, Centers for Disease Control; Atlanta, Georgia

Correspondence: John F. Beltrami. E-mail: hzb3@cdc.gov.

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To the Editor:

In this era of evidence-based public health, an iterative process that uses data to inform, evaluate, and modify interventions and other activities such as prevention, surveillance, and field work is critical. In the October 2006 issue of Sexually Transmitted Diseases, Trick et al. published evidence-based public health work directed towards arrestees,1 who are a sexually transmitted disease (STD) core group.2 Due to limited funds, universal male screening for chlamydia and gonorrhea in all ages during intake at Cook County Jail was not sustainable. Using results from a survey to determine which correlates might best inform a selective screening and treatment program, jail staff plan to screen males who are less than 26 years of age.

This work represents advanced public health decision making and practice that others should consider emulating. Because a high proportion of arrestees are released from jail so quickly after incarceration (e.g., about 50% within 48 hours),3–5 screening programs that approach inmates several days or weeks after arrest would be expected to have less impact on a local epidemic than STD screening at intake/booking. Screening at intake/booking would reach a maximal number of high-risk persons just before they reenter their community. Screening alone, however, will do little to control an epidemic if there is no direct link to treatment. Programs that link screening and treatment for STDs in intake/booking areas (including rapid protocols)6–10 are feasible, cost-effective, and detect high numbers of infected persons.3,4,6–11 Of 119 infected arrestees who were surveyed in the Trick et al. study, 54 (45%) were treated before release. Given the difficulty of locating an infected person for treatment after release and the possibility of ongoing STD transmission, collaboration between correctional facilities and health departments is essential to improve overall treatment rates.

The work by Trick et al. is consistent with the 2006 National Plan to Eliminate Syphilis from the United States (SEP), which promotes evidence-based public health and, when appropriate, integration of syphilis and other STD control efforts.12 Of 75 recommended SEP activities, 20 relate to corrections and include screening, treatment, behavioral interventions, evaluation, surveillance, data dissemination, case and partner finding, training, collaboration, and policy development. Because of continually high rates of chlamydia and gonorrhea in the United States and recent increases of syphilis,13 effective testing and treatment for syphilis and other STDs should be considered in all correctional facilities,3,4,14 particularly in areas with heterosexual syphilis epidemics.15 Important activities that support such STD screening and treatment include ensuring timely, complete corrections-related case and laboratory reporting and a continuity of services established before release into the community.3,4,16 In the coming year, SEP staff will be preparing written guidance for the implementation of jail screening and treatment programs that will be syphilis specific but relevant to other STDs such as chlamydia and gonorrhea. The guidance will help health departments, jails, and their partners decrease community STD rates and better address a group of persons in dire need of STD services.

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References

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