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Screening Women in Jails for Chlamydial and Gonococcal Infection Using Urine Tests: Feasibility, Acceptability, Prevalence, and Treatment Rates


Sexually Transmitted Diseases: May 2002 - Volume 29 - Issue 5 - p 271-276

Background Women entering jails are at high risk for sexually transmitted diseases; however, screening for chlamydial and gonococcal infection is not routinely performed in most jails. New urine tests have made it easier to screen for these infections in nonclinical settings.

Goal The feasibility and acceptability of urine-based screening for women entering jails and the prevalence of and treatment rates for chlamydial and gonococcal infections were determined.

Study Design Women entering jails in Chicago, Illinois; Birmingham, Alabama; and Baltimore, Maryland, who signed consent forms were tested for chlamydial and gonococcal infection by means of the urine ligase chain reaction assay. Those testing positive were treated in jail; health department staff members attempted to contact those already released.

Results Most women who were approached agreed to be tested (range, 87–98%, depending on city), and most of these women provided a specimen (range, 92–100%). Among 5364 women aged 16 to 75 years who were tested, the prevalence of chlamydial and gonococcal infections was high, especially among those <25 years of age (range, 15.3–21.5% for chlamydial infection and 8.2–9.2% for gonorrhea, depending on city). The majority of women testing positive were treated in jail or outside of jail (61–85%).

Conclusions Screening women in jails for chlamydial and gonococcal infection with urine tests is feasible, is acceptable to most women, and leads to detection and treatment of many infections. Routine screening should reduce medical complications in this population and should prevent transmission in the community, given that many women are soon released.

Among women entering jails in three counties in the United States, the prevalence of chlamydial and gonococcal infection, as indicated by urine testing, was high, especially among those younger than age 25 years. The majority of women who tested positive were treated.

From the *Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Atlanta, Georgia; †Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; ‡Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Chicago Department of Public Health, Chicago, Illinois; and ∥Maryland Department of Health and Mental Hygiene, Baltimore, Maryland

The authors thank Dr. Connie Mennella, of Cermak Health Services, James Dickes and Dr. Romina Kee, of the Chicago Department of Public Health (CDPH), Richard Meriwether, of the University of Alabama at Birmingham (UAB), and David Akers, of the Maryland Department of Health and Mental Hygiene (DHMH), for implementing the study; Jennifer Tawes, of Johns Hopkins University, Anne Evens and Steve Mier, of CDPH, and Margo Jones and Willa Sanders, of UAB, for compiling data; Susan Clark, of the Jefferson County Health Department, Theodius Mitchell, of DHMH, and Joan Crawford, M. L. Hunter, and Lauren MacDonald, of CDPH, for locating and treating women; Dr. Edward Hook, of UAB, and Charles Rabins, of the Illinois Department of Health, for providing laboratory services; and Dr. Carolyn Black, Billy Litchfield, and Kathleen Hutchins, of the Centers for Disease Control and Prevention (CDC), for technical assistance on laboratory, protocol, and data issues, respectively. They especially thank Richard Voigt, of the CDC, for his help in implementing the study and his untiring efforts to promote screening for STDs in jails across the country.

Supported by the Office of Women's Health, CDC.

Presented in part at the 12th Meeting of the International Society of STD Research (Denver, CO, 1999) and published in part in MMWR Morb Mortal Wkly Rep 1999; 48(Sept 17):793–796.

Correspondence: Kristen Mertz, MD, Georgia Department of Human Resources, 2 Peachtree Street NW, 14th Floor, Atlanta, GA 30303. E-mail:

Reprints: Epidemiology and Surveillance Branch, Division of STD Prevention, CDC, MS E-02, 1600 Clifton Road NE, Atlanta, GA 30333.

Received for publication April 25, 2001,

revised August 30, 2001, and accepted September 7, 2001.

© Copyright 2002 American Sexually Transmitted Diseases Association