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Screening for Sexually Transmitted Diseases in Short-Term Correctional Institutions: Summary of Evidence Reviewed for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Spaulding, Anne C. MD, MPH*; Miller, Jamie MPH; Trigg, Bruce G. MD; Braverman, Paula MD§; Lincoln, Thomas MD; Reams, Patricia N. MD; Staples-Horne, Michelle MD, MPH**; Sumbry, Anitra MPH††; Rice, Dana DrPH‡‡; Satterwhite, Catherine Lindsey PhD, MSPH, MPH§§

doi: 10.1097/01.olq.0000431353.88464.ab

Young persons entering US jails and youth detention facilities have high rates of sexually transmitted diseases (STDs). The Centers for Disease Control and Prevention added STD screening guidelines specific to correctional settings to the 2010 STD Treatment Guidelines. This article summarizes published evidence from 1990 to 2009 used to develop the recommendations. The literature supports routine screening of adolescents and young women (aged ≤35 years, or on the basis of local institutional prevalence data) for chlamydia and gonorrhea because of high prevalence and the subsequent risk of adverse reproductive outcomes. Chlamydia positivity among young women (aged <20 years) in juvenile detention facilities and adult facilities is more than 14%. Men in correctional settings are also at high risk for chlamydia and gonorrhea. Among boys in juvenile detention facilities, chlamydia positivity is estimated at 6.6%; among young men in adult facilities, positivity is 16.6%. Screening men (to reduce sequelae among women) should be considered based on local epidemiology and resource availability. Syphilis screening is not strongly supported in published literature because of low prevalence and is not routinely recommended; however, some screening may be warranted based on local prevalence. Although there is a great diversity in the organization of correctional facilities, implementation of screening recommendations is possible owing to improvements in test technology (urine specimens) and through integration of a standard screening protocol. Based on the high burden of disease and substantial opportunities to reach a high-risk population, correctional facilities are important venues to target efforts to control STDs.

This study summarizes evidence supporting the 2010 Centers for Disease Control and Prevention recommendations for sexually transmitted disease screening and management for individuals in jails and juvenile detention facilities—strategic places for finding chlamydia and gonorrhea.

From the *Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; †National Coalition of STD Directors, Washington, DC; ‡Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM; §Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH; ¶Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA; ∥Department of Pediatrics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA; **Georgia Department of Juvenile Justice, Decatur, GA; ††Ohio State University College of Medicine, Columbus, OH; ‡‡Departments of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI; and §§National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA

The authors wish to thank MPH candidates Brittany Burgess, Jessica Cook, Meghan Donohue, Amelia Jazwa, Michelle Leon, and Christopher Simpson of the Rollins School of Public Health of Emory University, who assisted with literature review for this work.

The findings and conclusions in this report have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Source of support: None declared.

There are no conflicts of interest to report.

Correspondence: Anne Spaulding, MD, MPH, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Room 3033, Atlanta, GA 30322. E-mail:

Received for publication August 1, 2012, and accepted May 14, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association