Letter to the Editor
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.
1. Trick WE, Kee R, Murphy-Swallow D, et al. Detection of chlamydial and gonococcal urethral infection during jail intake: Development of a screening algorithm. Sex Transm Dis 2006; 33:599–603.
2. Thomas JC, Tucker MJ. The development and use of the concept of a sexually transmitted disease core. J Infect Dis 1996; 174(Suppl 2): S134–S143.
3. National Commission on Correctional Health Care. The Health Status of Soon-to-be-Released Inmates: A Report to Congress. Chicago, IL: National Commission on Correctional Health Care, 2002.
4. Institute of Medicine. Committee on Prevention and Control of Sexually Transmitted Diseases. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Eng TR, Butler WT, eds. Washington, DC: National Academy Press, 1997.
5. CDC. Assessment of sexually transmitted diseases services in city and county jails—United States, 1997. MMWR 1998; 47:429–431.
6. CDC. Syphilis screening among women arrestees at the Cook County Jail—Chicago, 1996. MMWR 1998; 47:432–433.
7. Beltrami JF, Cohen DA, Hamrick JT, et al. Rapid screening and treatment for sexually transmitted diseases in arrestees: A feasible control measure. Am J Public Health 1997; 87:1423–1426.
8. Blank S, McDonnell DD, Rubin SR, 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; 24:218–226.
9. Tulloch S, Bohle E, Hoyt N, et al. A rapid intervention syphilis elimination project in a Maryland correctional facility in Baltimore (Abstract). Presented at 2000 National STD Prevention Conference, Dec 4–7, 2000, Milwaukee, WI.
10. Kahn RH, Scholl DT, Shane SM, et al. Screening for syphilis in arrestees: Usefulness for community-wide syphilis surveillance and control. Sex Transm Dis 2002; 29:150–156.
11. Silberstein GS, Coles FB, Greenberg A, et al. Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail. Sex Transm Dis 2000; 27:508–517.
12. CDC. Together we can: The national plan to eliminate syphilis from the United States. Atlanta, GA: US Department of Health and Human Services, 2006. Available at www.cdc.gov/stopsyphilis
13. CDC. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: US Department of Health and Human Services, 2005.
14. Cohen DA, Kanouse DE, Iguchi MY, et al. Screening for sexually transmitted diseases in non-traditional settings: A personal view. Int J STD AIDS 2005; 16:521–527.
15. Kahn RH, Voigt RF, Swint E, et al. Early syphilis in the United States identified in corrections facilities, 1999–2002. Sex Transm Dis 2004; 31:360–364.
16. Conklin TJ, Lincoln T, Flanigan TP. A public health model to connect correctional health care with communities. Am J Public Health 1998; 88:1249–1250.