Implementation of an STD screening program for female inmates housed in a large county jail

As Gonococcal and Chlamydial infections among women are frequently asymptomatic, an essential component of control continues to be the screening of women at high risk for Sexually Transmitted Diseases (STDs). There are an estimated 1.4 million new cases of Gonococcal and Chlamydial infection each year, many of which go undiagnosed and untreated. The prevalence of Gonococcal and Chlamydial infection among inmates is many times higher than among the general population. Many individuals entering correctional facilities have a history of high-risk sexual behaviors, substance abuse, or mental illness. As a result, high rates of infection have been documented among persons entering the correctional system due to increased risky behaviors and confinement. Without routinized screening, the true prevalence of Gonococcal and Chlamydial infections among inmates, are unknown. This pilot program examines the extent to which potential opportunities for Gonorrhea and Chlamydia treatment are missed among inmates in the Wayne County Jail by current practices of complaint-based screening. The purpose of this pilot project was to: (1) assess the prevalence of infection among female inmates; and (2) develop recommendations to guide and expand future screening and education programs in jails. Over a 4-month period, female inmates, aged 39 and under, were screened upon entry into the jail, using a urine-based test. Participants completed a 20-question behavioral risk assessment survey and received STD educational materials. Tests were analyzed by the local health department and positive inmates were treated by jail health providers. Inmates released prior to treatment were contacted in writing and instructed to follow up at the local health department for treatment.

187 females have been screened in this program to date, with 11.7% and 2.3% test positivity rates for Chlamydia and Gonorrhea, respectively. The cohort was 57.5% African-American and 81.6% were aged 30 and under. Sixty-nine percent (69%) reported not using condoms the last time they engaged in sexual activity and 53% reporting having sex under the influence of drugs or alcohol. The majority of incarcerated women have a variety of high-risk behaviors coupled with limited access to primary medical care or screening in their communities, placing them at high-risk for transmitting STDs. Routinized, jail-based Gonorrhea and Chlamydia screening programs can provide a mechanism by which at-risk individuals can be identified and treated. Through interagency partnerships, this program demonstrates that jail-based routinized screening, coupled with education and post-release support, can be an effective practice standard for identifying at-risk females.