Division of STD/HIV/AIDS Chicago Department of Public Health Significant Decline in Reported Cases of Chlamydia and Gonorrhea among Males Following Discontinuation of Male Screening in a Large County Jail – Chicago, 2002-2004 William Wong, MD Division of STD/HIV/AIDS Chicago Department of Public Health City of Chicago

Background Cook County Jail (CCJ) is the largest single-site pre-trial detention facility in the U.S. Serves Cook County, IL (including Chicago) Daily new admissions: ~350 Daily census: ~11,500 Annual census: >100,000

Number of STDs Reported by CCJ 2001-2005 Year 2001 2002 2003 2004 2005 Chlamydia 1,531 3,508 1,404 665 1,163 Gonorrhea 859 1,474 620 453 514 Syphilis 107 94 69 134 101 2001 numbers are underreported due to data problems April 2003 CCJ discontinues universal male screening Sept 2005 CCJ begins targeted screening of men 35 years old

STD Prevalence among Adult Detainees at CCJ, 2002 No. Positive / No. Tests % Positive Women Chlamydia 1,187 / 15,117 7.9 Gonorrhea 689 / 15,117 4.6 Syphilis 518 / 14,495 3.6 Men Chlamydia 4,296 / 90,006 4.8 Gonorrhea 1,437 / 90,006 1.6 Syphilis 817 / 84,883 1.0

CCJ STD Screening Program Prior to April 2003, CCJ offered universal screening for chlamydia and gonorrhea for male detainees High acceptance rate: >85% After April 2003, CCJ stopped universal STD screening for males due to lack of funding, and continued testing for chlamydia and gonorrhea for symptomatic male detainees

Objectives To evaluate the impact of discontinuing a universal male STD screening program in a large county jail

Methods Analyzed surveillance data from reported morbidity for gonorrhea and chlamydia Compared number of reported chlamydia and gonorrhea cases during the 12 month periods before and after the discontinuation of universal STD screening

Reported Chlamydia & Gonorrhea from CCJ before and after universal STD screening was discontinued, April 2002-March 2004 Reported Chlamydia Cases – Chicago, April 2002 – March 2004 Reported Gonorrhea Cases – Chicago, April 2002 – March 2004 BEFORE AFTER % CHANGE No. % Chicago Cases 24,885 22,563 -9.3% Male Cases 7,911 5,198 -33.3% Jail Cases Among Men 3,312 277 -91.6% BEFORE AFTER % CHANGE No. % Chicago Cases 13,249 11,541 -12.9% Male Cases 6,741 5,432 -19.5% Jail Cases Among Men 1,130 108 -90.4%

Reported Cases of Chlamydia & Gonorrhea from CCJ Before and After Universal STD Screening was Discontinued, April 2002-March 2004 ↓ 82.3% ↓ 70.9%

Reported Chlamydia & Gonorrhea from CCJ Before and After Discontinuation of Universal STD Screening April 2002-March 2004 Gonorrhea Chlamydia Gonorrhea Chlamydia BEFORE April 2002 to March 2003 AFTER April 2003 to March 2004

Impact on City-wide Morbidity Reporting Before After Proportion of male CT 40.6% 5.1% Proportion of male GC 16.3% 1.9% Overall declines in CT reported: ↓9.3% Overall decline in GC reported : ↓12.9%

Conclusions Corrections-based STD screening programs are effective at identifying individuals at-risk for sexually transmitted diseases Significant declines in reported male GC and CT were noted in Chicago following discontinuation of the CCJ universal STD screening program

Number of STD Cases diagnosed at CCJ, 2001-2007 Year 2001 2002 2003 2004 2005 2006 2007 Chlamydia 1,531 3,508 1,404 665 1,163 1,064 195 Gonorrhea 859 1,474 620 453 514 307 85 Syphilis 107 94 69 134 101 86 23 2001 numbers are underreported due to data problems April 2003 Universal male STD screening discontinued Sept 2005 Targeted STD screening begun for men 35 years old Feb 2007 STD screening program discontinued Oct 2007 STD screening program restarted in the Emergency Dept

Acknowledgements Jennifer Broad, MPH Tamara Cox MPA Sergio Rodriguez, MD Mohamed Mansour MD PhD Concetta Menella MD Dorothy Murphy-Swallow MS RN John Raba MD

Chicago Department of Public Health City of Chicago Contact Information William Wong, MD Director, STD/HIV Prevention and Control Services Medical Director, Division of STD/HIV/AIDS Chicago Department of Public Health City of Chicago Phone: 312-742-7372 Email: wong_will@cdph.org