Surveillance of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Women in Detention in Baltimore, Maryland

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Abstract
In conjunction with a program to expand syphilis and HIV infection services, women were also offered screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) during intake at the Baltimore Women's Detention Center. The goal was to assess the effectiveness of a routine screening program for CT and GC in women in a detention setting. The association among infection, race, and area of residence was also explored. CT and GC prevalences were determined and analyzed by demographic data, including zip code, for 1858 women enrolled over a 48-week period. Informed consent was obtained, and infections were detected with use of urine samples tested by ligase chain reaction. Overall, the population had prevalence rates of 5.9% (109/1858) and 3.4% (63/1858) for CT and GC respectively. Among whites, CT and GC prevalences were 9.0% (29/323) and 8.7% (28/323), respectively. Among African Americans the prevalence rates were 5.1% (77/1510) and 2.3% (34/1510) for CT and GC, respectively. White women <25 years of age were associated with the highest CT and GC prevalences, at 20.0% (13/65) and 13.9% (9/65), respectively. African American women <25 years of age also were associated with the highest CT and GC prevalences, at 13.9% (24/173) and 5.8% (10/173), respectively. Multivariate analysis of risk factors and demographic data indicated that ages <25 years and 25 to 34 years, white race, and certain zip codes of residence were risk factors for infection. This study illustrated that urine-based screening for CT and GC is feasible in detention settings and can be productive in high-prevalence areas. Geographic analysis demonstrated no definitive relationship among race, infection, and area of residence, although it did demonstrate clustering of infected individuals and could be useful in future interventions. These findings demonstrated the need for implementing screening programs for sexually transmitted infections in detention centers.