1. 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,
William Wong, MD
Division of STD/HIV/AIDS
Chicago Department of Public Health
City of Chicago

2. 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

5. 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

6. STD Prevalence among Adult Detainees at CCJ, 2002
No. Positive / No. Tests % Positive
Women Chlamydia ,187 / 15,
Gonorrhea / 15,
Syphilis / 14,
Men Chlamydia 4,296 / 90,
Gonorrhea 1,437 / 90,
Syphilis / 84,

7. 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

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

9. 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

10. 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%

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

12. 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

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

14. 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

15. 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

16. 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

17. 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: