Combating chlamydia in the military: why aren't we winning the war?

Sexually Transmitted Infections in U.S. Military Women: A Scoping Review 2000-2018

PURPOSE

High rates of sexually transmitted infections (STIs) have been documented among U.S. military servicemembers. The purpose of this scoping review is to evaluate the literature to determine what is known about the risk factors, preventive measures, and health outcomes regarding STIs among active duty servicewomen.

METHODS

A search of six bibliographic databases and the grey literature identified articles published from January 1, 2000, to December 31, 2018. A two-level review process was used to evaluate the inclusion of articles.

RESULTS

Fifty-six articles were included. The majority of studies (n = 47) were descriptive (95%). The primary STIs of focus were chlamydia (66%) and gonorrhea (38%), with a lesser focus on herpes simplex virus 1 and 2 (17%) and syphilis (11%). There were no studies on chancroid or pubic lice. Chlamydia and gonorrhea were highly prevalent. Age, race, and gender were nonmodifiable risk factors, whereas behaviors, beliefs, socioeconomic level, marital status, and concomitant or repeat infections were modifiable risk factors. Educational programs and studies evaluating efficacious STI prevention methods were lacking. STI diagnoses occurred in servicewomen at their home stations as well as in deployed settings.

CONCLUSION

STIs remain an ongoing public health challenge with insufficient research to guide military and health care leaders. Future research should focus on prospective designs that leverage identified risk factors and at-risk populations where the most impact can be made to promote reproductive health.

Incidence rates of pelvic inflammatory disease diagnoses among Army and Navy recruits potential impacts of Chlamydia screening policies

BACKGROUND

U.S. Navy policy requires Chlamydia trachomatis screening of all women upon entry to recruit training in conjunction with an educational session, and yearly screening thereafter until age 25. Army policy directs only annual screening of asymptomatic women aged <25. Hence, screening of Army recruits may not occur for up to 12 months following accession. Using routinely collected surveillance data, the rates of outpatient pelvic inflammatory disease (PID) following accession into the Army or Navy were compared to assess the potential implications of these policies.

METHODS

The population at risk comprised active-component women aged <25 who accessioned to either the U.S. Army or Navy between January 1, 2001, and December 31, 2005. Subjects were followed up to 60 months from accession, either until a first outpatient PID diagnosis occurred or they departed from military service. Data were collected from 2001 to 2006 and analyzed in 2007. Multiple Poisson regression was used to assess the effects of potentially important covariates. Time-to-event analysis was employed to characterize risk over time.

RESULTS

There were 1276 and 546 incident outpatient diagnoses of PID among 58,088 Army and 33,046 Navy accessions during 93,918 and 65,863 person-years of follow-up, respectively. The crude incident rate was 64% higher in the Army (13.6/1000 person-years) than the Navy (8.3/1000 person-years). Risk for the Army increased soon after accession, followed by a decline, while risk for the Navy remained comparatively uniform.

CONCLUSIONS

PID rates were higher in the Army than Navy during the first years of active service. A comprehensive study to elucidate the source of this observed difference is warranted.

Prevalence of Chlamydia trachomatis Among Active Duty Male Soldiers Reporting to a Troop Medical Clinic for Routine Health Care

OBJECTIVE

To determine the prevalence of chlamydia among young, male soldiers receiving routine healthcare and to measure risk factors associated with sexually transmitted infections (STI).

MATERIALS AND METHODS

Male soldiers between the ages of 18 to 25 years seeking routine healthcare were screened for chlamydia. Educational information regarding Chlamydia trachomatis was provided before testing. The transcription-mediated amplification (TMA) urine-based test was used as a sensitive and specific screening tool to detect disease. Assessment of risk factors was determined by questionnaire. Subjects who tested positive for chlamydia were treated with azithromycin 1 g in a single dose.

RESULTS

A total of 138 male soldiers were screened for chlamydia. The majority of soldiers screened reported to sick call for evaluation of an injury, 31.9%. The estimated prevalence of chlamydia was 8.0% (95% CI: 0.035-0.125). Soldiers who tested positive for chlamydia were more commonly asymptomatic, 72.7%. Of those who screened positive for chlamydia, 63.6% did not use a condom during their last encounter. No subjects who tested positive for disease had been treated for an STI in the past.

CONCLUSIONS

The prevalence of chlamydia in this population of young, male soldiers is high. These results should spur providers to incorporate STI risk assessment and screening into a variety of clinical encounters.

Prevalence of Chlamydia trachomatis in Asymptomatic Brazilian Military Conscripts

BACKGROUND

Few data are available on the prevalence and risk factors for Chlamydia trachomatis infection among young men in Brazil.

OBJECTIVES

To assess prevalence and risk factors for C. trachomatis infection in male military conscripts.

METHODS

In 2000, 627 young men recruited for military service in Goiania, Goias, Brazil, were enrolled in this cross-sectional study. Participants completed a demographic and sexual risk behavior questionnaire, and urine samples were screened for C. trachomatis by polymerase chain reaction.

RESULTS

The prevalence of chlamydial infection among asymptomatic conscripts was 5.0% (95% confidence interval [CI], 3.3-7.3). In multivariate analysis, failure to use condoms (odds ratio [OR](adjusted) 5.3; 95% confidence interval [CI], 1.2-23.4; P = 0.028) and having more than 2 sexual partners in the last 2 months (OR(adjusted) 2.6; 95% CI, 1.1-6.9; P = 0.049) were significantly associated with positivity for C. trachomatis.

CONCLUSIONS

A substantial number of asymptomatic young male military recruits were infected with C. trachomatis, and risk factors for this infection were related to sexual behavior. Further research is required to determine if routine screening may be considered as a strategy to reduce prevalence among this population.