Sexually transmitted diseases and incarceration

PURPOSE OF REVIEW: To summarize recent literature on the prevalence and burden of sexually transmitted diseases (STDs) - focusing on syphilis, chlamydia, and gonorrhea - among adult correctional inmates and detained juveniles. The review is largely limited to US settings. RECENT FINDINGS: The prevalence is higher and the consequences of STDs are generally more severe for incarcerated women than men. Chlamydia and gonorrhea may be more prevalent among confined juveniles than among incarcerated adults, whereas syphilis is probably more prevalent among adults. The opportunity exists to provide effective STD prevention, screening, and treatment to seriously affected and underserved correctional populations, thus benefiting patients and their partners as well as the larger public health. Substantial research shows how screening might be targeted to be most cost-effective. Few correctional systems, however, have implemented the STD screening and treatment programs needed to take full advantage of this public health opportunity. Moreover, few systems have adopted condom provision for inmates, in the face of clear evidence that high-risk sexual activity occurs in correctional settings. SUMMARY: The clinical tools are available to improve STD prevention, screening, and treatment in correctional facilities. However, more research and advocacy is needed to convince decision makers of the importance of committing the necessary resources and adopting the policies needed to close the gap between opportunity and reality in correctional STD programs.