Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01

Publications

Infectious Diseases
Prevention and Control
in Canadian Federal
Penitentiaries 2000-01

RESULTS

Sexually Transmitted Diseases

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Sexually transmitted diseases (STDs) are a major cause of acute illness, infertility and long-term sequelae.¹ The negative impact of STDs on health is magnified by their potential to facilitate the transmission of HIV.^2,3 Although women are especially vulnerable to the long-term effects of STDs and are the major focus of prevention efforts, men are equally important in the cycle of STD transmission.

Because STDs sometimes carry a social stigma, they tend to be under-diagnosed and, therefore, untreated. It is likely that most STDs go unreported as a result of symptomatic management of infections. Many important pathogens such as Chlamydia trachomatis and Neisseria gonorrhoeae may be present among inmates in the absence of symptoms. Because testing for STDs is voluntary, inmates may underestimate their personal risk of infection and refuse opportunities to be screened. Thus, clinical diagnosis, together with laboratory identification by testing, continues to be important for STD management. Case-finding and partner notification are equally critical components of an infection control strategy for STDs.

Recent changes in rates of chlamydia, gonorrhea and syphilis in the general Canadian population further emphasize the need for closer monitoring of these infections among inmates.⁴ Inmates of correctional facilities may be at risk for STDs due to their high-risk behaviours prior to incarceration, which might include sex trade work, engaging in unprotected sex and having multiple sexual partners.^5,6 Unfortunately, data in the area of STDs in correctional facilities are sparse. The incomplete nature of available data on STDs in inmates reflects the paucity of routine testing for these infections in correctional facilities.⁶

IN SUMMARY

• Rates of genital chlamydia (0.18% in 2001), gonorrhea (0.10% in 2001) and syphilis (no reported cases) were relatively unchanged from those of 2000.
• Inmates in Prairie Region reported the highest rates of chlamydia (0.4% in 2001) and gonorrhea (0.4% in 2001).
• 80% to 90% of STD infections were reported among men offenders in 2000-01.
• The lack of routine screening among persons at high-risk for STDs suggests that reported rates are underestimates of actual rates among inmates.

Genital chlamydia (Chlamydia trachomatis)

Chlamydia is the most commonly reported bacterial STD in Canada, occurring at an estimated rate of 0.15% in 2001, with higher rates in certain at-risk groups.⁷ More than 50% of men and 70% of women can be asymptomatic despite the existence of active infection.^1,8 As a result, it is believed that most infections remain substantially under-diagnosed.

Chlamydia in CSC facilities

The Correctional Service of Canada (CSC) institutions reported 23 cases (0.18%) of genital chlamydia in 2001, of which 91% were diagnosed in men offenders. Of the 21 cases (0.17%) reported in 2000, 86% involved men offenders (Table 9).

The majority of chlamydia cases were reported in inmates from the Prairie Region (52% of all cases in 2001 and 76% in 2000). Atlantic was the only region for which no chlamydia cases were reported in either 2000 or 2001. It must be noted that variability of reported rates by region are likely influenced by levels of screening.

Gonorrhea (Neisseria gonorrhoeae)

Gonorrhea is the second most commonly reported STD in Canada, occurring at an estimated rate of 0.02% in the Canadian population in 2001.⁷ Men 20-24 years of age and women 15-19 years account for the majority of cases in the Canadian population.^1,8

The increasing resistance of gonococcal strains to current antibiotic treatments9 emphasizes the need for ensuring effective treatment and follow-up of recent sexual contacts, both within penitentiaries and in the community. Because more than 50% of cases are asymptomatic,⁷ especially in women, transmission of gonorrhea can continue unabated among untreated cases and their sexual partners.

Gonorrhea in CSC facilities

During 2001, 13 cases (0.10%) of gonorrhea were reported in CSC facilities, 85% of which were reported among men offenders. All 11 reported cases (0.09%) in 2000 involved men offenders (Table 9).

Half of all reported gonorrhea cases in 2000 were identified in Prairie Region, as was 12 of the 13 cases in 2001.

Infectious Syphilis (Treponema pallidum)

In Canada, syphilis is frequently reported among men 20-25 years of age and usually occurs in areas where infection continues to be prevalent.^1,8

Syphilis in CSC facilities

Syphilis was not reported in any CSC institution in 2000-01 (Table 9).

Table 9. Reported bacterial STDs in inmates in Canadian federal penitentiaries, 2000-01.

Conclusion

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Sexual activity within correctional facilities is known to occur.^10-12 Unprotected sexual intercourse between men is not only a behaviour associated with HIV infection, but it also influences the transmission of other STDs.^13-16

The introduction of men condoms, dental dams and water-based lubricant in federal penitentiaries in 1992 serves as merely one component of a prevention strategy for STDs. As previously mentioned, partner notification, testing and treatment of all recent sexual contacts are equally important parts of appropriate follow-up of STD cases. Recent advances in non-invasive, rapid-testing technologies such as urine testing have made screening for STDs in correctional facilities more widely available and acceptable by persons seeking testing. Despite the availability of such tests, anecdotal reports suggest that higher rates of testing uptake have not been realized in CSC. Given that most STD infections are asymptomatic, health-care providers in correctional facilities may not be aware of the burden of disease in the inmate population and will continue to conduct STD testing only when symptoms are evident. Assessment for STD testing should take into account an inmate's history of STDs as well as sexual risk behaviours associated with infection. Greater use of routine testing for those at risk and an improved capacity for surveillance are needed to better define STD morbidity among federal inmates. The Canadian STD Guidelines8 can be consulted for details regarding risk groups for which targeted screening should be practised in penitentiaries.

References

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