INTRODUCTION: Sexually transmitted infections (STIs) place a high burden on the Military Health System (MHS) and adversely impact service members’ ability to perform their duties. This study examined Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) epidemiology among a population of U.S. service members and their beneficiaries and explored differences in CT and NG prevalence by anatomic site and sex.
METHODS: We conducted cross-sectional analyses of enrollment visit data from participants in a randomized controlled trial of a behavioral intervention to prevent STIs (Knocking out Infections through Safer sex and Screening) at Joint Base Lewis-McChord, WA and Fort Liberty, NC. At enrollment, participants completed questionnaires and provided biological specimens for nucleic acid amplification testing for CT and NG.
RESULTS: Among 439 participants enrolled between November 2020 and February 2023, 423 (96.4%) were on active duty in the U.S. Army. Of these participants, 173 (39.4%) were female and the median age was 23 (interquartile range 21, 25) years. A reactive test for CT or NG at any anatomic site was observed in 120 participants (prevalence 27.3%), including 60 who had a reactive test for CT or NG at oropharyngeal and/or anorectal sites (prevalence 13.7%). Anorectal CT prevalence was significantly higher among females than males (12.7% vs. 5.3%; P = .005).
CONCLUSIONS: This study highlights opportunities to improve screening to identify cases of CT and/or NG that may otherwise go undetected and thus lead to adverse health outcomes, especially for females. The high burden of extragenital CT/NG also underscores the importance of generating evidence to inform more comprehensive screening, treatment, and prevention strategies.
The hidden burden of extragenital chlamydial and gonorrheal infections in a population of U.S. army service members and their medical beneficiaries
Military Medicine, 190 (Suppl 2), 242-251. doi: 10.1093/milmed/usaf151.