Sexually Transmitted Infections in the United States Military, 2000-2006

Background:
Sexually transmitted infections (STI) are commonly reported notifiable diseases in the US military. Although prevention and controls efforts are similar to those applied in the civilian sector, the four US military services (Army, Navy, Air Force, and Marine Corps) develop and implement individual STI screening and reporting policies.

Objective:
To summarize incidence rates of chlamydia (CT), gonorrhea (GC), non-gonococcal urethritis (NGU), and primary/secondary syphilis (TP); assess variations within and between services; and to identify pertinent service policies.

Method:
Laboratory confirmed cases of CT, GC, NGU, and TP among active-duty service members from January 1, 2000 to December 31, 2006 were abstracted from the Defense Medical Surveillance System. Policy documents were obtained from government web sites and/or military service-specific medical personnel.

Result:
Of the 4 STIs, CT rates have remained the highest, ranging from 95 to 1600 (per 100,000 person-years). Among the 4 military services, the Army reported the highest rates for all 4 STIs (CT rate, 2006: 1598.2; GC rate, 2006: 342.3; NGU rate, 2006: 61.4; TP rate, 2006: 7.5). Annual CT and GC rates were consistently higher among women less than 25 years of age in comparison to men of the same age; NGU rates consistently higher among men; and TP rates generally higher among men. Reporting and screening requirements varied between services.

Conclusion:
This is the first report of STI incidence for 2006 in the US military. The population at greatest risk for STI is among individuals less than 25 years old. The US military is a representative sample of this population. Our report has documented elevated CT rates particularly among women in the military and differences by service.

Implications:
In order to closely examine variability between services and assess the impact of different screening policies between services on overall rates, standardization of diagnostic and reporting criteria are vital.