Expanded Sexually Transmitted Infection Surveillance Efforts in the United States Military: A Time for Action

Abstract

The U.S. military is composed primarily of persons less than 35 years of age. These young, healthy people are at great risk for contracting sexually transmitted infections (STIs), which have been a threat to military service members (SM) throughout history.1 Although influenced by screening policies in place, reportable STI rates for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in the U.S. military almost always exceed those in the civilian setting, even after adjusting for age, race, and U.S. geographic region of origin.2,–4 Furthermore, the threat posed by STI to military populations is magnified by assignment to areas where hazardous pathogens such as antimicrobial-resistant NG may be prevalent.5,–7

According to the World Health Organization (WHO) 2008 estimates, the total global number of new cases of four of the curable STI—CT, NG, syphilis, and Trichomonas vaginalis—was nearly 500 million cases in adults aged 15 to 49 years.8 These four STIs are responsible for considerable morbidity, above and beyond that attributable to human immunodeficiency virus (HIV) infection. If left untreated, NG and CT among women often lead to pelvic inflammatory disease (PID), which can lead to infertility, ectopic pregnancy, and chronic pain. In men, they are a cause of epididymitis, a painful condition that can also lead to infertility. Syphilis remains an important cause of mortality, particularly in congenital cases where the infection is passed from mother to infant. STIs also increases the risk for transmission of HIV,9,10 and treatment of STIs has been shown to reduce the risk of HIV acquisition in HIV-endemic areas.11,12