147. Chlamydia and Gonorrhea Prevalence and Treatment in Detained Youths in Hawaii: A follow up Study on Strategies for Improvement

ABSTRACT

Purpose: Adolescents acquire Chlamydia trachomatis with rates in 15-19 y/o females more than 4.8x the adult population and males 2.5x higher. There is growing recognition of the health consequences of untreated sexually transmitted infections (STI) especially for women in juvenile or correctional facilities. The previous study was a retrospective analysis conducted at the only juvenile detention facility in the state of Hawaii from 2014-2017. It revealed high prevalence of STIs, Chlamydia (CT) and Gonorrhea (GC), in both males and females with fewer than half the documented infections being treated prior to discharge, indicating a need for routine and timely testing to allow treatment of those infected as opposed to a presumptive STI treatment. The purpose of this study is to look at the prevalence rate of CT and GC after implementing routine testing and to assess treatment rate upon timely result receipt. Methods: This retrospective analysis was conducted at the only juvenile detention facility in the State of Hawaii from June 1, 2020-May 31, 2021. It documented the prevalence rate of CT and GC after implementing routine testing upon detention. It also looked at the timeliness of treatment and treatment rates as the time frame marked the first year of implementing routine CT and GC urine screen upon detention and sending the screen tests at a commercial lab for timely results. This time frame is unprecedented in the era of the coronavirus pandemic. This study was approved by Hawai‘i DOH Institutional Review Board. Results: Of the 218 admissions, 187 were tested (85%). 14 refused and 17 were under the state's age of consent (15%) prohibiting routine sample collection and testing as ordered by the facility. Of the 187 tests, 75(35%) were females, 143(65%) were males. CT was prevalent in 25% of females and 7% of males. GC was found in 13% of females and 3% of the males. CT-positive tests of females sent to commercial lab were treated timely 80% of the time vs. 60% for the CT-positive tests sent to the state lab. For CT-positive tests of males and GC-positive tests of females and males, the commercial and state labs showed the same timeliness of treatment. Rates of untreated females with CT was 12%, untreated males 25%;untreated females with GC was 11%, all males with GC were treated. The average result time receipt of tests sent to commercial lab was 6 days vs.2 weeks with the state lab. Conclusions: Prevalence rate of CT and GC remained consistently higher in females than males despite females making up only a third of the census. Timely treatment rate was remarkable for tests sent to commercial lab decreasing the number of untreated youths. This avoided presumptive CT and GC treatment, further leaving out the potential for antibiotic resistance, a continuous and growing concern prompting the updates in the CDC STD treatment guidelines in 2021. Sources of Support None.