Methods: Using ICD-9 diagnosis codes, we analyzed the medical records of 100,005 individuals from all service branches, divided in equal cohorts (n=6,667) between 1997 and 2011. Incidence rates were calculated for pathogen-specific STIs along with syndromic diagnoses (cervicitis, vaginitis, urethritis and pelvic inflammatory disease). Descriptive statistics were used to characterize the individuals within each accession year cohort, and in order to determine the proportion who had experienced at least one STI, repeat infections were censored.
Results: The total sample included 70,995 males and 29,010 females. The STI incidence rates (per 100 person-years) for women and men were as follows: chlamydia (3.5 and 0.7), gonorrhea (1.1 and 0.4), HIV (0.04 and 0.07) and syphilis (0.14 and 0.15). During the 15-year study period, 22% of women and 3.3% of men sustained a pathogen-specific STI; inclusion of syndromic diagnoses increased these percentages to 41% and 5.5%, respectively. Higher rates of pathogen-specific STIs were observed among African-Americans compared with Caucasians (11.3 vs 3.8, p<0.001), enlisted service members compared with officers (5.5 vs 2.7, p<0.001) and individuals with a history of deployment compared with non-deployed individuals (6.8 vs 4.4, p<0.001). In the overall sample, increasing number of years of service was associated with an increased likelihood of an STI diagnosis (p<0.001 for trend).
Conclusion: In this survey of military personnel, we found very high rates of STI acquisition throughout military service, especially among women. While longitudinal increases of STI diagnoses are partially the result of longer follow-up time, the high rates observed among women demonstrate that STI-related risk is significant and ongoing throughout military service. Lower STI incidence rates among men probably represent under-diagnosis and demonstrate a need for enhancing male-directed screening and diagnostic interventions.
R. Bower, None
J. Sanchez, None
E. Co, None
A. Ganesan, None
G. E. Macalino, None
B. Agan, None
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