Testing for Sexually Transmitted Infections in Symptomatic Male Military Trainees

A high burden of sexually transmitted infections (STIs) exists among trainees entering United States Air Force Basic Military Training (BMT). Although women entering training are universally screened for STIs, men are rarely tested. The rates of testing among symptomatic men who present with dysuria during BMT are unknown. Furthermore, rates of follow-up testing among male service members who present with dysuria during BMT as they progress through their careers are unknown.

All male basic trainees who received care and were diagnosed with dysuria or urinary tract infection (UTI) between 2019 and 2023 were retrospectively analyzed to evaluate their diagnostic workup and follow-up care for over the 3 years after diagnosis. To assess the impact of presumptive STI therapy on subsequent follow-up care, patients who received empiric treatment for STIs were compared with those who did not, with a focus on evaluating future STI testing rates and incidence.

Of the 102,382 men who entered BMT during the study period, 82 (0.08%) were diagnosed with dysuria or a UTI during training. Seventy percent of symptomatic men were tested for gonorrhea and chlamydia (GC/CT) with a 23% positivity rate. Only 25 (30%) received any additional follow-up STI testing in their next 3 years in the military, with a positivity rate of 12%. Those who were empirically treated for STIs were more likely to have a documented sexual history (81% vs. 45%, P = .004), receive a GC/CT test (96% vs. 57%, P = .002), and have additional STI testing in the 3 years after diagnosis (46% vs. 23%, P = .04).

This study found that despite a high positivity rate for STIs in symptomatic men, sexual history documentation and STI screening were inconsistent in this population. As males account for the majority of basic trainees, efforts to accurately capture the burden of STIs are imperative to limit the impact on military populations.