Follow up testing among male U.S. Air Force basic trainees diagnosed with chlamydia or gonorrhea, 2017-2023

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Military Medicine

Background:

• Current U.S. Air Force and Space Force policy mandates universal screening for gonorrhea and chlamydia in female basic military trainees.
• Male basic military trainees are only tested for these STIs if symptomatic or upon request, leading to unclear epidemiological data.
• Follow-up testing rates and subsequent infection burdens among male trainees testing positive are not well understood.

Purpose of the Study:

• To compare follow-up testing rates for gonorrhea and chlamydia between male and female U.S. Air Force and Space Force basic military trainees.
• To assess subsequent STI diagnoses in male trainees after a positive test compared to matched female trainees.
• To evaluate the impact of current screening protocols on infection management in male basic trainees.

Main Methods:

• A retrospective cohort study identified male basic trainees testing positive for gonorrhea or chlamydia at Joint Base San Antonio-Lackland (2017-2023).
• Cases were matched 1:1 with female trainees testing positive for the same pathogen, controlling for age and accession date.
• Medical records were reviewed for follow-up testing within 12 months and subsequent diagnoses up to 3 years post-initial positive test.

Main Results:

• Of 50 male trainees with positive tests, 60% reported symptoms; 86% of infections were chlamydia.
• Only 56% of male trainees received follow-up testing within 1 year, significantly lower than the 76% observed in matched female trainees (OR 0.4).
• Despite lower follow-up rates, future infection rates were not statistically different between male and female trainees.

Conclusions:

• Lower screening rates for male basic trainees may contribute to reduced follow-up testing, hindering infection identification and transmission prevention.
• Male basic military trainees exhibit follow-up testing rates significantly below recommended guidelines.
• The study underscores a critical gap in STI management for male trainees, despite similar rates of future infections compared to females.