Department of Defense Sexually Transmitted Infections: Estimation of Burden among Active Duty Service Members using Clinical Diagnoses, Laboratory Results, and Medical Event Reports

Abstract : This project established the foundation for the use of laboratory and encounter data in sexually transmitted infection (STI) surveillance and applied the capture-recapture statistical methodology to estimate cases not captured in laboratory results, clinical diagnoses, or medical event reports (MERs). Methods used to extract reportable STIs (chlamydia, gonorrhea, syphilis) in CY 2006 across the Department of Defense are detailed in this report. Cases from the three sources were then stacked and labeled with which database(s) it was identified using a 30-day gap-in-care rule. When data were matched, the majority of cases for each disease were from only one database. There were few cases identified in all three sources: 1.0 of chlamydia, 5.0 of gonorrhea, and no syphilis cases. The capture-recapture statistical method estimated that approximately 154 syphilis cases (95 CI: 147.6, 160.4) may be missing when using the three data sources, for a total estimated case burden of 356 cases. Though using all three sources for surveillance may require more resources than single-source surveillance methods, using only one source does not provide a complete picture of true STI burden. Using diagnoses or MERs alone would have identified less than a tenth of chlamydia cases and a fourth of gonorrhea cases.