Background The burden of sexually transmitted infections (STI) within the US military is primarily assessed through review of case reports for notifiable conditions (e.g., Chlamydia, gonorrhoea, and syphilis). The degree to which under-reporting affects burden approximations is unknown. This study was conducted to assess the burden of Chlamydia and gonorrhoea infections and compare case capture across multiple military medical data systems.
Methods Incident infections among Army active duty soldiers from January 2007-December 2011 were identified using three data sources: Health Level 7 laboratory records (HL7), Military Health System Data Repository (MDR) medical records, and case reports from the Disease Reporting System internet (DRSi) and its predecessor, the Reportable Medical Event System (RMES). A thirty day rule was used to define incident cases; i.e., successive records logged within 30 days were excluded.
Results 53,228 incident Chlamydia infections and 11,065 incident gonorrhoea infections were identified over five years; calendar year 2011 incidence rates were 22.0 and 4.2 infections per 1000 person-years, respectively. Chlamydia case capture was 80%, 74%, and 35%, respectively for case reports, HL7, and medical records. Gonorrhea case capture was 65%, 62%, and 56%, respectively for medical records, case reports and HL7. A notable decrease in laboratory identified infections occurred in 2011, decreasing from highs of 78% and 60% in 2008 to 67% and 49% for Chlamydia and gonorrhoea, respectively.
Conclusion The results emphasise the need to utilise multiple databases to obtain more complete estimates of STI burden among active duty Army personnel. While this comprehensive approach provides a better approximation of burden, estimates are likely conservative since many infections go undetected or undocumented. Future analyses should incorporate advanced statistical methods such as capture-recapture methodology to estimate infections not identified through conventional passive surveillance. Furthermore, the decreased case detection through laboratory records is notable, and worthy of investigation.
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