title: The Association between Sexually Transmitted Infections, Length of Service and Other Demographic Factors in the U.S. Military.
abstract: BACKGROUND
  Numerous studies have found higher rates of sexually transmitted infections (STIs) among military personnel than the general population, but the cumulative risk of acquiring STIs throughout an individual's military career has not been described.
  
  
  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. As women receive frequent STI screening compared to men, these groups were analyzed separately. Incidence rates were calculated for pathogen-specific STIs along with syndromic diagnoses. Descriptive statistics were used to characterize the individuals within each accession year cohort; repeat infections were censored.
  
  
  RESULTS
  The total sample included 29,010 females and 70,995 males. The STI incidence rates (per 100 person-years) for women and men, respectively, 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 study period, 22% of women and 3.3% of men received a pathogen-specific STI diagnosis; inclusion of syndromic diagnoses increased STI prevalence to 41% and 5.5%, respectively. In multivariate analyses, factors associated with etiologic and syndromic STIs among women included African American race, younger age and fewer years of education. 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).
  
  
  CONCLUSIONS
  In this survey of military personnel, we found very high rates of STI acquisition throughout military service, especially among women, demonstrating that STI-related risk is significant and ongoing throughout military service. Lower STI incidence rates among men may represent under-diagnosis and demonstrate a need for enhancing male-directed screening and diagnostic interventions.
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.|Naval Medical Center San Diego, San Diego, California, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Deiss
authors.affiliation: Naval Medical Center San Diego, San Diego, California, United States of America.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bower
authors.affiliation: William Beaumont Army Medical Center, El Paso, Texas, United States of America.
authors.forename: Edgie
authors.initials: E
authors.lastname: Co
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
authors.forename: Octavio
authors.initials: O
authors.lastname: Mesner
authors.affiliation: Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland, United States of America.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Sanchez
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Masel
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.|Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
authors.forename: Grace E
authors.initials: GE
authors.lastname: Macalino
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008889:Military Personnel; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology