Background:
20 adolescent sites screen for gonorrhea and chlamydia, including county detention facilities, jail, shelters, school-based clinics and drug court.

Objective:
Access adolescents, provide screening for early detection and treatment of infections, in order to stem the spread within the larger community

Method:
Newly admitted adolescents/ young adults are offered urine testing for chlamydia and gonorrhea at all sites except schools. Students accessing school-based clinics are offered testing, regardless of reason for clinic visit. Nurses interview participants using computerized sexual questionnaire. Sites have capability to sync and upload data for analysis.

Result:
Over 8000 adolescents have been screened since 12/00. Sexual questionnaire reveals high number of lifetime partners, 17% have a history of STD, 16% females report history of pregnancies. Majority of the chlamydial infections are asymptomatic (males - 80%, females - 55%), overall chlamydia positivity females 17%; males 10%. School clinics have higher chlamydia positivity compared to detention sites. Students accessing school clinic for reasons other than “STD check” had 15% chlamydia positivity. Nearly 50% of infections would be missed if only students requesting STD services were tested. Partners of positive students had >60% chlamydia positivity, although mostly asymptomatic (65%).

Conclusion:
By screening adolescents at multiple community sites, asymptomatic infections can be detected, treated, partners notified, decreasing complications and spread of infections into broader community. Partnering with other adolescent sites helps develop collegial support and increases awareness of silent epidemic and need for project funding.

Implications:
Other demonstration projects needed in communities with varying demographics and morbidity. Explore other non-traditional settings to offer non-invasive screening to adolescents who rarely seek health care and are mostly asymptomatic.