Chlamydia and Gonorrhea Screening Program Targeting High-risk Adolescents Entering Juvenile Detention in North Carolina

Background:
North Carolina has high STD rates (2002 rank 22nd for chlamydia rate, 9th for gonorrhea, and 4th for syphilis). Nationally, adolescents entering detention facilities are at high risk for STDs. According to the 2002 STD Surveillance Report, the median positivity for males entering detention facilities was 6.0% for chlamydia and 1.7% for gonorrhea. The rates were even higher for females (16.7% chlamydia, 5.6% gonorrhea). To address this issue, the HIV/STD Prevention and Care Branch partnered with the Department of Juvenile Justice and Delinquency Prevention (DJJDP) and the State Laboratory of Public Health (SLPH) to screen at risk youth for STDs in North Carolina.

Objective:
The program sought to provide urine-based chlamydia and gonorrhea screening for all adolescents entering state residential detention facilities called Youth Development Centers (YDC) and to provide treatment for all who test positive.

Method:
The program is monitored and funded through the CDC Infertility Prevention Program.

Result:
From 10/2003 to 12/2006 the program screened 100% of the 1,492 adolescents (1,268 males age 11-18 and 224 females age 12-17) admitted to YDC facilities. Among boys, 115 (9.1%) were positive for chlamydia and 9 (0.7%) were positive for gonorrhea. Among girls, 39 (17.4%) had chlamydia and 14 (6.3%) gonorrhea. All infected adolescents received treatment and risk reduction counseling.

Conclusion:
The prevalence of both chlamydia and gonorrhea in adolescents entering YDC in North Carolina is high. Chlamydia rates are higher than gonorrhea and rates for both diseases are higher among females.

Implications:
Urine-based screening for chlamydia and gonorrhea in juvenile detention is feasible and yields a high number of cases relative to the number of adolescents screened. It is believed that many of these cases would not have been identified through traditional programs. The program can be used as a model for expansion to additional (non-residential) juvenile detention facilities in North Carolina.