School-based Screening for Chlamydia and Gonorrhea: A Ten-year Experience

Background:
Rates of sexually transmitted diseases (STDs) in the United States are highest among adolescents, many of them regularly attend school.

Objective:
To describe findings of ten years of chlamydia and gonorrhea screening in inner city public high schools.

Method:
Between school years 1995-1996 and 2004-2005, all students in selected schools in an urban public high school district were offered testing for chlamydia and gonorrhea using nucleic acid amplification tests in urine specimens, regardless of STD symptoms or sexual activity. Students younger than 18 were eligible to participate if they obtained written or verbal consent through the telephone from their parents/guardians and students 18 years or older could sign their own consent. Consent was obtained from each participating student each year regardless of their participation in previous years. Prevalence of chlamydia and gonorrhea among students screened are reported among students in grades 9-12.

Result:
During the ten-year period, participation ranged between 1933 students in 3 schools and 6080 students in 13 schools. The prevalence of chlamydia ranged between 4.6% (1996-1997) and 9.4% (2000-2001 and 2003-2004) among males and between 9.9% (1996-1997) and 16.6% (2003-2004) among females. The prevalence of gonorrhea ranged between 0.8% (1999-2000) and 1.8% (2000-2001 and 2002-2003) among males and between 2.1% (1997-1998) and 4.8% (2000-2001) among females. Each year, prevalence for chlamydia and gonorrhea was higher in females than in males and increased with age.

Conclusion:
There was a high and sustained prevalence of chlamydia and gonorrhea among adolescents attending inner city local public high schools. Repeated screening was not associated with declines in chlamydia and gonorrhea in this dynamic population. School-aged adolescents should be routinely screened for chlamydia and gonorrhea in high prevalence areas.

Implications:
The application of nucleic acid amplification tests to detect STDs in non-clinical settings should be explored in high-risk and difficult to reach populations.