Screening for Chlamydia and Gonorrhea in Family Court, Philadelphia, PA

Background:
Chlamydia (CT) is the most commonly reported infectious disease in the United States. To reduce disease incidence and sequelae, programs should identify venues in which screening can identify cases of CT among males and females that would otherwise go undetected. In Philadelphia, screening was expanded to include adolescents adjudicated delinquent in Family Court.

Objective:
To determine the feasibility of establishing routine screening for Chlamydia and gonorrhea in a Family Court setting; to evaluate the positivity rates among adolescents screened through this venue.

Method:
The Family Court of Philadelphia is responsible for adjudicating all cases of juvenile delinquency; approximately 4,500 youth are managed annually. Screening began in April 2004 through a collaborative effort between the Philadelphia Department of Public Health, STD Control Program and the Family Court of Philadelphia. It was designed to offer all youth placed on probation an opportunity to receive a confidential urine-based NAAT for Chlamydia and gonorrhea. Prior to implementation, concerns about confidentiality, self-incrimination by adolescents, and possible bias by the court should positive results become known, were addressed.

Result:
From April 2004 through June 2007, 2,874 STD counseling sessions were perfomed resulting in 2,339 urine tests for Chlamydia/gonorrhea. In total, 179 tests were positive for Chlamydia, gonorrhea or both STDs including 10 adolescents found to be reinfected once during the 39 months of testing within Family Court. Positivity among females was 12.6% (62/492) and 6.3% (117/1,847) among males. Overall, treatment was confirmed for 92.2% (165/179) of those infected.

Conclusion:
Family Court can be an effective venue to reach adolescents at high risk of infection with Chlamydia and gonorrhea. Such a program is feasible and well accepted by youth. Participation is dependent upon the cooperation of court staff.

Implications:
STD Programs should consider collaborative screening efforts with organizations providing services to adolescents to enhance other venue-based screening programs.