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Background: Although college students may consent for their own health care, commercially insured students may forgo sexual health care due to potential health plan disclosure of services to parents through billing, costly co-payments for out-of-network care, and out-of-pocket expenditures.
Objectives: Remove barriers to sexually transmitted infection (STI) services.
Methods: In June 2007, a large western New York State university and county public health laboratory partnered to offer gonorrhea and chlamydia screening tests (BD Probetec ET; Becton Dickinson, Sparks, MD) to students seeking STI services at the university’s student health service. For commercially-insured and uninsured students, a $10 fee per STI visit was assessed to defray the cost of provider time and specimen processing. Commercial insurers were not billed.
Results: Between June 4, 2007 and May 31, 2009, there were 1,462 student visits for STI screening. The median student age was 21 years, 56% were female, and 58% Caucasian. The majority (67%) presented for asymptomatic STI screening. Among the 1,384 gonorrhea and chlamydia tests performed, 8 (0.5%) were gonorrhea positive and 85 (6.1%) were chlamydia positive. Chlamydia positivity varied by gender (males=44/615 or 7.2%, females=41/766 or 5.4%), race (blacks=37/264 or 14%, Hispanics=7/82 or 8.5%, whites=29/795 or 3.6%), age (age <25yrs=77/1214 or 6.3%, age 25+yrs=6/169 or 3.6%) and reason for visit (contact to STI=22/110 or 20%, symptomatic=20/158 or 12.7%, asymptomatic screening=44/943 or 4.7%). Two students were co-infected with chlamydia and gonorrhea.
Conclusions: A substantial chlamydia burden exists among young adults, many asymptomatic, accessing a university health clinic for STI testing. A public health partnership identified infected students who may otherwise have forgone care and increased STI community screening without increasing staffing.
Implications for Programs, Policy, and/or Research: With shrinking public health resources, partnering with university clinics for confidential STI testing can be a cost efficient outreach strategy to reach at-risk populations that may otherwise forgo these services.