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Background:Due to high prevalence in adolescents, Philadelphia has run an in-school gonorrhea (GC) and Chlamydia (CT) testing and treatment program for high school students since 2002.
Objectives:To describe 1) data trends from 2002-2011; 2) program changes in response to trends; 3) risk behaviors for students who test positive
Methods:Following a presentation, student urine specimens were confidentially obtained and processed. From 2009-present, students were asked if they ever had sex; infected students were asked risk behavior questions during in-school treatment. Answers from interviewed students were compared with reportable disease records.
Results:From 2002-11, the PHSSSP performed 141,961 tests on 97,996 students; 7.2% were positive (97.5% treated). Of the positives, 44.2% were rescreened within 3 months; 12.6% again tested positive (89.9% treated). Yearly number of tests has declined since 2008 but in 2009-10, most sexually active students chose to test (71%). Positivity initially appeared to decline but by 2009 had increased over the 2002-03 baseline. In response, risk assessments for infected students began in 2009 and were performed on 1114 (64%). Infected students were more likely to be black than white (OR 4.2, CI 3.1-5.6). Among interviewed students, 318(28.6%) had ≥2 partners in past 60 days, 245(22.0%) had been arrested, and 128(17.5%) females had been pregnant. Prior STD was disclosed by 143(12.8%) though this was unreliable when compared to documented prior STD. Compared to females, males were more likely to have higher partner number, earlier sexual initiation, and longer time from sexual initiation to first STD.
Conclusions:High school screening does not appear to reduce prevalence of GC/CT, though it is able to identify students likely at high risk for adverse outcomes from unprotected sex. Treatment of large numbers of infected females is likely preventing PID.
Implications for Programs, Policy, and Research:Mechanisms for offering behavioral interventions to infected students should be developed.