School-Based Chlamydia and Gonorrhea Screening for High School Students Using Different Recruitment Strategies: Who Agrees to Be Screened?

Background: Universal screening for chlamydia and gonorrhea in public schools can effectively identify infections that otherwise might remain undiagnosed, but can be labor-intensive and expensive. Educating adolescents about their risk may persuade those at higher risk to agree to screening, which can reduce costs.

Objectives: To examine findings from screening events at two urban high schools, one with an educational component and one without, to identify differences in the samples who presented for screening, including positivity rate.

Methods: Urine-based screening was offered at 2 urban high schools, one as part of a health fair, with no education aside from an information booth adjacent to the screening area (some students were offered extra credit for screening), and another after an assembly to raise awareness of STD risk, particularly HIV. Students completed a brief information sheet prior to screening.

Results: Adolescents aged 13 to 19 participated, 216 at the health fair (“school 1”), and 79 after the assembly (“school 2”). Most students from both schools were African-American (61%) or Latino (36%). School 2 participants were older (16.4 versus 15.9, p=0.0013) and more were female (67% versus 43%, p=0.0003). More school 2 participants reported one or more sex partners in the past year (93% versus 71%), same-sex partners (17% versus 6%), and a history of HIV testing (27% versus 15%; all p<0.05). Somewhat more school 2 participants tested positive for chlamydia (10% vs. 4%, p=0.0515).

Conclusions: This analysis suggests the method of recruitment may affect both screening uptake and positivity rate.

Implications for Programs, Policy, and Research: Staffing and other costs per infection detected are reduced when a higher proportion tests positive. Raising adolescents’ awareness of their risk through educational and motivational speakers may improve their ability to assess their own risk and promote screening uptake, increasing the likelihood of finding infections, and thereby, cost-effectiveness.