Repeated School-based Screening for Sexually Transmitted Diseases: A Feasible Strategy for Reaching Adolescents

Abstract

Objectives. To determine whether repeated school-based screening and treatment for chlamydia and gonorrhea will decrease the prevalence of infection among students. Design. At three high schools serving over 2000 students, all 9th through 12th grade students were given the opportunity to be tested during three consecutive school years for chlamydia and gonorrhea, using urine ligase chain reaction tests. Five comparable schools with 5063 students enrolled served as wait-listed controls. Setting. Eight urban public high schools in Louisiana. Participants. Annually, 52% to 65% of all enrolled students participated; among those enrolled in schools for ≥2 years, 83.4% of students were tested at least once. Intervention. Education of all students; counseling and treatment of infected students with oral single-dose antibiotic therapy. Main Outcome Measure. Prevalence of Chlamydia trachomatis and gonorrhea infection. Results. At first test, 286 (11.5%) of 2497 girls and 143 (6.2%) of 2308 boys were infected with chlamydia, and 48 (2.5%) of 1883 girls and 19 (1.2%) of 1628 boys had gonorrhea. Over 90% of infections were asymptomatic. With repeated testing, chlamydia prevalence among boys dropped to half the rate of comparison schools (3.2% vs 6.4%). Among girls chlamydia prevalence declined only slightly (10.3% vs 11.9% in comparison schools). Conclusion. There are high rates of asymptomatic sexually transmitted diseases (STDs) in the general urban school population. Repeated screening and treatment are associated with declines in chlamydia prevalence among boys. Expansion of STD screening and treatment programs to school settings is likely to be a critical component of a national strategy to control bacterial STDs.