School-based screening for sexually transmitted infections: A pilot for Cleveland

Sexually transmitted infections (STIs) are common among adolescents. In Cleveland, one in nine females, ages 15-19, has Chlamydia, the most common reportable STI. Rates among African-American girls are increasing. While most infections are asymptomatic, as many as 40% of young women testing positive will develop serious complications, including pelvic inflammatory disease, chronic abdominal pain, increased risk of ectopic pregnancy, and infertility.

Adolescents face barriers to accessing reproductive health care, such as concerns about cost, confidentiality, transportation and clinic hours that require them to miss school. One strategy to address these barriers is to perform mass screening for STIs in school. The availability of very sensitive and specific urine tests for gonorrhea and Chlamydia makes this feasible. In Ohio, urine-based tests and STI treatment are provided to Title X reproductive health clinics through the Infertility Prevention Project at no cost.

We propose to offer universal screening for Chlamydia and gonorrhea to all 11th and 12th graders at a public high school which houses a school-based health clinic. The clinic has obtained parental consent for treatment of 80% of its students. It is staffed by a full-time nurse practitioner and a medical assistant. We plan to offer the students information about the test class by class, obtain specimens, and send them to the State Laboratory. Results will be available one week later. Those testing positive will receive single-dose azithromycin (for Chlamydia), or intramuscular ceftriaxone (for gonorrhea) in the school clinic. Based on existing STI prevalence, we anticipate high rates of positivity.