Sexually Transmitted Diseases
Original Articles
Screening for Gonorrhea and Chlamydia by DNA Amplification in Adolescents Attending Middle School Health Centers
Opportunity for Early Intervention
BURSTEIN, GALE R. MD, MPH*; WATERFIELD, GERALDINE MS, CPNP§; JOFFE, ALAIN MD, MPH†,§; ZENILMAN, JONATHAN M. MD‡; QUINN, THOMAS C. MD‡,#; GAYDOS, CHARLOTTE A. DrPH‡
*From the Department of Molecular Microbiology and Immunology, †Division of General Pediatrics and Adolescent Medicine, ‡Division of Infectious Diseases, The Johns Hopkins University, Baltimore; §Baltimore City Health Department, Baltimore; and #National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
The authors thank Pat Hauptman, Laura Davidson, Sharon Hobson, Helen Thomas, Nancy Woodhead, Marcy Amos, Dawn Kulszycki, and Sharon Will from the Baltimore City middle school-based health centers and the Johns Hopkins University Chlamydia Research Laboratory technicians who performed the laboratory assays. The authors also thank Marie Diener-West and John Santelli for their thoughtful comments.
Dr. Burstein's research is supported by the Association of Teachers of Preventive Medicine in collaboration with the Centers for Disease Control and Prevention.
Reprint requests: Gale R. Burstein, MD, MPH, Johns Hopkins University, Division of Infectious Diseases, 720 Rutland Ave, Room 1159, Baltimore, MD, 21205.
Received for publication March 5, 1998, revised June 23, 1998, and accepted July 14, 1998.
Abstract
Goal:
To determine prevalence and incidence ofNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample.
Study Design:
170 female students and 43 male students making 256 and 47 visits, respectively, ≥ 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained.
Results:
GC: 11.4% of female student and 2.1% of male student tests were positive. Incidence was 34.0 cases/1,000 person months(95% Confidence interval [CI]: 19.5-67.5). Median time tofirstpositive andrepeatpositive test was 4.6 and 2.6 months, respectively. For CT: 16.4 % of female student and 2.1% of male student tests were positive. Incidence was 57.5 cases/1,000 person months (95% CI: 35.2-93.8). Median time tofirstpositive andrepeatpositive CT test was 6.0 and 4.8 months, respectively. Assessed risk factors failed to specify a candidate screening population.
Conclusion:
These data suggest that all sexually active adolescent girls in this high risk setting should be offered testing for GC and CT at least twice per year, regardless of age or other sexual risk behaviors and that STD control efforts in high risk middle schools should be encouraged.