The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61919

Nancy E Fritz, MD, Pediatrics/Adolescent Medicine, Cook County ACHN, 1900 w Polk Street, Rm 1114, Chicago, IL 60612, 312-572-4954, teendrnan@excite.com, Margo Bell, MD, Pediatrics, Adolescent Medicine, Cook County Ambulatory and Community Network, 1900 W. Polk #1113, Chicago, IL 60612, Christiane E. Stahl, MD, Department of Pediatrics, University of Illinois at Chicago, 840 S. Wood St., M/C 856, Chicago, IL 60612, and Sakiba Issa, MD, Dept of medicine, Cook County Hospital, 1114 w polk st, #1114, Chicago, IL 60612, Angola.

The alarming frequency of STIs in teens, and their propensity to lead to serious sequellae, makes effective screening an urgent public health issue. To better understand how epidemiology varies by gender and mode of testing, we examined screening patterns for gonorrhea/Chlamydia in an adolescent population. This study looks retrospectively at gonorrhea/Chlamydia screening conducted over 6 years on sexually active students enrolled in a school based health center (SBHC). During the first 3 years, screening on urethral or cervical swabs utilized DNA probe technique. During the 2nd 3 years, urine samples were tested using DNA amplification. Resultant differences in screening numbers are described, as are epidemiologic patterns. Results: 1189 students were screened 2754 times. Shifting to non-invasive screening increased the number of females screened 1.6 times, males 13 times, and number of infections diagnosed by 1.4 and 3.8 times respectively. Additional diagnosis by amplification testing could be attributed primarily to asymptomatic Chlamydia infections. Even with identical screening policies, females were tested 3.3 times more often than men—and had greater prevalence and incidence of infection than males, after adjustment for follow-up differences. Once-infected females were more likely to become subsequently infected than never-positive females. Males were more likely to be treated on presentation than females. Conclusions: Though shifting to non-invasive screening for gonorrhea/Chlamydia in a SBHC can enhance diagnosis, especially for men, females continued to have more regular follow-up and higher incidence and prevalence of disease. Epidemiology for presenting symptoms and recurrence patterns differed by gender as well.

Learning Objectives:

At the conclusion of this session, participants should:
• understand various enhanced screening outcomes of shifting to a Dna amplification model;
• understand the epidemiologic differences of infection between males and females in this population;
• be cognizant of some of the challenges in effectively screening teenagers for asymptomatic STI infections.

Keywords: STD, School-Based Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.