School-based STD screening: what next?

After non-invasive screening for chlamydia and gonorrhea became available in the early 1990s, the first population-based high school screening programme was launched in New Orleans in 1995.1 There was a great deal of excitement about the potential of the method to eliminate a large reservoir of asymptomatic infections. The access to high-risk adolescents was unparalleled—like catching fish in a barrel.

Many other American researchers followed suit, instituting their own school-based screening programmes in partnership with schools in Chicago, San Francisco, Baltimore, Philadelphia, Los Angeles, NYC and Miami. Initially, in New Orleans there was a suggestion that the repeated screening was having an impact on overall prevalence of disease,2 but as time went on, it was clear that the early promise was not fulfilled. Adolescents were not fully compliant with the testing. In spite of expansion to 13 high schools in the city and participation rates at each screening reaching 35–65% of all enrolled, high rates of infection, especially among high school girls, persisted.3

Initially, the failure to show a decline in New Orleans was attributed to the inability to screen enough students in enough schools, so efforts to obtain more funding for an expansion were undertaken. Funding could not be raised for New Orleans, but in 2002 the City of Philadelphia developed a comprehensive programme offering mass screening in every high school in the city. Yet, after 5 years and 85 000 tests, chlamydia and gonorrhea GC prevalence rates appear to remain steady …