Background Providing treatment to individuals screened for a health condition is a key component of any health screening program. School-based screenings for sexually transmitted diseases (STD) offer the possibility of efficiently and promptly treating participants because students can be easily located after they have been tested. We describe treatment rates and time to treatment for students with Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) infection in a school-wide screening program.
Methods Between 1995 and 2005, 20 224 high school students were tested for CT and NG during annual screenings using urine specimens and commercial nucleic acid amplification tests. Test results were available approximately five working days after specimen collection. Students who tested positive were located at school during regular class hours for counselling and treatment by a school nurse, a clinic nurse, a public health nurse, or a physician. Treatment was with a single 1 gram oral dose of azithromycin for CT and 500 mg oral ciprofloxacin for NG, administered under direct observation. Before its removal from the market, cefixime 400 mg in single oral dose was used to treat NG. The names of infected students who could not be located in school were forwarded to a public health Disease Intervention Specialist (DIS) for follow-up. The DIS provided the program with an update on the follow-up status of each name referred.
Results During the 10-year period, 3422 infections (CT: 2746; NG: 304; CT and NG: 372) were identified. Treatment was documented for 2844 infections (83.1%). There were no significant differences in rates of treatment (p>0.37) by gender or by infection. The rates of treatment varied by school year from a low of 64.8% in 1996–1997 to a high of 94.9% in 1997–1998 (p<0.0001). For 2692 infections with documented dates of treatment, the median time from specimen collection to treatment was 21 days (75th percentile: 33 days).
Conclusions This high school STD screening and treatment program achieved high treatment rates for both CT and NG, although the treatment effort required strong commitments of various individuals from the screening program, the administrations in participating schools, and the local health services. Differences in treatment rates per school year reflected the dynamic interplay of these various individuals and organisations as well as the commonly high absentee, truancy, and dropout rates among students in the school district.
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