Effectiveness of School-based Chlamydia Screening: A Literature Review

Chlamydia trachomatis (CT) is the most commonly reported notifiable sexually transmitted disease (STD) in the United States (1). In women, chlamydia can result in serious sequelae, such as pelvic inflammatory disease (PID), chronic pelvic pain, tubal factor infertility, and ectopic pregnancy (1-3). In men, chlamydial infection can cause epididymitis, an inflammation of the epididymis, which in complicated cases can lead to scrotal abscess, testicular infarction, and infertility (1, 4). As a part of Healthy People 2020, the U.S. Department of Health and Human Services has defined a nationwide objective to reduce the number of adolescents infected with CT (5). In an effort to reduce the public health burden of CT in adolescents, school-based screening has been initiated in cities across the country. A critical review of studies reporting the results of CT screening initiatives in schools and other non-traditional settings was published in 2005 (6). Since that time, additional studies have been published reporting results of new and existing school-based screening initiatives. The purpose of this literature review is to critically assess the effectiveness of school-based chlamydia screening programs, as measured by recruitment of high-school aged males and females for screening, the detection chlamydial infection, and reinfection/rescreening rates. The majority of the studies available for review are cross-sectional prevalence reports of the screening uptake and CT prevalence detected in specific programs or specific SBHCs over different periods of time. This makes comparison of the effectiveness of programs and SBHCs difficult. SBHC screening had a lower average screening uptake then did school-based programs, though only one study reviewed provided screening coverage information for SBHCs. This study saw screening uptake ranging from 17%-56% in SBHCs, while the screening uptake in school-based programs ranged from 30.9%- 47.6% (7-9). All school-based programs had a larger screening uptake in males relative to females. All urban screening programs showed higher rates of CT positivity in females versus males, despite males having a higher screening uptake. In the two, reinfection studies evaluated, reinfection rates were high, ranging from 13.6% in a SBHC to 26.3% in a school-based program. Strengths and limitations of all reviewed studies are reported, as well as directions for future research