Are STD Prevalence Projects Important?: Active Case Finding Through a School-based Screening Program versus Passive Surveillance --- District of Columbia, 2008–2011

BACKGROUND: During 2011, among 70 U.S. counties and cities, the District of Columbia (DC) ranked eighth in reported rates for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Sexually active teenagers are at higher risk of acquiring sexually transmitted diseases (STDs) because of behavioral and biological reasons. To focus limited resources on this population at high risk, the DC Department of Health (DOH) implemented the School-Based STD Screening Program (SBSP) during 2007 to provide diagnostic and treatment services. We evaluated SBSP’s effectiveness in active CT or GC case findings, compared with passive surveillance.

METHODS: SBSP data are imported into DOH’s STD Management Information System (STD*MIS). We examined 2008–2011 STD*MIS data to assess CT or GC prevalence among youth aged 15–19 years, and to characterize SBSP cases.

RESULTS: Overall, 8,293 chlamydia infections, 2,562 gonorrhea infections, and 215 coinfections were reported among youth aged 15–19 years; surveillance detected 10,441 (94.3%) and SBSP 629 (5.7%). During 2008–2011, SBSP’s contribution increased from 1.5% to 6.8% of cases. The majority of SBSP-detected infections were among females (67.1%) and blacks (95.3%). Eighty-two percent of SBSP-detected infections and 48.9% of surveillance-detected infections were among youth aged 15–17 years. During 2008–2011, the number and proportion of SBSP-detected male cases increased from 12 (1.6%) to 72 (8.4%), but was unchanged in surveillance data. Of 123 SBSP patients with available data, reported knowledge of HIV status increased from 18.2% to 50.0%.

CONCLUSIONS: SBSP detected a larger proportion of infections among males and youth aged 15–17 years than passive surveillance. These findings illustrate SBSP helps identify CT or GC cases among populations at high risk that surveillance can miss.