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Novel approach to screening for STDs in teens

When it comes to sexually transmitted diseases, teenagers have high rates of infection. Of the 15 million cases of STDs reported in the U.S., about a quarter occur in teenagers. And while rates of some diseases—such as syphilis—have dropped dramatically, other gonococcal and chlamydial infections are on the rise.

Too often, these infections go undiagnosed and therefore untreated, which allows the diseases to be spread to new partners. Without treatment, chlamydial and gonococcal infections can damage a woman's reproductive organs, making it difficult to become pregnant or carry the pregnancy to term.

A University of Pittsburgh School of Medicine team recently tested a novel way of detecting STDs in the hope of improving rates of detection among high school girls attending a school health clinic in that city from 1997-98. The researchers, led by Harold C. Wiesenfeld, MD, CM, wanted to see if teen girls would be willing to collect their own samples using vaginal swabs and what rate of infection would turn up using this method. They organized a study to determine whether self-collection was an effective way of obtaining samples for detecting STDs and whether the teens found it acceptable and even preferable to a pelvic examination done by a health professional.

They wanted to overcome what they perceived as obstacles to teens getting quality health care, including:

• fear of a painful pelvic exam
• concerns of confidentiality
• the stigma associated with STDs

Teen girls enrolled
The study, which was reported in the June issue of Sexually Transmitted Diseases, focused on detecting three of the more common STDs: chlamydia, gonorrhea and trichomoniasis in 228 female participants age 15 to 19 years. Participants were asked before the testing about their medical history, the reason for the visit to the clinic, STD risk factors (including number of partners, method of contraception) and current symptoms. A teen did not have to be seeking care for an STD or related symptoms to participate. Afterward, they were asked if they found this method easy to use.

The median age was 16 years old, with nearly equal numbers from grades nine through 12 and an even racial mix of blacks (46%) and whites (47%).

Lack of GYN care?
The teens in the study found it hard to believe they could have a STD. Less than half of the students (41%) who participated were seeking testing for STDs. While 116 students (51%) reported a gynecologic symptom (such as lower abdominal pain or vaginal discharge), only 3 percent believed they truly had an STD, according to the prescreening questionnaire. Fourteen percent had had a previous STD.

Risky behavior
Sexual activity was common, with 206 of the 228 girls (90%) saying they had had sexual intercourse. Multiple sexual partners were common, with almost half stating they had had more than one partner in the past year. While 81 percent had used condoms at one point or another, only 57 percent said they used condoms the last time they had sex. Despite the risky behavior, 43 percent of students had never had a gynecologic exam and one-half had never been tested for an STD.

High rates of infection
Using polymerase chain reaction to test for the infections, the researchers found that:

• 40 (18%) tested positive for chlamydia, gonorrhea or trichomoniasis.
• Trichomoniasis was the most common, found in 10 percent, followed by chlamydia (8%) and gonorrhea (2%).
• Nearly 13 percent of adolescents who had never had a pelvic exam tested positive for an STD.
• Among those infected, 87 percent did not think they currently had an STD.
• Half would not have sought testing if the study had not been available.
  

High marks
The vast majority thought that self-collection was easy to do (99%) and 83 percent of the girls who had had a pelvic exam preferred self-collection to an exam, prompting the researchers to conclude that such a program could easily be implemented in the high school setting.