1. Philadelphia High School STD Screening Program Declining Disease Prevalence After 4 Years of Screening Lenore Asbel, Melinda Salmon, C. Victor Spain, Christa Seidman, Mindy J Perilla, Martin Goldberg

2. Background Adolescents disproportionately affected 2003 – Philadelphia 15-19 year olds –43% of CT infections and 31% of GC infections –Chlamydia rate: 6,705 /100,000 Rate among females 10,256 /100,000 –Gonorrhea rate: 1,597 /100,000 Increased screening throughout the city had begun

3. Reported Cases of Chlamydia: Philadelphia, 1991-2003 Year Number of cases *Chlamydia reportable as of October 1991 1994: Infertility Prevention Project (IPP) 1999 data analysis: shows high re-infection rates in women 1997 & 1998: Increasingly sensitive laboratory technologies Youth Study Center Adult prisons Citywide HS screening & 5 HRC HS 2000 – present: New surveillance programs Nov 2001: 2 HRC high schools (HS) DHCC’s July ‘01

4. High School Screening Pilot Project during the 2001-2002 school year. Health Resource Center STD Screening (2 schools) Male TestsFemale TestsTotal Total # of tests5366831219 Total positives (%) 28 (5.2%)110 (16.1%)138 (11.3%) Positive for CT only (%) 26 (4.9%)87 (12.7%)113 (9.3%) Positive for GC only (%) 0 (0.0%)10 (1.5%)10 (0.8%) Dual Infection (%)2 (0.4%)13 (1.9%)15 (1.2%)

6. How it all works Parents notified by school district Meet with schools to set up screening Educational presentation The process Each student makes a decision, on their own, whether or not to submit a specimen

7. Numbers of Students Reached by Philadelphia’s STD High School Screening Program # of Persons Year 1 (2002-03) Year 2 (2003-04) Year 3 (2004-05) Attending Presentation ~30,000 Screened19,71317,01916,378 Positive persons Chlamydia + GC + 1,052 (5.3) 1013 (5.1) 94 (0.5) 813 (4.8) 768(4.5) 96 (0.6) 680 (4.2) 642 (3.9) 75 (0.4) Treated (%)1,051 (99.9)807 (99.3)676 (99.4) {55 co-infected}{37 co-infected}{41 co-infected}

8. Percent Positive for GC/CT combined by Sex and Year

9. Percent Positive for GC/CT combined by School Type and Year

10. Percent Positive for GC/CT combined within age-group by year

11. Over the first three years…  CT positivity rate among participating high school students  declined from 5.1% in 2002-2003 to 3.9% in 2004- 2005  GC positivity rate remained fairly stable  0.5% to 0.4%  Overall GC/CT infection  24% decline in positivity rate  35% decline in the number of positive cases

12. Preliminary Year 4 Data GC/CT infection rates seem to have increased slightly from Year 3 – though remain less than Year 1 Total positivity in Year 4: 4.7% –Female positivity: 7.2% –Male positivity: 2.4% Overall testing rates have decreased

13. Reported Cases of Chlamydia: Philadelphia, 1992 - 2005 Year Number of Cases

14. Rates of Chlamydia per 100,000 Population, by Age: Philadelphia, 1995 – 2005 Year Rate per 100,000 population Rates for 1995 to 1999 calculated with 1990 Census denominator. Rates for 2000 to present calculated with 2000 Census denominator.

15. Conclusions High school STD screening program implemented successfully with few issues The broad-based screening program implemented in Philadelphia public high schools was successful in finding and treating cases of CT and GC

16. Continuing the program yearly has contributed to the declining rates of infection among students. –Preliminary decreases in testing rates and increases in positivity in Year 4 require further evaluation. High School screening may also have contributed to a citywide decline in chlamydia infection rates. –Broad-based screening in a variety of venues important Conclusions, continued…

17. Many Thanks!!!!!!! Screening Staff High School Staff and Administrators Support Staff Martin Goldberg, Melinda Salmon, Caroline Johnson Vic Spain, Mindy Perilla, Christa Seidman