1. M. Jacques Nsuami, MD, MPH Stephanie N. Taylor, MD
Treatment and Follow Up in School-Based Sexually Transmitted Disease Screening Programs
M. Jacques Nsuami, MD, MPH
Stephanie N. Taylor, MD
LSU Health Sciences Center, New Orleans, LA
9/16/2019

2. School and students’ participation in the New Orleans STD Screening Program
# of Schools
Tested
Chlamydia
Gonorrhea
Fall 3
1662
106
Spring
627 33
1721 71 28
1375 55 23 8
3851
325 61 12
6020
464
119 13
6080
578
2869
355 93
3069
346 66 7
2235
274 67
2229
285 53 9
2169
258 52

3. Prevalence of chlamydia among 9-12th graders in the New Orleans STD Screening Program

4. Prevalence of gonorrhea among 9-12th graders in the New Orleans STD Screening Program

5. Treatment and Follow up in School STD Screening Programs
Providing treatment and follow up to individuals screened for a health condition is a key component of any screening program. There is no justification for screening if treatment and follow up cannot be provided.
Treating students who test positive for CT/GC in school settings is conceivably more efficient because students can be easily located.
However, there is no single best approach to locating or notifying infected students of their test results and scheduling treatment in schools. What may work in one school may not work or may not be accepted in another school, even within the same school district.
Processes for treatment are often negociated on a school-by-school basis.
Flexibility remains the key.

6. Following Results Notification
All programs
Offer in-school single dose observed therapy for CT/GC to all students testing positive and who are located in school;
Return to each school generally multiple days to locate students needing treatment;
Treatment sessions include STD counseling.

7. In-School Treatment Baltimore -SBHCs Indian Health Service
-Nurses Office
-IHS Clinic
New Orleans
-Office in a SBHC
New York City
-Any other available private space
Philadelphia
-Counselors Office

8. Following Results Notification
All programs
Collaborate with local health services/departments to treat students who are not located in school, those who refuse in-school treatment, or prefer to be treated by their private physician;
-Indian Health Service: coordination between tribe, IHS, and
the local health department is critical to ensure
no one falls through the cracks.
-New Orleans: the Medical Director of the STD Clinic is also
the Medical Director of the School-Based STD
screening program.
-New York City, Philadelphia: a policy for expediting HS
student treatment is in place in the City STD
Clinics.
City STD Clinics and DIS are of great assistance to school-based STD screening programs.

9. Patient Follow Up Students treated in school Baltimore:
are instructed to return to the SBHC for retesting after 3 months.
New Orleans, New York City:
are referred to the STD Clinic to seek additional STD evaluation including HIV testing;
NO: are not offered in-school retesting at 3 month but all are encouraged to be tested every year regardless of their previous participation and test results.
NYC: are offered retesting 3-4 months after treatment in schools with SBHCs (through the SBHC).
Philadelphia:
may be offered in-school retesting 3-4 months after treatment when staffing and school schedule permit.

10. Patient Follow Up Students not located and treated in school
Indian Health Service:
Coordinates between tribe, IHS, and the local health department to ensure no one falls through the cracks.
New Orleans, New York City, Philadelphia:
are referred to DIS for field follow up.

11. Partner Notification and Follow Up
Students treated in school
New Orleans, New York City, Philadelphia:
are interviewed to elicit partner information.
Partners who attend school and located in school
are tested for CT/GC (New York City) and offered treatment (New Orleans, New York City, Philadelphia);
are referred to the city STD Clinic for further STD evaluation including HIV testing (New Orleans, New York City).

12. Partner Notification and Follow Up
Partners not in school and/or not located
New York City:
are contacted by phone if possible, and if not located by phone, in person visits are made to their school or home.
Once located, partners are given information about their exposure to an STD, then given information to go to the Clinic for treatment.

13. Partner Notification and Follow Up
Partners not in school and/or not located
New Orleans, Philadelphia:
Elicited partner information is given to DIS who initiates notification of exposure and follow up to the city STD clinic.
At the STD clinic, partners undergo routine STD evaluation and management (New Orleans) or are seen in an expedited visit (Philadelphia).

14. Location of treatment for positives detected in the Philadelphia High School STD Screening Program

15. Time before treatment (days)
Time before treatment in the New Orleans High School STD Screening Program
School Year
Total treated*
Time before treatment (days)
% treated within 30 days
Mean
Median
Total
137
223
229
222
811 21 25 23 17 22 19 15
86.1%
80.0%
83.4%
95.5%
83.8%
*Students with documented date of treatment

16. Conclusions
School-based STD screening programs generally achieve high treatment rates;
Treatment usually require strong collaboration with local health services, and tremendous amount of time and personnel;
In inner-city schools, treatment is frequently delayed by high absentee and truancy rates;
Protocols to ensure high partner notification and treatment have been difficult to develop, which partly contributes to high rates of reinfections among students;1
Collectively, these programs demonstrate that schools provide unique opportunities to control STDs among adolescents.
1Gaydos CA et al., Sex Transm Dis. 2008;35:

17. Acknowledgements Panelists: Special Thanks:
Lenore Asbel, MD, Philadelphia, PA
Lori de Ravello, Albuquerque, NM
Charlotte A. Gaydos, DrPH, Baltimore, MD
Meighan Rogers, MPH, New York City, NY
Special Thanks:
Greta Anschuetz, MPH,
Compiled data on location of treatment in the Philadelphia School Screening Program