Monitoring std prevalence and reproductive health care among high-risk adolescent women

Abstract Background: Urban adolescent women, particularly those in socially disadvantaged situations are at high risk for infections with Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) and their sequelae. Non-invasive screening technologies, including ligase chain reaction (LCR) and polymerase chain reaction (PCR) urine tests for CT and GC allow for provision of screening services in settings frequented by high-risk adolescents where such services have not been traditionally provided. In 1999, the CDC lead a multi-site project monitoring STD prevalence and reproductive health service, collecting a standard set of variables in women Methods: Adolescent women who present for intake/services at selected facilities are enrolled in the project. In collaboration with CDC, sites developed a set of standard variables to be collected, including demographics, risk behaviors, symptoms, test performed, and test results. Dependent on services already performed, sites added CT and/or GC urine PCR/LCR and pregnancy testing to existing screening protocols. Results: In first 3-months, 533 adolescent women were enrolled in this on-going study; 379 in juvenile institutions, 38 in drug treatment centers, and 116 in school-based clinics. Mean age was 16 yrs, over 90% were sexually experienced, nearly 50% did not use condom with the last sex, less than 40% reported “current” birth control use, over 2/3 had sexual intercourse in past 3 months, many with multiple partners. Prevalence rates for CT and GC are summarized in the table. Clinic Youth Detention Drug Treatment School-based Birmingham Denver Birmingham Denver Birmingham Denver N 216 163 27 17 85 31 CT 30 (13.9%) 32 (19.6%) 2 (7.4%) 2 (11.8%) 7 (8.1%) 3 (9.7%) GC 18 (8.4%) NA 0 NA 5 (5.9%) NA Conclusions: Non-invasive (urine) LCR/PCR tests allow for easy monitoring of selected STDs among adolescent women in high-risk settings. These findings may contribute to a sentinel surveillance system among high-risk populations and, in turn, may provide the rationale for the development of health care/intervention priorities at policy level.