More than 15 million Americans are infected with sexually transmitted diseases (STDs) each year. Yet many more go undiagnosed, increasing the need for innovative screening and treatment programs.
Researchers at Washington University School of Medicine in St. Louis implemented an STD study program that moves beyond the traditional clinic walls. They set up booths in community gathering places frequented by people at high risk for STDs. In bars, soup kitchens and other sites, they offered urine screening for chlamydia and gonorrhea -- two of the most commonly reported STDs. These two diseases are sometimes undiagnosed because they often produce no obvious symptoms. If left untreated, those infected risk transmitting the disease to sex partners, and they also can suffer serious long-term complications. The latter include pelvic inflammatory disease, ectopic pregnancy or infertility.
"We were able to identify people who in most cases didn't know they were infected. Moreover, we also interrupted further transmission of STDs into the community," said Bradley Stoner, M.D., Ph.D., assistant professor of medicine in the infectious diseases division and lead author of the paper in the March 2000 issue of Sexually Transmitted Diseases. The Centers for Disease Control and Prevention funded this study.
Out in the community
Field workers, in collaboration with the St. Louis City Department of Health and Hospitals, offered screenings at a variety of sites, including shelters, residence facilities, bars, drug-treatment centers and soup kitchens. At each site, they invited attendees 15 years and older to participate. As the project progressed, screenings were restricted to people 15 to 30 years of age to maximize the likelihood of detecting prevalent disease.
"We know that these diseases tend to congregate in younger clientele, with the highest prevalence being in teenagers and young adults," Stoner said. Participants were asked to submit a urine sample and complete a contact information sheet. Stoner said his team initially was concerned that prospective participants might be unwilling to submit a urine sample out of fear it would be used for drug testing. "But once we explained to people what we were doing and why we were doing it, we had a very high acceptance rate," he said.
Subjects were given a phone number to call a week later to get test results. The investigators collected 277 urine samples and identified 24 people with gonorrhea and/or chlamydia. Participants who tested positive were directed to the city's health department for treatment if they lacked a personal physician. If subjects who tested positive failed to call in for results, screening staff tried to locate them and get them to a treatment facility.
"In some cases, we had difficulty tracking down a few of the positive cases because they were transient," Stoner said. "But we were able to document treatment for 90 percent of the people testing positive."
Reducing rates is key
Diagnosing 8.7 percent of study participants with gonorrhea and/or chlamydia is a very high success rate for most infectious diseases, Stoner pointed out. "We've demonstrated that a community-based program such as this one can identify rates of infection that are essentially the same as those you see in a family clinic, where people are coming in for care," he said.
Tests and personnel costs were $38 for each urine sample and $435 for each positive case identified. Researchers said that, while initial costs may seem expensive, the program would save the long-term expense of taking care of patients with pelvic inflammatory disease and other complications of STDs. "We have very high rates of STDs in the United States, and our feeling is that anything we can do to lower infection rates is valuable," Stoner said. "These diseases are out there, and screening programs like this one can contribute to the goal of reducing the overall prevalence of STDs. We therefore think it's important to reach out to people at high risk rather than expecting them to take the initiative."
Note: For more information, refer to: Jones CA, Knaup RC, Hayes M, Stoner BP, "Urine Screening for Gonococcal and Chlamydial Infections at Community-Based Organizations in a High-Morbidity Area," Sexually Transmitted Diseases, 27(3): 146-151, March 2000.
Journal
Sexually Transmitted Diseases