Experts Debate Merits of School-Based Testing for STDs
March 10, 2000 (New York) -- How would you react if your teen-ager came home
from school with a note requesting permission to test him or her for a sexually
transmitted disease (STD)? Would you allow it, knowing that you may not have
access to the results unless your child wants you to?
The subject is controversial and troubling for many parents and their kids.
However, unwanted pregnancies and rising rates of STDs like chlamydia and
gonorrhea among teen-agers are forcing experts to call for a balanced debate on
whether such testing should be widely available in schools, a British physician
writes in Saturday's issue of The Lancet. Such tests are typically conducted in
family planning clinics or health centers.
David Hicks, MD, at Royal Hallamshire Hospital in Sheffield, England, writes
that many of his colleagues initially agreed with the idea of STD testing in
schools, but then had questions, such as: "Would the results be given to
parents?" "Who else would have access to the information?" and
"Who would bear the responsibility for investigating further if sexual
abuse, rape, or incest is uncovered?"
Hicks' letter was prompted by a study published in
Pediatrics in December 1999 describing a three-year voluntary STD testing
program for 14- to 17-year olds in Louisiana high schools. At their first test,
12% of girls and 6% of boys had chlamydia infection; 3% of girls and 1% of boys
had gonorrhea. Chlamydia and gonorrhea are two of the most common and easily
treated STDs in the U.S.
By the end of the program, only 3% of boys had chlamydia, which was half the
rate of boys who had not participated in the program. There was a slight
decline in both chlamydia and gonorrhea infection in girls.
Results of the STD tests were given to students, who were advised to share
them with their parents, but sharing results with their parents was not
mandatory. The same confidentiality policy is carried out at family planning
and STD clinics across the country.
"We felt that if we had said that the parents would be given the
results, many students would not have been tested, and therefore many
infections would go unrecognized and there would be severe health consequences
that could have been prevented," says Thomas A. Farley, MD, MPH, medical
director of the STD/HIV Programs in the Louisiana State Office of Public Health
in New Orleans and senior author of the Pediatrics study.
Alarmingly, the Pediatrics study found that, of those infected with
gonorrhea or chlamydia, 90% had no symptoms. Indeed, adolescents are more
likely than adults to have no symptoms of STD infection, according to the
American Academy of Pediatrics' Committee on Adolescents, which also reports
that of the 20 million cases of STDs reported each year, one-third occur in
school-aged youth. As many as one in four adolescents contracts an STD before
graduating from high school.