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.
The authors concluded that incorporating STD screening into schools might help this hard-to-reach population. And based on the drop in chlamydia infection in boys, they say STD screening programs in schools may aid STD prevention efforts.
Hicks writes that another thorny issue related to STD testing in schools is having to document teen-agers' complete sexual history. He says the health care worker who takes the sexual history has an "enormous burden to bear" regarding the reporting of events such as rape, incest, abuse, prostitution, and under-age sex.
But Farley says a detailed sexual history is unnecessary for most teen-agers undergoing STD testing. In his program, only teens who test positive for an STD have a more detailed sexual history taken, which includes identification of sex partners and making attempts to get them treated -- as well as counseling on safe sex and birth control.
He says his program has not encountered any cases of non-consensual sex or abuse, but admits that it is a concern when implementing these types of programs nationwide. "Some sort of reasonable policy needs to be put in place that balances out all the issues," Farley tells WebMD. But issues of what to do with sensitive information and how to report it through the proper channels should not prevent implementation of STD screening programs for teen-agers, he adds.
"Without programs such as this, we have many, many students out there with infectious diseases that are serious -- and [that] potentially increase their risk of HIV infection. So dealing with issues that involve a percentage of those students, perhaps a small percentage, shouldn't prevent us from implementing a program that has an overall big health benefit," Farley says.
- As many as one in four adolescents contracts an STD before graduating from high school, and adolescents are even more likely than adults to have no symptoms of STD infection.
- Rising rates of STDs have led some experts to suggest screening tests for STDs be available in high schools.
- Widespread availability of STD screening may help combat this public health problem, but there are many ethical issues to be considered.