Chlamydia Screening Strategies and Outcomes in Educational Settings: A Systematic Review

Jamil, Muhammad Shahid MPH, MHM, MBBS*; Bauer, Heidi M. MD, MS, MPH; Hocking, Jane S. PhD; Ali, Hammad MPH, MBBS*; Wand, Handan PhD*; Walker, Jennifer PhD§; Douglas, Laura MPH; Donovan, Basil MD*∥; Kaldor, John M. PhD*; Guy, Rebecca J. PhD*

Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0000000000000095

Abstract: Chlamydia trachomatis (CT) screening programs have been established in educational settings in many countries during the past 2 decades. However, recent evidence suggests that high uptake of screening and management (treatment, partner notification, and retesting for reinfection) improves program effectiveness. We conducted a systematic review to understand the screening strategies, the extent of screening conducted, and uptake of management strategies in educational settings. Screening studies in educational settings were identified through a systematic search of published literature from 2005 to 2011. We identified 27 studies describing 30 screening programs in the United States/Canada (n = 10), Europe (n = 8), Australia/New Zealand (n = 5), and Asia (n = 4). Most studies targeted both male and female students (74%). Classroom-based strategies resulted in 21,117 testes overall (4 programs), followed by opportunistic screening during routine health examination (n = 13,470; 5 programs) and opportunistic screening at school-based health centers (n = 13,006; 5 programs). The overall median CT positivity was 4.7% (range, 1.3%–18.1%). Only 5 programs reported treatment rates (median, 100%; range, 86%–100%), 1 partner notification rate (71%), 1 retesting rate within a year of an initial CT diagnosis (47%), and 2 reported repeat positivity rates (21.1% and 26.3%). In conclusion, this systematic review shows that a variety of strategies have been used to screen large numbers of students in educational settings; however, only a few studies have reported CT management outcomes.

In Brief

A systematic review of Chlamydia trachomatis screening in educational settings found that screening programs have been successfully conducted in a range of educational facilities and used a variety of strategies.

Author Information

From the *The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; †Division of Epidemiology, School of Public Health, University of California, Berkeley, CA; ‡Center for Women’s Health, Gender and Society, Melbourne School of Population Health, and §Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia; ¶Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA; and ∥Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia

Conflict of interest: None declared.

Correspondence: Muhammad Shahid Jamil, MPH, MHM, MBBS, The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia. E-mail:

Received for publication June 4, 2013, and accepted December 18, 2013.

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