Abstract
The objectives of the study were to investigate the rates of sexually transmitted infections (STIs), uptake of full STI screening and contraceptive use during pre- and post National Chlamydia Screening Programme (NCSP) periods and to determine the prevalence of sexual abuse/assault. The method used was a retrospective case notes audit of children aged <16 years. STIs were found in 20% (n = 264) of children; 10% had genital chlamydia. 157 (59%) of 264 children had an assessment for non-consensual sexual activity; of those, 34% had a history of past or continuing sexual abuse/assault. An uptake of ‘full STI screening’ and contraceptive use were similar in both pre- and post-NCSP periods. Overall STIs and chlamydia rates were higher during post-NCSP period. In conclusion, NCSP has not yet made any significant impact on sexual health of under-16-year-olds and the prevalence of past or ongoing sexual abuse/assault was high.
Introduction
Increasing proportions of children are becoming sexually active before they reach the age of 16 years. 1 There is a high rate of sexually transmitted infections (STIs) in children aged <16 years.2,3 Children may be involved in past or ongoing non-consensual activity.
National Chlamydia Screening Programme (NCSP) for young people aged 16–25 years using first voided urine sample (FVU) was introduced in Bedfordshire in September 2004. The programme has also included children <16 years if they are found to be Fraser competent.
Our aim was to study the uptake of ‘full STI screening’, contraceptive use and STI rates during pre- and post-NCSP periods and documentation in the case notes for assessment of sexual abuse/assault and other risk factors.
Method
Newly attended boys and girls aged <16 years presenting between January 2002 to December 2006 to a genitourinary (GU) medicine clinic in a district general hospital were studied. A ‘full STI screening’ was defined in men as genital swabs for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and in women as genital swabs for NG, CT, Trichomonas vaginalis and other vaginal infections with or without blood test for syphilis and HIV and was routinely offered to all the attendees.
Data were collected retrospectively using standardized proforma. The results were then compared with those attended during pre-NCSP period (January 2002 to December 2004) and post-NCSP period (January 2005 to December 2006).
Results
A total of 264 children were studied; 78% of them were girls. Age range was 10–15 years. Seventy-two percent were white; 28% belonged to black and other ethnic minority groups. Demographic details uptake of ‘full STI screening’ and contraceptive use were similar between pre- and post-NCSP periods. However, uptake of HIV test was higher in the post-NCSP period.
Uptake of ‘full STI screening’, STI rates and contraceptive use
One-hundred and fifty seven out of 264 (59%) children had an assessment of non-consensual sexual activity and other risk factors; of those, 53 (34%) had a history of past or continuing sexual abuse/assault. 91% (n = 53) of victims were girls.
Discussion
Screening for an STI has both direct individual and indirect population-wide effects. The models have predicted that continuous opportunistic screening of young people at high uptake rates could reduce prevalence of CT within few years. Inequalities in coverage may result in a less efficient and less equitable outcome. 4 The study showed that although STI rates were high, access and uptake of screening were poor among boys. Despite similar level of uptake of ‘full screening’ and contraceptive use between the two periods, overall STI and CT rates were higher during post-NCSP period. An increased uptake of HIV test in the post-NCSP period was related to change in the testing policy. Higher STI and CT rates in the post-NCSP period could be due to deteriorating sexual health and/or introduction of nucleic acid amplification test in our laboratory when NCSP was introduced. Following this audit, the under-16 proforma had been modified to improve the documentation of risk factors as >40% of children were not assessed for sexual abuse/assault. In conclusion, CT remains the most common STI in both pre- and post-NCSP periods. Prevalence of sexual abuse/assault was high. The NCSP has not made significant impact on sexual health of under-16-year-olds attending the GUM clinic.