EXECUTIVE SUMMARY

Young people 15-24 years of age account for half of the nearly 20 million new sexually transmitted infections (STIs) that occur each year in the United States, according to data from the CDC. College health centers are playing a pivotal role in the introduction and performance of timely STI screenings.

  • Colleges with health centers provide a variety of sexual health services, but two-year colleges may require additional support, a recent national analysis notes. Possible improvements include increasing routine chlamydia screening for women, extragenital STI testing for men who have sex with men, and removing barriers to testing by offering express and self-testing.

Young people 15-24 years of age account for half of the nearly 20 million new sexually transmitted infections (STIs) that occur each year in the United States, according to data from the CDC.1 Both the number and rates of reported cases of chlamydia and gonorrhea continue to be highest among people in this age group, with young women facing the most serious long-term health consequences. The CDC estimates that undiagnosed STIs cause more than 20,000 women to become infertile each year.1

College health centers are playing a pivotal role in the introduction and performance of timely STI screenings. To get an overview of what services are being offered, CDC researchers recently surveyed colleges and universities across the United States to describe the array of sexual health services provided.2

To perform the survey, researchers sampled 885 U.S. colleges from the 2014-2015 Integrated Postsecondary Education Data System, a system of interrelated surveys conducted annually by the U.S. Department of Education’s National Center for Education Statistics. Only active, two- or four-year, degree-granting, accredited institutions, which enrolled at least 500 students, were included. A total of 482 schools responded to the survey (55%), and were weighted to be nationally representative. The analysis stratified results by minority-serving institutions (MSIs) and non-MSIs, as well as two-year (2y) and four-year (4y) facilities.

Of the weighted sample, researchers say 67.7% of colleges reported having a student health center, of which 74.4% offered STI diagnosis and treatment (4y vs. 2y; 78.3% vs. 57.6%; P < 0.001). Almost three-quarters (73.5%) of health centers reported routine chlamydia screening in women (4y vs. 2y; 75.4% vs. 63.6%; P = 0.004) and 24.7% offered express STI testing (26.1% vs. 15.6%; P = 0.005); follow-up chlamydia screening and self-collected vaginal swabs were offered at 82.7% and 31.0% of health centers, although no significant differences existed. Almost all facilities offered HIV testing (92.3%), with MSIs reporting higher availability of HIV testing compared to non-MSIs (96.2% vs. 91.2%; P = 0.005). In regard to services for men who have sex with men (MSM), 46.8% of facilities offered pharyngeal and rectal (43.8%) STI testing. HPV vaccination was offered at 70.3% of centers. Free testing was offered at only 10.3% of health centers. Of note, 37% of facilities reported that a local health department or outside organization was the primary source of STI services.2

Colleges with Health Centers

Colleges with health centers are providing a variety of sexual health services, but two-year colleges may require additional support, the analysis notes. Possible improvements include increasing routine chlamydia screening for women, extragenital STI testing for MSM, and removing barriers to testing by offering express and self-testing.2

The American College Health Association (ACHA) is a national nonprofit association serving as the nation’s principal leadership organization for advancing the health of college students and campus communities. In 2015, it marked its 25th year of polling member institutions to obtain information about their screening practices for cervical cytology and STIs. The most recent available data set includes information about gynecologic services, Pap tests, and testing for STIs performed at U.S. colleges and universities during calendar year 2014.

A total of 152 institutions/health centers completed the survey online; however, not all respondents completed every question. Health centers reported 3,090,509 visits in 2014, including 423,534 women’s health visits. More than three-quarters of facilities (75.7%; n =115) were public, four-year institutions.

What did the survey show? Basic screening for chlamydia, gonorrhea, and HIV is widely available upon patient request; 96.1% of health centers (n = 146) reported offering routine screening for STIs for sexually active students upon request, regardless of risk factors. More than half (65.1%; n = 99) indicated they offered STI testing based on identified demographic risks.

Most of the health centers (88.2%; n = 134) reported routinely screening sexually active women younger than age 26 for chlamydia. This area indicates room for improvement; the CDC recommends annual chlamydia screening for all sexually active women younger than age 25.

When it comes to gonorrhea testing, most health centers (72.8%; n = 110) reported they perform gonorrhea testing from nongenital sites (rectal or pharynx) in MSM. This number has increased from 60.3% in 2012 and 70.8% in 2013. The CDC recommends screening for gonorrhea at all exposed sites in MSM and for rectal chlamydia in MSM who report a history of receptive anal intercourse.3

Health centers are doing their part when it comes to promoting safer sex: 72% reported they provided free male condoms, while 47.3% said they offered oral dams and 46.7% provided lubrication at no cost.

The ACHA Sexual Health Education and Clinical Care Coalition is working with results from the 2015 college year survey to prepare the data set, says Lesley Eicher, MEd, CHES, CSE, coalition chairperson.

REFERENCES

  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: U.S. Department of Health and Human Services; 2015.
  2. Caccamo A, Habel M, Beltran O, et al. Making the grade: Assessing the provision of sexual health services at U.S. colleges & universities. Presented at the 2016 STD Prevention Conference. Atlanta; September 2016.
  3. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3):1-137.