Not-so-safe sex: STIs at Princeton

“We wanted to get the word out that this is available,” SGAC special projects chair Adjani Peralta ’11 said, noting that HIV is the only STI for which University Health Services (UHS) provides free testing to all students.

Though the University dropped from 29th to 61st on the annual Trojan Sexual Health Report Card this year, the rates of STIs among students on campus are on par with those at other colleges and universities in the United States, based on the fall 2008 National College Health Assessment (NCHA) II and data provided by UHS to The Daily Princetonian.

Though all STI testing is free under the University’s health insurance plan, students with outside insurers may face high prices.

“If you want to pay out of pocket, it’s an expensive proposition,” said Olga Hernandez, nurse practitioner and coordinator of Sexual Health and Wellness Services. “If you want to do the whole battery of tests, which includes chlamydia and gonorrhea, herpes, HIV and syphilis all together, it could be close to $300.”

For its report card, Trojan grades schools in 13 categories, including HIV and STI testing, explained Bert Sperling, president of Sperling’s BestPlaces, the company that ran the survey for Trojan. The University’s overall grade point average was 2.69, and it received a B for HIV testing and an F for STI testing. UHS officials said they were not consulted for the Trojan rankings, though Sperling said his company sent them a questionnaire and called their office.

For HIV and STI testing, grades are determined by the availability and costs of tests on campus. Sperling noted that schools offering free HIV and STI testing on campus received the best scores.

Two years ago, the University could subsidize tests for chlamydia, gonorrhea and all other STIs. After changes in the law, testing now has to go through labs, which increased the costs, explained Dr. Peter Johnsen, director of medical services at UHS. This change created concerns at UHS that students would not get tested, causing the University to include all STI testing under its health insurance plan.

HIV testing can be done for free at UHS for all students, but it takes two to three weeks for results to arrive, Hernandez said, adding that if a student wants the result the next day, which many do, it costs $90.

Recently, there has been a rise and slight fall in HIV testing on campus, with 377 tests in the 2005-06 academic year, 504 in 2006-07 and 484 in the last academic year. Though a small number of students have self-reported that they are HIV-positive, there has never been a positive test for HIV in the history of UHS, Hernandez said.

In fall 2008, 24 percent of students in the United States reported getting tested for HIV, and 0.3 percent tested positive, according to NCHA data from 26,685 students at 40 different schools.

Since UHS does not offer anonymous testing, some students get tested at other sites, Johnsen said. Under New Jersey state law, only specific sites — such as the Robert Wood Johnson University Hospital in New Brunswick and Henry Austin Health Center in Trenton — can perform anonymous HIV tests, he added.

When students do get tested for STIs at UHS, the results are confidential, but the patient must provide his or her name and identifying information, such as date of birth. The results are recorded in that student’s chart. All positive HIV tests must be reported to the New Jersey Department of Health and Senior Services.

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UHS is looking into the possibility of providing cheaper testing for chlamydia and gonorrhea through the state, Johnsen said.

In the 2005-06 academic year UHS ordered 477 tests for chlamydia and gonorrhea, which are tested simultaneously. Seven of those tests came back positive for chlamydia and three for gonorrhea. In subsequent years, the number of tests for the two STIs rose. In the last academic year, UHS ordered 672 tests. Six came back positive for chlamydia and one for gonorrhea.

The UHS report explained that the rise in the number of tests ordered reflects a push for chlamydia testing, especially for women. The Centers for Disease Control and Prevention (CDC) recommend that all sexually active women below the age of 25 get tested for chlamydia, which is the most commonly reported STI for adolescents and young adults between 15 and 24, according to CDC data. In the fall 2008 NCHA II, one percent of respondents reported contracting chlamydia and 0.3 reported contracting gonorrhea.

The 2007-08 academic year saw a jump in chlamydia diagnoses on campus, with UHS ordering 638 tests for the STI, 13 of which came back positive. UHS administrators provided two explanations for this “blip.” Hernandez said that this “little spike” occurred in a two-week period, when a flurry of students came in to get tested.

“We were wondering, were they sharing partners? There are people who engage in not serial monogamy ... would have a lot of partners in the same night,” she said.

UHS director John Kolligian proposed a different explanation, though he stressed that they could not know the definite reason for the fluctuations.

“It could also be that during that blip or during one period … it rose to someone’s consciousness to get tested, and then they became positive and then told their friends, ‘Go out there and get tested. I didn’t think I would have anything,’ ” he said.

After students finish paying testing fees, they have to wait for the results. A positive diagnosis can result in tears, Hernandez said. She noted that with STIs like chlamydia, students are upset that they have to talk with their partners, but the situation is less traumatic because the infection can be treated. Herpes, though, is a different story.

“It’s a very emotional diagnosis,” she said. “It takes them a while to understand that they have herpes for life. Herpes is probably one of the hardest ones.”

Rates of Type 1 genital herpes have remained stable, with five cases discovered on campus in the 2005-06 academic year and four last year. Rates of Type 2 genital herpes also remain constant, with nine cases in 2005-06, a dip to two in 2007-08 and six last year. In the fall 2008 NCHA II, 0.8 percent of respondents reported having genital herpes.

“Among the guys, herpes has been the one that has been the most troubling for them to deal with,” Johnsen said, noting that a few students come in for testing when they have symptoms, but many get tested before starting a new relationship.

Being diagnosed with an STI that cannot be cured, like herpes or HIV, could cause a student severe distress, but some of these results are false positives.

During the 2005-06 and 2006-07 academic years, UHS had a high rate of abnormal pap smears, which indicate a high risk for HPV. There were 129 abnormal pap smears in 2005-06 and 158 in 2006-07.

“We were concerned that there were more false positives than we were comfortable with,” Kolligian explained. “We looked for a different lab that had a higher degree of accuracy.”

Hernandez noted that UHS changed labs in 2007-08, resulting in a drop in abnormal pap smears. There were 88 abnormal pap smears in 2007-08 and 39 in the last school year.

Hernandez noted that the drop might also have been due to the advent of the new HPV vaccine Gardasil, which the FDA approved in June 2006.

Given the sensitive nature of STI tests, even in the cases of false positives, UHS decided not to stratify the data based on gender, age or class year.

“I might have some concerns that this level of detail might be experienced by someone on campus as almost too much information given the assumptions that people make of privacy … especially around more intimate parts of their health,” Kolligian said.

This may be especially true with STIs that are less common on campus. There have been two cases of pubic lice since 2005-06. There has been a dip and then rise of scabies cases, with eight in 2008-09.

Other STIs have been less prevalent. There has not been a diagnosis of trichomoniasis since the 2005-06 academic year, when UHS saw seven. There have been no cases of chancroid or hepatitis since 2005-06. Though there were 94 syphilis tests ordered on campus in the 2005-06 academic year, 106 in both the 2006-07 and 2007-08 academic years and 79 last academic year, there has not been a positive diagnosis for the STI in the last four years.

“It’s really not possible to make any generalizations about the sexual health of our student body, our community, based on the data that we’re presenting,” Kolligian explained. “The national health data that we have access to at this point really does suggest that college students are a pretty healthy cohort, and that is the prism through which we view our students’ health and our students’ sexual health.”

He added that, for the most part, University students make healthy decisions, including those related to sexual health, with the exception of “concerning and problematic” instances of “impaired” judgment.

“If on a Thursday night or a Saturday night they’re drinking too much, then all of the typical thoughtfulness and caution and … common sense can be put on hold for a while,” he said.