BALTIMORE — For 11 years, school nurse Marcy Amos has bandaged the skinned knees and treated the asthma attacks of sixth-, seventh- and eighth-graders at Harlem Park Middle School. More recently, she and her co-workers have also been grappling with another common problem of adolescence--chlamydia, the country's most frequently reported sexually transmitted disease.
Sex is nothing new among middle-school kids in this tough west Baltimore neighborhood. Drugs and crime are rampant, family supports are often lacking, and children grow up too fast. As part of her job at the school-based health center, the outspoken and motherly Amos tries to sit down with all of the sixth-grade girls at Harlem Park to give them the facts about sex. She strongly encourages abstinence. But Amos and the other clinic nurses know that in the city's public schools, the median age of first sexual intercourse is 13 1/2 for girls, 12 1/2 for boys.
For the school's nurses, asking about sexual activity is a routine part of monitoring students' health. "I talk about it with everybody," said nurse practitioner Sharon Hobson, who works with Amos and sees patients in the school health center's two small examining rooms. "You don't know unless you ask."
Pregnancy or a severe gonorrhea infection in the pelvic organs are always among the possibilities that cross these nurses' minds when a 13-year-old girl comes to the health center with abdominal pain. But in the past few years, they and other health workers who treat sexually active adolescents have begun to worry almost as much about chlamydia, an infection that often causes few or no symptoms in a young woman yet can leave her permanently infertile or can cause premature birth of her infant if she is infected while pregnant.
In the past eight months, a new testing program at the school, being conducted as part of a study by researchers at Johns Hopkins School of Medicine, revealed a disturbingly high rate of chlamydia infection among Harlem Park students, most of whom are 11 to 14 years old. Of 135 urine samples taken from sexually active middle schoolers since November, 24--almost 18%--showed infection with chlamydia. Both girls and boys were infected. High rates of infection have also been found in studies of urban high school students in various cities.
