BEHAVIOUR

How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs?

Catherine H Mercer¹, Lorna Sutcliffe¹, Anne M Johnson¹, Peter J White², Gary Brook³, Jonathan D C Ross⁴, Jyoti Dhar⁵, Paddy Horner⁶, Frances Keane⁷, Eva Jungmann⁸, John Sweeney⁹, George Kinghorn¹⁰, Geoff G Garnett², Judith M Stephenson¹ and Jackie A Cassell¹¹

¹ Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, University College London, Mortimer Market Centre, off Capper Street, London, UK
² Department of Infectious Disease Epidemiology, Faculty of Medicine Imperial College Faculty of Medicine, London, UK
³ Central Middlesex Hospital, North West London Hospitals NHS Trust, Acton Lane, Park Royal, London, UK
⁴ Department of GU Medicine Heart of Birmingham Primary Care Trust, Whittall Street, Birmingham, UK
⁵ Department of Genitourinary Medicine, Leicester Royal Infirmary, Leicester, UK
⁶ The Milne Centre, United Bristol Healthcare NHS Trust, Bristol, UK
⁷ Department of Genitourinary Medicine, Royal Cornwall Hospital, Truro, UK
⁸ Archway Sexual Health Clinic, Clerkenwell Building, Archway Campus, Archway Road, London, UK
⁹ Department of Genitourinary Medicine, Blackpool Primary Care Trust, Victoria Hospital, Whinney Heys Road, Blackpool, UK
¹⁰ Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
¹¹ Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, UK

Correspondence to:
Correspondence to:
Dr Catherine H Mercer
Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK; cmercer{at}gum.ucl.ac.uk

Objectives: To quantify the contribution of patient delay, provider delay, and diversion between services to delayed access to genitourinary medicine (GUM) clinics. To describe the factors associated with delay, and their contribution to STI transmission.

Methods: Cross-sectional survey of 3184 consecutive new patients attending four GUM clinics purposively selected from across England to represent different types of population. Patients completed a short written questionnaire that collected data on sociodemographics, access, and health-seeking behaviour. Questionnaires were then linked to routinely collected individual-level demographic and diagnostic data.

Results: Patient delay is a median of 7 days, and does not vary by demographic or social characteristics, or by clinic. However, attendance at a walk-in appointment was associated with a marked reduction in patient delay and provider delay. Among symptomatics, 44.8% of men and 58.0% of women continued to have sex while awaiting treatment, with 7.0% reporting sex with >1 partner; 4.2% of symptomatic patients reported sex without using condoms with new partner(s) since their symptoms had begun. Approximately 25% of all patients had already sought or received care in general practice, and these patients experienced greater provider delay.

Conclusions: Walk-in services are associated with a reduction in patient and provider delay, and should be available to all populations. Patients attending primary care require clear care pathways when referred on to GUM clinics. Health promotion should encourage symptomatic patients to seek care quickly, and to avoid sexual contact before treatment.

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