Background The implementation of healthcare reform in the U.S has led to a debate on whether publicly-funded STI clinics will continue to be necessary. A large proportion of STIs are reported from non-STI clinic providers and this proportion will grow with universal access to care. However, STI clinics serve vulnerable populations such as men who have sex with men (MSM) and racial/ethnic minorities who have no other access to STI care. In addition, many prefer the confidentiality and expertise of STI clinics. We studied characteristics of patients reported with gonorrhoea in the City and County of Denver and compared those reported from the Denver Metro Health (STI) clinic (DMHC) with those reported from elsewhere.
Methods As part of the CDC-funded STD Surveillance Network (SSuN), DMHC and the Colorado Department of Public Health and Environment (CDPHE) collect additional risk information for gonorrhoea cases residing in the SSuN catchment area. Of all incident gonorrhoea cases within a given month, 40 are randomly selected for an interview by CDPHE staff to collect demographic, treatment, and risk information. All gonorrhoea cases diagnosed between 1 January 2008 and 31 October 2010 were examined.
Results Of 2933 gonorrhoea cases for the 2-year period, 932 (32%) were diagnosed at DMHC. Cases diagnosed at DMHC were considerably more likely to be male (74% vs 38% p<0.0001), and tended to be slightly older (mean age 27.0 vs 24.9, p=<0.0001) than cases diagnosed elsewhere. CDPHE successfully contacted 41% of selected cases for interviews. A significantly higher proportion of cases diagnosed in the STI clinic were MSM compared to cases diagnosed elsewhere (34.7% vs 14.5%, p≤0.0001). No differences were found in terms of race/ethnicity, number of reported sex partners, education level, or previous gonorrhoea infection.
Conclusions In the City and County of Denver, heterosexual men and MSM are more likely to be diagnosed with gonorrhoea in the STI clinic than women. The successful transition of STI services to non-STI healthcare systems in the context of healthcare reform, will not only depend on the STI expertise in those settings, but in large part on a shift in health seeking behaviours among men, many of whom may be considered core STI transmitters. The continued need for and utilisation of STI clinics in countries with long-standing universal access to care, should give us pause in abandoning our STI clinical system to soon.
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