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Building the bypass—implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009
  1. Catherine H Mercer1,
  2. Catherine R H Aicken1,
  3. Claudia S Estcourt2,3,
  4. Frances Keane4,
  5. Gary Brook5,
  6. Greta Rait6,
  7. Peter J White7,8,
  8. Jackie A Cassell1,9
  1. 1Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK
  2. 2Centre for Infectious Disease: Sexual Health and HIV, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Barts Sexual Health Centre, St Bartholomew's Hospital, London, UK
  3. 3Infection and Immunity, Barts and the London NHS Trust, London, UK
  4. 4Department of Genito-urinary Medicine, Royal Cornwall Hospitals NHS Trust, The Hub, Royal Cornwall Hospital (Treliske), Truro, Cornwall, UK
  5. 5Patrick Clements Clinic, Central Middlesex Hospital, North West London Hospitals NHS Trust, London, UK
  6. 6Research Department of Primary Care and Population Health, University College London, London, UK
  7. 7MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, UK
  8. 8Modelling & Economics Unit, Health Protection Agency Centre for Infections, London, UK
  9. 9Brighton and Sussex Medical School, Mayfield House, University of Sussex, Falmer, Brighton, UK
  1. Correspondence to Dr Catherine H Mercer, Centre for Sexual Health and HIV Research, 3rd floor Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; c.mercer{at}


Objective The objective of this study was to examine changes in patient routes into genitourinary medicine (GUM) clinics since policy changes in England sought to improve access to sexual healthcare.

Methods Cross-sectional patient surveys at contrasting GUM clinics in England in 2004/2005 (seven clinics, 4600 patients) and 2009 (four clinics, 1504 patients). Patients completed a short pen-and-paper questionnaire that was then linked to an extract of their clinical data.

Results Symptoms remained the most common reason patients cited for attending GUM (46% in both surveys), yet the proportion of patients having sexually transmitted infection (STI) diagnosis/es declined between 2004/2005 and 2009: 38%–29% of men and 28%–17% of women. Patients in 2009 waited less time before seeking care: median 7 days (2004/2005) versus 3 days (2009), in line with shorter GUM waiting times (median 7 vs 0 days, respectively). Fewer GUM patients in 2009 first sought care elsewhere (23% vs 39% in 2004/2005), largely from general practice, extending their time to attending GUM by a median of 2 days in 2009 (vs 5 days in 2004/2005). Patients with symptoms in 2009 were less likely than patients in 2004/2005 to report sex since recognising a need to seek care, but this was still reported by 25% of men and 38% of women (vs 44% and 58%, respectively, in 2004/2005).

Conclusions Patient routes to GUM shortened between 2004/2005 and 2009. While GUM patients in 2009 were less likely overall to have STIs diagnosed, perhaps reflecting lower risk behaviour, there remains a substantial proportion of high-risk individuals requiring comprehensive care. Behavioural surveillance across all STI services is therefore essential to monitor and maximise their public health impact.

  • Genitourinary medicine services
  • primary care
  • general practice
  • service delivery
  • sexual behaviour
  • sexual practices
  • risk behaviours
  • heterosexuals
  • sexual health
  • adolescent
  • surveillance
  • sexual networks
  • public health
  • GUM services
  • service development
  • risk profiles
  • STD
  • STD clinic
  • hepatitis
  • information technology
  • primary care
  • screening

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  • Funding The 2004/2005 study (full title: ‘Effects of Delayed Access to Services, Variation in Service Provision, and Lack of Partner Notification Services on the Transmission of STIs: Quantification of Impact in the UK’, abbreviated to ‘Patient Access and the Transmission of Sexually-transmitted Infections’ (‘PATSI study’)) was funded by the UK Medical Research Council, with funding allocated from the Health Departments, under the aegis of the MRC/UK Health Departments Sexual Health and HIV Research Strategy Committee (grant number G0200565). The 2009 study (full title: ‘Public Health Outcomes, Costs and Cost-effectiveness of GUM and Primary Care Based STI Services: How to Maximise STI Control and Cost-effectiveness for a Population’, abbreviated to ‘Maximising STI Control’ in local patients (‘MSTIC study’)) was funded by the UK Medical Research Council via the MRC/DH Sexual Health and HIV Research Strategy Committee (grant number G0601685). The funding bodies had no role in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The views expressed are those of the authors and not necessarily those of the MRC or the Health Departments.

  • Competing interests None.

  • Ethics approval The research protocol for the 2009 study was approved by the London Research Ethics Committee (number: 09/H0718/1), while ethical approval for the 2004/2005 study was obtained from the South West Multi-Centre Ethics Committee (number: MREC/04/6/02).

  • Provenance and peer review Not commissioned; externally peer reviewed.