Context: Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs.
Methods: As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD.
Results: An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking.
Conclusions: The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.
PIP: This article provides population-based estimates of the prevalence of patient-reported sexually transmitted diseases (STDs) and characterizes patterns of treatment utilization according to specific STDs and client characteristics in the US. Using data from the 1992 National Health and Social Life Survey, which included 3432 persons aged 18-59, an estimated 2 million STDs were self-reported in the previous year, and 22 million 18-59 year olds self-reported lifetime STDs. Respondents reported bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) more than viral STDs (genital herpes, genital warts, hepatitis and HIV). About 49% of the respondents who had an STD mentioned having gone to a private practice for treatment, while only 5% had sought treatment at an STD clinic. Moreover, variations were seen in treatment-seeking for specific bacterial STDs, such as chlamydia and gonorrhea. Other factors that could influence where people go for treatment include gender, race, and income status. Characteristics of providers could also influence patient choice, such as geographic distribution, availability of support services, quality of care, convenience, and privacy.