Background:
Since many public sexually transmitted disease (STD) clinics have closed, more STDs are being diagnosed in other outpatient settings.

Objective:
To describe STD practices of U.S. clinicians in nine specialties providing outpatient care.

Method:
In May 2004, 6906 confidential, self-administered surveys were mailed to clinicians randomly sampled from national registries of physicians practicing family and general medicine, adolescent medicine, obstetrics/gynecology, urology, or dermatology; nurse practitioners; certified nurse-midwives; and physician assistants. Clinicians had to provide outpatient care > 8 hours/week to be eligible. Clinicians were asked to estimate the number of patients with STDs diagnosed in the past 12 months.

Result:
The adjusted response rate was 81% (n=4305). Thirty-six percent of respondents had practiced >20 years and 46% saw >100 patients per week. Most (75%) worked in private settings and reported that many patients paid with private insurance (49%). More clinicians had recent experience diagnosing genital herpes (91%, mean: 16 cases), than genital warts (89%, mean: 10 cases), Chlamydia (80%, mean: 14 cases), or HIV (50%, mean: 5 cases) and diagnostic experience varied by clinical specialty. Most clinicians (84%) reported patients asked for information on STD prevention, most common among OB/GYN, mid-level providers, and adolescent medicine physicians. Clinicians in practices with >75% of patients privately-insured (21%) had equivalent to slightly more STD diagnostic experience and STD education queries compared to clinicians with fewer privately-insured patients (79%).

Conclusion:
In this nationally-representative survey, most clinicians practiced in private settings and reported recent viral and bacterial STD diagnostic experience. Interventions are needed to ensure quality STD care in private outpatient settings, such as clinician training, decision support tools, coverage of quality diagnostic tests and treatments, and adequate reimbursement.

Implications:
Publicly-funded STD programs should develop partnerships that will improve access to quality viral and bacterial STD care in private outpatient settings.