Background:
Sexually transmitted disease testing and treatment are subsidized and provided at local public health clinics throughout the nation. However the proportion of care provided by public clinics is unknown: a national population-based self-report survey suggests that the source of care for STDs may be mostly from private or emergency room (ER)providers.


Objective:
To review and describe time-trends among public, ER and private providers for state case reports of Chlamydia (CH) and Gonorrhea (GN) from a large urban county in Kansas.


Method:
STD case reports 2000-2004 were analyzed by year for a large urban county which comprised 17% of state population and 25-28% of STD cases in Kansas. Cases were classified as diagnosed/treated by public STD clinics (PublicSTD), ER, and private clinics/other (PC/O).


Result:
Numbers of annual CH (2004 N=1,888) and GN (2004 N=722) cases increased most years. Rates exceeded 2010 objectives. Trend analysis showed that the proportions of cases diagnosed and treated at ER and PC/O steadily increased and those seen at PublicSTD declined during 2000-2004. In 2004, CH and GN sources of care were 15% and 17% at PublicSTD, 14% and 21% at ER, and 71% and 62% at PC/O, respectively.


Conclusion:
STD case counts increased during 2000-2004 in a Midwestern urban county. Subsidized public clinics served diminishing - while emergency rooms and private/other clinics served increasing - proportions of STD cases.


Implications:
These changes may derive from changes in care seeking behavior among STD patients, changes in patient demographics or changes in clinic operations. These findings have important implications for infectious disease and public health agency policy.