Background:
Due to increasing demands and dwindling resources, STI clinics must increase efficiency and still deliver quality care. In this environment, the greatest amount of resources should be devoted to those at highest risk for STI and their sequelae.

Objective:
To evaluate the introduction of a triage system based on patients' risk, offering limited services to those at low risk.

Method:
The Denver Metro Health Clinic introduced the “express visit” (EV) for low-risk (asymptomatic, no contact to STI, non-MSM, low behavioral risk) patients, as a no-cost option for patients who could not afford required clinic co-payments in 2004, and expanded this service to reduce the impact on patient volume during the transition to an electronic medical record system in March, 2005. EV is comprised of urine testing for chlamydia and gonorrhea, HIV rapid testing, and RPR. We report on the effects of the fully implemented system during a 3-month time frame (September – November, 2005).

Result:
A total of 2,637 visits were evaluated. Of these, 684 (25.9%) were EV. The proportion of EV was similar for women (33.9%) and men (35.6%). Chlamydia rates among women who had EV were 9.8% (20/203) compared to 15.9% (111/696) for regular visits. Among men, these rates were 8.9% (31/347) and 20% (230/1150) respectively. The rate differential between EV and regular visits for gonorrhea were 0.9% (2/203) and 4.0% (28/696) for women and 0.5% (2/214) and 9.6% (111/1152) for men (p values for all comparisons < 0.01).

Conclusion:
Based on the rates of the two most common curable STI, risk-based triage appeared to effectively identify those at highest risk for STI. Still, the prevalence of chlamydia in those having EV was still sufficiently high to warrant screening.

Implications:
Risk-based triage is an effective method to increase effective screening in an STD clinic.