Background:
Standard protocol in the Los Angeles County Sexually Transmitted Disease Program (STDP) has been to immediately assign all positive laboratory gonorrhea and chlamydia reports to public health investigators (PHIs) for follow-up. Due to the high volume of chlamydia and gonorrhea infections and limited staff resources, field staff can no longer effectively manage all cases.

Objective:
Determine the feasibility of replacing immediate PHI assignment of chlamydia and gonorrhea cases with a direct fax to the diagnosing provider after non-receipt of a confidential morbidity report (CMR).

Method:
From July-October 2005, all chlamydia and gonorrhea cases received by STDP from laboratory reports that lacked a treatment CMR by day 10 had a letter and CMR faxed to the diagnosing provider. Fax numbers were confirmed and transmitted on a secure line. If no CMR was received after three faxes or if provider reported a case not treated, the case was assigned to PHI. Cases ineligible for faxing included cases that were pregnant, out of jurisdiction, and LAC public health projects/programs.

Result:
Of 10,503 laboratory reports, 77% of cases had provider-confirmed treatment by day 25. Within ten days of lab report 6,768 (64%) CMRs were received, identifying 59% of cases treated and 5% unable to treat. Faxes were sent for a total of 3,071 (29%) cases resulting in 1,891 (60%) confirmed treatments, 322 (10%) unable to treat, and 858 (28%) no response. Of the 2,213 returned faxes, 55% were received after the first fax, 24% after the second, and 21% after the third.

Conclusion:
Allowing providers time to treat and report cases followed by repeated fax contact of non-reporting providers resulted in documented treatment of more than three-quarters of cases.

Implications:
Alternative strategies, such as faxing non-reporting providers maximizes PHI resources for untreated cases and high risk special populations such as young adolescents and pregnant women.