Abstract: Utility of Self-Reported Symptoms and Risk Behaviors in Identifying STD Patients Suitable for “Testing-Only” Visits (2010 National STD Prevention Conference)

Tuesday, March 9, 2010: 11:15 AM

Cottonwood (M1) (Omni Hotel)

Fujie Xu, MD, PhD, Division of STD Prevention, CDC, Atlanta, GA, Bradley Stoner, MD, PhD, Washington University School of Medicine, St. Louis, MO, Stephanie Taylor, MD, Louisiana State University Health Sciences Center, New Orleans, LA, Leandro A. Mena, MD, MPH, Division of Infectious Diseases, University of Mississippi Medical Center and Mississippi State Department of Health, Jackson, MS, David H. Martin, MD, Department of Medicine, Section of infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA and Lauri Markowitz, MD, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background: Due to increasing demands and dwindling resources at STD clinics, testing-only visits (clinic visits with a GC and Ct test but without full examination) have been used to increase the efficiency of STD services.

Objectives: To develop algorithms for identifying attendees for testing-only visits, and to quantify conditions (STDs and services) that would be missed if the selected attendees would use testing-only visit.

Methods: We conducted a self-administered survey in patients seeking routine clinical care at STD clinics in 3 cities (Jackson, MS, New Orleans, LA and St. Louis, MO) during May-August, 2008. Medical charts were abstracted to obtain clinical data. STDs were assessed using standard clinical diagnostics.

Results: Approximately 900 patients completed the survey at each site and medical charts were abstracted for a total of 2709 patients. We evaluated the prevalence of selected STDs and other clinical services in association with STD symptoms (including discharge, genital lesions, dysuria, foul odor, etc) and risk behaviors in the past 3 months (including new partner, multiple partners, concurrent partners, etc). In both males and females, STD symptoms were better than risk behaviors in predicting clinical outcomes that would be missed if the attendees would use testing-only visit. Among females, 26.5% reported no symptoms, although within this group the prevalence of bacterial vaginosis, candidiasis and trichomoniasis was relatively high (29.0%, 9.0% and 5.8%, respectively). Among males, 39.1% reported no symptoms, and within this group the prevalence of genital tract infections was low except for genital warts (4.6%).

Conclusions: Questions about STD symptoms can help identify suitable patients for testing-only visits.

Implications for Programs, Policy, and/or Research: When physical examination by a qualified healthcare professional limits the access to STD services, the efficiency of STD clinics may be improved by offering testing-only visits to specific patient groups.

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