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Background: Prior studies found that ≤20% of patients receive STD services through public STD clinics. A paucity of data exists regarding where patients go for STD services and whether they present to different places depending on symptoms.
Methods: A de-identified, integrated registry containing electronic health records from the Indiana Network for Patient Care (INPC) and the Marion County STD Program were used to examine visit type for all patients who had ≥1 STD test performed during the years 2003-2014. The combined data represent ≥95% of all STD testing in a large metropolitan area documented by two health information systems. Logistic regression models were used to assess the demographic and clinical correlates of visiting a particular setting 75% of time. Additional logistic regression analyses with repeated measures were performed to examine associations between patient characteristics and positive testing results.
Results: We identified 375,039 individuals ≥13 years old with 1,449,962 visits who were tested for STDs. The majority of individuals were female (77.4%) and self-identified as white (45.5%), followed by black (35.7%) and Hispanic (4.3%). STD clinic and other outpatient visits respectively accounted for ~11% and ~61% of documented visits. Individuals who sought STD services at outpatient locations were more likely to be female, self-identified as Hispanic, have commercial/public/Medicaid/Medicare insurance, or HIV positive. Individuals who went to STD clinics for STD tests >75% of the time were more likely to be black, have unknown insurance, and be older (p<0.0001). Furthermore, individuals who had a positive test were more likely to attend an STD clinic than an outpatient clinic (p<0.0001).
Conclusions: While only a small proportion of STD testing is performed by public STD clinics, these clinics serve vulnerable and underserved populations that may not have access to STD services otherwise. Therefore STD clinics play a crucial role in STD control.