Abstract
Background
Screening and diagnosis of Sexually Transmitted Infections (STIs) requires use of nucleic acid amplifications tests (NAATs) on optimal anatomical specimens. Vaginal or cervical swabs are preferred in women and first-catch urine in men. Furthermore, extra-genital testing is recommended for men who have sex with men (MSM) and for men who have sex with women (MSW) based on exposure history. Increasingly, STI care is being provided in non-STI specialized settings such as Urgent Care (UC) and Primary Care clinics (PC). Therefore, we aimed to characterize the types of anatomical specimens being utilized for the diagnosis of STIs in non-STI specialized clinics.
Methods
We conducted a retrospective analysis of all Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) tests obtained at 46 adult outpatient clinics (PC, UC and Obstetrics & Gynecology [OB/Gyn]) part of an integrated health system in Des Moines, Iowa, between January 1, 2019 and December 31, 2019. In this database, no information was available regarding patient history of sexual exposure site(s). Descriptive statistics, including counts, percentages, and differences in proportions were estimated and stratified by outpatient clinic type.
Results
We identified a total of 18,503 encounters involving 2,802 men and 15,701 women. Rates of extragenital testing were overall low, but higher in male patients (14.6%) than in female patients (0.20%). Among male patients, extra-genital testing was obtained in 21.1% of patients seen in PCs compared to 5.2% in UCs (p< 0.0001) (Table 1). Notably, 177 (50.9%) of the extra-genital samples collected at PCs were obtained at a clinic specializing in the care of MSM. Among female patients, the proportion of urine-based tests was highest in PC (32%), while non-urine genitourinary samples were more frequently obtained at Ob-Gyn clinics (92.7%) (p< 0.0001) (Table 2).
Conclusion
Extragenital site testing for GC and CT remains an uncommon practice across all clinic setting types, and high proportions of female patients evaluated at PC and UC clinics were tested using urine specimens. Our results indicate a need for effective education and implementation processes for optimal testing modalities in primary care clinics.
Disclosures
All Authors: No reported disclosures
Mixed sexually transmitted infections in adult male patients with urethral discharge and female patients with pelvic inflammatory disease
