Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center

Abstract

Background and objectives: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center.

Methods: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ analyses were used to assess association between STI testing, chief complaint, and sexual history.

Results: Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01).

Discussion: Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs.