1497. Evidence-Based Care for Sexually Transmitted Infections: Missed Opportunities in an Academic Medical Center

Abstract

BackgroundColorado has had rising rates of gonorrhea and syphilis. Guidelines for those diagnosed with sexually transmitted infectious (STIs) stipulate that patients should receive screening for other STIs, including syphilis and HIV. We aimed to study how often patients received guideline-based evaluation and hypothesized that providers adequately treat STIs but fail to provide comprehensive screening.MethodsWe retrospectively reviewed 868 patients diagnosed with chlamydia, gonorrhea, and trichomonas within the University of Colorado Health System. We defined “comprehensive screening” as testing for both syphilis and HIV and “re-screening” as testing again for the originally detected pathogen. Statistical analysis was performed with chi-square analysis.ResultsEight hundred one (92.2%) of 868 patients received treatment, 98.3% of which was guideline-based. At time of diagnosis, 16 (3.0%) of 550 patients seen in the emergency department, urgent care, or obstetrical triage received comprehensive screening compared with 183 (57.5%) of 318 patients seen in clinics. Comprehensive screening at diagnosis was more common in infectious disease (ID, 84.2%) and obstetrics (OB, 70.8%) clinics than in gynecology (GYN, 29.1%), family medicine (FM, 45.2%), or internal medicine (IM, 41.3%) clinics (P < 0.01). 62 (43.1%) of 144 patients without prior comprehensive screening received screening at time of follow-up, more commonly in ID (68.4%) and OB (57.1%) clinics than in FM (24.1%) and GYN (22.9%) clinics (P < 0.01). Two hundred (84.7%) of 236 patients seen in follow-up received re-screening. Only 96 patients (11.1%) received extra-genital testing at any point; of these 93 (96.9%) were men and 79 (82.2%) were tested in ID clinic.ConclusionGuideline-based treatment and re-screening were routinely performed for those diagnosed with STIs. However, rates of comprehensive screening were below standard of care. Additionally, extra-genital testing was not routinely performed in any setting outside of ID clinic. Providers in ID and OB clinics, where screening is either routine or protocolized, were more likely to perform comprehensive screening. Protocolization of STI screening within the University of Colorado Health System may improve guideline adherence and improve identification of comorbid STIs in high-risk populations.Disclosures All authors: No reported disclosures.