Title: STI’s on the rise. Are we testing, treating, and educating effectively?
Authors: Alexander Athanase, MD; James Dombrowski, MD; Laura Miller, MD; Jennifer LaManna, PhD; David Gemmel, PhD
Email: aathanase@mercy.com
Introduction: Incidence of sexually transmitted infections (STIs) in the United States has increased, rising 7% from 2017 to 2021. Disportionately, STIs affect minorities, younger individuals, and sexually fluid men. Gonorrhea increased by 28%, syphilis by 74%, and congenital syphilis by 203%, while chlamydia decreased by 4% and HIV by 12%. Likewise, Ohio saw a decrease in new infection rates of HIV, gonorrhea, and chlamydia in 2022, compared to 2021, but an increase in syphilis. STI symptoms vary by gender and can lead to complications if untreated, emphasizing the importance of testing and treatment. CDC provides screening guidelines and treatment protocols. This study evaluates our residency program’s STI screening, incidence, treatment, and demographics.
Methods: A retrospective chart review at Youngstown Primary Care Clinic focused on patients above 18 years old with STI symptoms, excluding minors and those undergoing general STI screening. Data from 60 patients with STI symptoms and positive test results were compiled into an Excel spreadsheet, along with treatment, test of cure, and demographics. The incidence of any STIs was tabulated by demographics and testing modality.
Results: Among patients (n=60) who were tested for STIs, most were female, 80%; under 40, 56.6%; and black, 45.0% or Hispanic, 26.7%. Urine testing was done in all but one patient, serum testing was only done in 53.3% of patients. The rate of any STI was 13.3% (8/60). Among blacks, Hispanics, and women, STI incidence was similar to overall incidence, 14.8%, 12.5%, and 10.4%, respectively. Among patients < 40, STI incidence was higher, 20.6%, compared to patients > 40, 3.8% (p=0.059). Most prevalent pathogens were HSV (n=3), chlamydia (n=3), gonorrhea (n=1), and trichomonas (n=1). When both urine and serum assessment for STIs was conducted, STI incidence was higher, 21.9%, than when urine testing alone was performed, 3.6% (p=0.037). Empiric treatment was offered to 23.3% of STI screened patients (14/60). No tests of cure were conducted.
Discussion: Opportunities exist to improve STI testing and treatment among symptomatic patients in clinic. Most patients were young, black or Hispanic, females. Only half of patients underwent serum testing, a CDC requisite for syphilis testing. Incidence rates of gonorrhea, chlamydia, trichomonas, and HSV were low. Only 24.5% of patients were treated empirically, with the majority (74.5%) not receiving any treatment. No patients underwent a test of cure. Our data aligns with CDC data showing decreasing STI rates in Ohio; however, missed detection of syphilis due to lack of serum testing may exist. CDC reports an increase in syphilis cases in the US and Ohio. Local anecdotal congenital syphilis case reporting exists. Avoidance of serum testing may be due to fear of testing positive for STIs, like HIV, which carries social stigma and requires lifelong treatment. Physician counseling with symptomatic STI patients may encourage serum testing.
