Where Do People Go for Gonorrhea and Chlamydia Tests: A Cross-Sectional View of the Central Indiana Population, 2003-2014

Background Despite major efforts to control their spread, reported sexually transmitted infections (STI) are increasing. Using data from a mid-sized Midwest metropolitan area, we examined the settings in which individuals are tested for gonorrhea and chlamydia in relation to demographics and test result to determine where interventions may best be focused. Methods A deidentified and integrated registry, containing records from all patients tested for an STI from 2003 to 2014, was created by combining data from a large health information exchange and the reporting district's STI Program located in Indianapolis, IN. Individual characteristics and visit settings where gonorrhea and chlamydia testing was performed were analyzed. Results We identified 298,946 individuals with 1,062,369 visits where testing occurred at least once between the ages of 13 and 44 years. Females were tested significantly more often than males and received testing more often in outpatient clinics whereas males were most often tested in the STI clinic. Individuals who used both STI and non-STI settings were more likely to have a positive test at an STI or emergency department visit (6.4-20.8%) than outpatient or inpatient setting (0.0-11.3%) (P < 0.0001). Test visits increased over the study period particularly in emergency departments, which showed a substantial increase in the number of positive test visits. Conclusions The most frequent testing sites remain STI clinics for men and outpatient clinics for women. Yet, emergency departments (ED) are increasingly a source of testing and morbidity. This makes them a valuable target for public health interventions that could improve care and population health.