Evaluation of a testing-only "Express" visit option to enhance efficiency in a busy STI clinic

Objective: To evaluate the use of a testing-only "express" visit option to enhance efficiency in a busy STI clinic. Methods: At the Denver Metro Health Clinic, clients at low risk for sexually transmitted infections (STI) are offered an express visit comprised of a urine test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) as well as optional syphilis and human immunodeficiency virus (HIV) testing, but no physical examination. Higher risk clients (STI-rellated symptoms, contact to STI, men having sex with men, injection drug use, exchange of sex for money or drugs) are offered a comprehensive visit that includes a physical examination. The triage system was evaluated for the period April 2005-July 2006 by comparing rates of CT, GC, syphilis, and HIV between the 2 visit options. Results: Of 13,447 clients with new visits, 3284 (24.4%) were express visits. When compared with clients with comprehensive visits, express visit clients had lower rates of CT (8.1% vs. 17.2%), GC (0.9% vs. 7.4%), syphillis (0.7% vs. 1.2%), and HIV (0.1% vs. 0.2%). Of 2969 STI cases, only 10.8% were diagnosed among clients with express visits. Express visits resulted in a 39% time saving for men and a 56% for women. With the possible exception of asymptomatic urethritis among men, underdiagnosis of STI beyond CT, GC, syphilis, and HIV among express visit clients appeared to be low. Conclusion: The triage system at DMHC effectively selects clients at highest risk for STI and increases clinic efficiency.