title: Understanding sexually transmitted infection screening and management in Indiana community health centers.
abstract: BACKGROUND
  The role of community health centers (CHCs) in preventive health care is central to health reform, yet little is known about how CHCs identify and manage sexually transmitted infections (STIs).
  
  
  METHODS
  A survey of Indiana CHCs from April to May 2013 measured reported STI services, clinic expectations for STI testing and management, barriers to screening and management, and partner services. Reported practices were compared with current Centers for Disease Control and Prevention (CDC) guidelines for STI testing in clinical settings.
  
  
  RESULTS
  Although most CHCs reported screening for syphilis (75.0%), chlamydia, and gonorrhea (85.7%), screening generally did not reflect CDC guidelines. Chlamydia and gonorrhea testing was provided primarily at patient request or when symptomatic by 67.9% of CHCs. Syphilis testing at 67.9% of CHCs reflected CDC guidelines for adults 65 years or younger and at 53.6% for first-trimester pregnant women. Chlamydia and gonorrhea screening reflected CDC guidelines for 17.9% of CHCs for gay/bisexual men and 60.9% for first-trimester pregnant women. One-third (35%) of CHCs reported not knowing the expectation for screening pregnant women and gay/bisexual men.
  
  
  CONCLUSIONS
  It is likely that CHCs are not aware of patient sexual health risks because standard of care screening was observed only for gonorrhea and chlamydia during the first trimester and for syphilis testing when symptoms were present. As CHCs increase their role in preventive care with the implementation of the Affordable Care Act, focus must be upon clinician awareness of patient sexual health and training to identify and manage STIs in their patient populations.
authors.affiliation: From the Indiana University School of Public Health-Bloomington, Bloomington, IN; and †Indiana Minority Health Coalition, Indianapolis, IN.
authors.forename: Shalini M
authors.initials: SM
authors.lastname: Navale
authors.forename: Beth E
authors.initials: BE
authors.lastname: Meyerson
authors.forename: Anita
authors.initials: A
authors.lastname: Ohmit
authors.forename: Anthony
authors.initials: A
authors.lastname: Gillespie
mesh_terms: D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003153:Community Health Services; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology